The outlines for Donald Trump’s attack on health care for several million Americans are clear, but it will take some time for the practical effects to kick in.
What all parties except Trump see is that the effects of the “big, beautiful bill” will be to remove upwards of 12 million from Medicaid eligibility through budget cuts, restrictions on states and lots of new paperwork both for individuals and officials.
Indeed, The Hill.com noted that while Trump’s bill was never framed directly as a health remake, it dramatically will upend health care in America. The bill’s provisions will impact patients, doctors, hospitals, and insurers, as Republicans partially paid for it by cutting more than $1 trillion from federal health programs
As Larry Levitt, executive vice president for health policy for KFF.org, which tracks health care issues, noted last week in an op-ed, the changes forced by the bill also will make enrollment in Affordable Care Act/Obamacare health plans more difficult, technical rules will affect some Medicare payments, and rural hospitals across the country will find themselves under increased financial pressures, forcing many to close. He argues that in all, the new law and changes could lead to a staggering 17 million more people uninsured to the 25 million already not covered.
In addition, the bill basically tells Planned Parenthood to either give up offering abortions in states where they are legal or face shutdown by declaring that organization off-limits for reimbursements for non-abortion treatments at 200 clinics serving 2 million patients.
Trump, of course, continues to insist that he and Republicans have not cut any health benefits, just cut “waste and fraud,” a laughable assertion. Apart from all else, Trump has dismissed 80,000 Veterans’ Affairs employees who handle health and services.
The Trump government is taking a broad swipe at medical services — all towards paying off (and falling well short) of the cost of tax cuts that largely will benefit the wealthiest in our country. The questions: what do we have to do practically and when?
Targeting Medicaid Eligibility
At heart, Trump’s approach, now rubber-stamped solely by House and Senate Republican majorities and the tiniest wins, is to target eligibility for Medicaid, a program serving 70 million. Trump repeatedly says that able-bodied adults slipping through the system are responsible for the hundreds of billions of dollars cut for fraud. Trump and Republicans in Congress also insist that undocumented immigrants — barred from receiving these benefits by law — are somehow responsible.
As an aside, the Centers for Medicaid and Medicare (CMS) say the prime target of fraud are extra fees and upgrading of reported disease treatments by for-profit Medicare Advantage insurers, who are not targeted in this bill.
Under the new law, beginning in December, 2026, states are required to collect and review paperwork every six months for everyone aged 19-64 to determine that they are working 80 hours a month or meet certain exemption statuses like pregnancy or disability, people in prison or rehabilitation — but individuals are now required to prove their disability or frailty or show efforts at finding work or volunteer commitments. To be eligible, income must be below 138 percent of the federal poverty level (roughly $42,760 for a family of four) who gained insurance when their states expanded Medicaid.
You can find detailed views of the requirements at KFF.
According to CMS, at least 65% of Medicaid applicants are employed, just paid below poverty standards. Of the remainder, there are whole groups who are disabled, pregnant, children, or seniors, including overlap with Medicare, vastly reducing the number of able-bodied men whom Trump and Republicans ridicule as sitting in basements playing video games.
But states are required to maintain databases on addresses, and the feds must create a system to prevent enrollment in more than one state as well as a master database on all deaths. Of course, these same agencies are losing budget for staff or federal support, so who exactly is going to handle this paperwork or enforce it is not clear.
Individuals applying for coverage must meet requirements for one or more months preceding the month of application. If a person is denied or disenrolled because of work requirements, they are also considered ineligible for subsidized Obamacare coverage.
If tax forms give you a headache, you can imagine this will too.
In Georgia, the only state with a Medicaid work mandate, ProPublica reports that the state has enrolled just a fraction of those eligible, largely because of bureaucratic hurdles in the verification system. As of May, two years in, about 7,500 of the nearly 250,000 eligible Georgians were enrolled, even though state statistics show 64% of that group is working.
Arkansas gave up on enforcing work requirements after seeing that red tape associated with verifying eligibility resulted in more than 18,000 people losing coverage within the first few months of the policy. A federal judge halted the program in 2019, ruling that it increased the state’s uninsured rate without any evidence of increased employment.
These systems mean filing the correct forms and documentation in the correct order every six months. Failing to do so correctly opens the possibility of a person losing coverage mid-year. The bill will also require people with incomes above the poverty line to pay out-of-pocket copays for most Medicaid services, like lab tests or doctor visits.
Impacting Health Services
The legislation will make it more difficult for people to sign up for and afford health plans on Obamacare exchanges. It limits eligibility for premium subsidies to people not eligible for any other federal insurance program and bars most immigrants and lawful permanent residents from receiving subsidies.
It requires immediate verification for eligibility, limits some special enrollment periods and ends automatic reenrollment ahead of the 2028 sign-up period, meaning enrollees will need to update their income, immigration status and other information each year. According to KFF, 10 million people were automatically reenrolled in ACA plans in 2025.
The new law will threaten rural hospitals who are required by law to provide services but who could face difficulty being reimbursed. Hospital closings would mean longer drives for rural patients and, inevitably, more deaths in emergency situations. The bill and promises from Trump will provide some money towards hospital in trouble, but not nearly enough to cover the estimated losses for hospitals expected to see a spike in emergency room usage.
Bottom line is that Trump’s sole domestic policies act is unpopular (see the KFF poll from last month), likely will not reduce targeted “fraud,” will hit at rural areas friendly to MAGA and veterans, and will result in a sicker, untreated nation.
Together with efforts at the Department of Health and Human Services to delegitimize vaccines and to cancel medical research, to replace independent medical experts with political loyalists, to overrule the Centers for Disease Control and Prevention with bromides against measles rather than treatments, we’re beginning to see the full outline of Trump’s oft-promised health programs. It’s anything but Making America Healthy Again.
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The post Blowing Up Health Care appeared first on DCReport.org.
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