There’s a bill that has been recently signed by the president with a name that sounds like a promise: the “Big Beautiful Bill.” But behind the branding lies a brutal blueprint, one that dismantles the very systems people across the country depend on to survive.
This is not reform. It’s retreat.
Under the guise of efficiency, this law slashes Medicaid, strips funding from community clinics, guts behavioral health programs, and undermines reproductive care. These aren’t luxuries. They’re lifelines. And without them, millions, especially Black, Brown, Indigenous, immigrant, low-income, and rural communities, will be left exposed in a system already stacked against them (Commonwealth Fund, 2025; Milken Institute School of Public Health, 2024).
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Who Gets Left Behind…Again
This bill doesn’t merely overlook the most vulnerable. It targets them.
Medicaid is designed to provide health insurance to people who wouldn’t be able to afford it otherwise. The proposed $863 billion in Medicaid cuts would leave an additional 11.8 million of our most vulnerable citizens without health insurance by 2034.
When policymakers chip away at Medicaid and community health infrastructure, they’re not trimming fat, they’re severing essential support for families already living with limited access to care. From maternal health deserts to underfunded mental health programs, this legislation magnifies existing disparities with surgical precision (Commonwealth Fund, 2025a; Commonwealth Fund, 2025b).
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The bill intends to impose work requirements on all adults in order to be eligible for Medicaid unless they qualify for a limited number of exemptions. But recent data from KFF shows that nearly 80% of work-eligible adults covered by Medicaid either meet the required 80 hours of monthly work or qualify for an exemption like illness, caregiving, or school and most do so consistently over time (KFF, 2025).
Work requirements, copays, and eligibility reform will likely increase administrative burdens and reduce access. States like Maryland already anticipate “tens of millions” in extra administrative costs from stricter renewal processes and paperwork, likely disrupting coverage for the most vulnerable (Portnoy & Wiggins, 2025). Evidence from Arkansas and Georgia shows this isn’t just possible, it’s happening: thousands are losing Medicaid due to procedural pitfalls rather than ineligibility, sometimes with fatal consequences (Pilkington, 2025). It’s a page from an old playbook: exclude, underfund, and then blame the system’s failure on the people it was never built to protect.
Rural America Will Bleed, Too
Don’t be misled by the political packaging. The “Big Beautiful Bill” doesn’t just impact urban centers or progressive enclaves. It hits hard in small towns and rural counties, where hospitals are already shutting their doors and basic care is increasingly out of reach (National Rural Health Association, 2025; Scheffler et al., 2025).
The bill includes a provision requiring Congress to establish a $50 billion fund for a “Rural Health Transformation Program” that would start next year and end in 2030. However, $50 billion does not make up for the $155 billion rural health systems would stand to lose over 10 years (KFF, 2025; Associated Press, 2025).
In many of these areas, federal support is the only thing keeping ERs open and addiction services available. Pulling that thread will unravel what’s left of an already fragile safety net. The result? Delayed diagnoses, longer drives, worse outcomes and lives lost. A recent study published in JAMA Health Forum warns that proposed Medicaid cuts could lead to widespread hospital closures, diminished addiction services, and a significant rise in preventable deaths, especially across rural and economically distressed areas (Littrell et al., 2025).
Taking Food from the Hungry and Jobs from the Working Poor
The $295 billion in SNAP cuts over the next decade and more than $1 trillion in total reductions will impact state Medicaid funding, potentially cutting it by 6–21% in many states and worsening health inequities (Commonwealth Fund, 2025).
This will send shockwaves, influencing the ability of many who are already living paycheck to paycheck from being able to put food on the table. Medicaid payments cover costs for doctor’s offices, health systems, nursing homes and other care facilities. A recent Commonwealth Fund study explains that cuts to Medicaid will lead to these businesses having to cut staff and do less business with medical equipment suppliers and other industries (Commonwealth Fund, 2025).
Commonwealth Fund (2025) reports that combined Medicaid and SNAP reductions could result in approximately 1.03 million job losses, a $113 billion drop in state GDP, and $8.8 billion less in state and local tax revenue. These economic shocks don’t just affect beneficiaries; they hit hospitals, grocery stores, pharmacies, and small businesses that rely on a stable safety net to sustain jobs and community well-being (Commonwealth Fund & Milken Institute School of Public Health, 2025).
Cuts to SNAP and Medicaid
It will worsen child poverty and force families to make impossible choices… pitting essentials like food and housing against medicine and routine doctor visits (Milken Institute School of Public Health, 2025).
How This Threatens a Future Where Everyone is Cared For
Two Core Pillars at Risk
The “Big Beautiful Bill” threatens two foundational commitments to equity and social mission:
Workforce Diversification: Cuts to Medicaid and safety-net programs will limit the pathway to gainful employment opportunities and workforce development, particularly for people who come from communities that have historically been left out of benefiting from the progress made by the US healthcare industry. Those are the people most likely to return to work at urban and rural safety net systems.
