The GOP’s massive spending and tax package, narrowly passed by the Senate on July 1, 2025, would slash Medicaid funding by over $1 trillion—potentially cutting coverage for nearly 12 million Americans amid rising backlash and legislative concessions.
At a Glance
- Senate-approved legislation trims over $1 trillion from Medicaid and risks coverage for nearly 12 million adults.
- New work mandates and documentation hurdles may disproportionately affect rural and low-employment communities.
- The Congressional Budget Office warns up to 17 million could lose health insurance when ACA subsidies expire.
- Moderate senators—including Lisa Murkowski—won carve-outs for Alaska and rural hospitals.
- Critics argue these cuts threaten public health and signal a broader shift in responsibility to state and local systems.
Coverage Cuts Echo in Rural Regions
CBO analysis shows the so-called One Big Beautiful Bill could eliminate Medicaid enrollment for nearly 12 million adults over a decade. Those losses target individuals facing new work requirements and stricter paperwork rules, as explained by NPR and KFF Health News.
Watch a breakdown: How the GOP Spending Bill Would Impact Medicaid
The Congressional Budget Office also estimates that the expiration of ACA subsidies could result in 17 million Americans losing insurance, threatening already fragile rural healthcare systems.
State-Level Safeguards and Political Pushback
Senator Lisa Murkowski broke a Senate tie, securing carve-outs for rural hospitals and food aid in her home state—an action AP described as “agonizing”.
The final Senate version includes over $3 trillion in tax cuts, but critics argue the Medicaid rollbacks shift responsibility to underfunded state budgets. Analysts at Vox warn of “irreversible coverage losses,” while MarketWatch outlines how the social safety net could be left barely functional.
What Happens Next
If enacted, the bill would transfer massive healthcare responsibilities to states already grappling with inflation, workforce shortages, and public health strain. Rural hospitals may shutter, mental health access may vanish, and millions could be left without essential care.
As the House drafts its version, lawmakers now face a defining question: scale back the damage—or double down and own the consequences.
