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Sweeping Budget and Spending Law Leaves Millions Uninsured, While Adding Trillions to Federal Deficit

July 23, 2025

The newly passed "Big, Beautiful Bill" represents the most substantial rollback of health coverage since the Affordable Care Act (ACA) was enacted in 2010, potentially leaving up to 16 million Americans uninsured while increasing the federal deficit by as much as $4 trillion over the next decade. According to Larry Levitt of KFF, this legislation will reduce federal health spending by more than $1 trillion, primarily through cuts to Medicaid and health insurance subsidies. Key provisions include new Medicaid work requirements, which could cause 4.

Who is affected

  • Up to 16 million Americans who may lose health insurance coverage
  • 11.8 million people expected to lose coverage due to provisions in the bill
  • 4.8 million people who may lose Medicaid coverage due to work requirement reporting complications
  • Lawfully present immigrants, including refugees, asylees, and those under Temporary Protected Status
  • Rural hospitals and their patients
  • Lower-income Americans facing cuts to Medicaid, SNAP, and other safety net programs
  • The bottom 40% of earners who will lose around $700 in after-tax, after-transfer income
  • Communities like Bakersfield, California, where over 60% of residents rely on Medicaid
  • Low-income families who don't earn enough to receive the expanded child tax credit

What action is being taken

  • Federal health spending is being reduced by more than $1 trillion through cuts to Medicaid and health insurance subsidies
  • New Medicaid work requirements for adults who became eligible under ACA expansion are being implemented
  • Income verification procedures for ACA insurance marketplace are being tightened, eliminating automatic renewals
  • Eligibility for ACA coverage is being removed for many lawfully present immigrants
  • A one-time $50 billion rural health fund is being established to offset some impacts on rural hospitals
  • The child tax credit is being increased from $2,000 to $2,200
  • A modest increase in the standard tax deduction for seniors is being provided

Why it matters

  • The legislation represents the most substantial rollback of health coverage since the ACA was enacted
  • It could result in 100,000-200,000 excess deaths over the next decade
  • The bill may increase the federal deficit by up to $4 trillion over the next decade
  • Rising deficits will increase borrowing costs across the board, affecting mortgages, car loans, student loans, and small business lending
  • The bill disproportionately benefits wealthy households while harming lower-income Americans
  • Rural hospitals may face closure, reducing healthcare access in those communities
  • The debt-to-GDP ratio could increase from 100% today to 135% by 2035
  • The tax and healthcare changes amount to what Sarin described as a "reverse Robin Hood" policy

What's next

  • No explicit next steps stated in the article

Read full article from source: The San Diego Voice & Viewpoint