The sweeping changes coming to Medicaid if Trump’s ‘One Big Beautiful Bill’ Act passes: Who would be most affected?

On Saturday night, Senate Republicans came one step closer to passing President Trump’s “one big beautiful bill,” securing a majority to begin debate on the sweeping legislative package.

The bill would extend tax cuts passed during Trump’s first term, which critics argue would primarily benefit the wealthiest households. Additionally, the Department of Homeland Security would see its budget increase by more than $66 billion for the next fiscal year to fund the administration’s ongoing deportation initiative, as well as other immigration enforcement activities.

To offset the revenue loss from tax cuts and increased government spending, Republicans have set their sights on Medicaid and the Supplemental Nutrition Assistance Program (SNAP). GOP leaders are framing the proposed changes as efforts to strengthen these programs, but critics warn the cuts could leave many without health insurance or food assistance.

The impact of work requirements on Medicaid recipients

Roughly 70 million people in the US, including 37 million children, receive health insurance through Medicaid.

One of the most significant changes Republicans hope to include in the bill is the imposition of work requirements for Medicaid recipients. According to the Congressional Budget Office, this measure would reduce federal spending by about $344 billion over the next decade.

House Speaker Mike Johnson and other GOP leaders argue that able-bodied young men are taking advantage of the program and that work requirements would encourage them to rejoin the workforce. However, the requirements would apply broadly, and Republican leaders have not provided any data supporting the claim that millions of young people are exploiting the public system. The imposition of additional bureaucratic hurdles is expected to leave millions without access to the vital program over the next 10 years.

Two-thirds of adults receiving Medicaid work full or part time

A May 2025 report from the Kaiser Family Foundation found that 44% of Medicaid recipients work full-time, and another 20% work part-time.

The bill would require millions of adults to work, volunteer, or participate in job training for at least 80 hours per month. Based on KFF’s data, two-thirds of recipients already meet these requirements. When accounting for students, people with disabilities or chronic illnesses, and caregivers, only about 8% of Medicaid recipients are retired, unemployed, or unable to find work. The bill passed by the House of Representatives provides exemptions for the following people:

Still, even with these exemptions, CBO Director Phillip L Swagel wrote in a letter to Congressional leaders that the agency’s analysis—rejected by GOP leaders—estimates that 18.5 million people would be subject to the work requirements each year. By 2034, Medicaid coverage is projected to decline by approximately 5.2 million adults.

The need for clear language to protect those struggling with substance abuse

Medicaid is a critical lifeline for millions in the US in need of treatment for substance abuse issues, with the Center for American Progress reporting that in 2019, Medicaid accounted for close to 60 percent of all spending on healthcare related to substance abuse disorders. The CAP found that although the House bill creates work requirement exemptions for individuals enrolled in a substance use disorder program, the bill contains minimal language explaining how states will regulate this system. Without proper mechanisms in place to protect those enrolled in a program, up to 1.6 million adults could lose access to Medicaid for failing to comply with work requirements.

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