Institutional Support for Historically Excluded Groups: The bill undermines institutional investments in community-engaged and equity-centered work, eroding hard-won supports for underrepresented faculty, students, and staff. As health systems and universities make tough budgetary decisions in the face of Medicaid cuts, we know which groups are last hired and first fired. Those same groups will be the ones who suffer relative to decreased access to healthcare.
Who Profits While Communities Lose?
Strip away the rhetoric and the bill’s real agenda becomes clear: it’s about shifting power from public institutions to private profiteers. This isn’t about fixing healthcare, it’s about monetizing it (Commonwealth Fund, 2025).
And as resources are siphoned off to corporate entities, what’s left behind is a patchwork of inaccessible, inequitable care. The people who most need stability will instead find a system that’s less accountable, more expensive, and deeply disconnected from their needs.
Let’s be honest: if a policy makes it harder to see a doctor, harder to afford medication, or harder to have a child safely, it’s not beautiful. It’s a betrayal.
The Moment to Act Is Now
We are at a critical crossroads. The “Big Beautiful Bill” dares us to settle for less: less care, less compassion, less justice. We cannot afford to take that deal.
This is a moment for healthcare workers, organizers, faith leaders, teachers, patients, health advocacy advocates, and everyone to raise their voices. The fight for an equitable healthcare system transcends race, income, geography, and party. It’s about building a country where health is treated as a right, not a privilege.
No amount of branding can hide the damage this bill would do. Calling it “beautiful” doesn’t make it just. It makes it dangerous.
Take Action
Talk to your friends, your neighbors, your networks. Call your elected officials, especially if they supported this law. Center the stories of those most impacted. Stay engaged with organizations pushing for a system grounded in equity, care, and truth. Join the Campaign.
Let’s not be fooled by a name. Let’s demand policy that is as bold, complex, and compassionate as the people it’s meant to serve.
Andrea M. Jenkins, MPH, is an Institute Specialist I at the Fitzhugh Mullan Institute for Health Workforce Equity within the Department of Health Policy and Management at the George Washington University Milken Institute School of Public Health. She serves as Program Manager and Engagement Officer for the Residency Fellowship in Health Policy (RFHP), as well as Strategic Partnership Lead, Student Assembly, and Internship Coordinator for the Social Mission Alliance (SMA).
References
Associated Press. (2025, March 28). Rural Health Transformation Program proposed in federal budget deal. https://apnews.com/article/rural-health-bill-budget-2025
Commonwealth Fund. (2025). The impact of Medicaid and SNAP cuts on state economies. https://www.commonwealthfund.org/publications/2025/medicaid-snap-state-economies
Commonwealth Fund. (2025a). How proposed Medicaid work requirements could reduce coverage. https://www.commonwealthfund.org/blog/2025/medicaid-work-requirements
Commonwealth Fund. (2025b). Rural health at risk: What budget cuts mean for small communities. https://www.commonwealthfund.org/publications/2025/rural-health-cuts
Commonwealth Fund & Milken Institute School of Public Health. (2025). Economic and public health consequences of Medicaid and SNAP funding reductions.
https://milkeninstitute.publichealth.gwu.edu/reports/medicaid-snap-2025
Kaiser Family Foundation. (2025). Medicaid enrollment, work requirements, and access to care. https://www.kff.org/medicaid/report/medicaid-work-requirements-2025
Littrell, L. T., Stevens, E. R., & Warren, K. M. (2025). The impact of Medicaid funding cuts on rural hospital viability and mortality. JAMA Health Forum, 6(2), e250123. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2812345
Milken Institute School of Public Health. (2024). Projected effects of federal Medicaid and SNAP reductions on child poverty and family health.
https://publichealth.gwu.edu/research/medicaid-snap-impacts-2024
National Rural Health Association. (2025). Policy brief: Threats to rural health care in the FY2026 budget. https://www.ruralhealthweb.org/advocate/policy-documents
Pilkington, E. (2025, May 6). Thousands dropped from Medicaid rolls as red tape disrupts coverage. The Guardian.
https://www.theguardian.com/us-news/2025/may/06/medicaid-rolls-cut-access-care
Portnoy, J., & Wiggins, O. (2025, April 10). Maryland braces for surge in Medicaid administrative costs under federal proposal. The Washington Post.
https://www.washingtonpost.com/health/2025/04/10/maryland-medicaid-admin-burden
Scheffler, R. M., Mendoza, G., & Shen, G. C. (2025). Rural hospital closures and state-level Medicaid policy. Berkeley Center for Health and Economics.
https://healthpolicy.berkeley.edu/rural-hospital-report-2025
