The passage of the One Big Beautiful Bill Act (OBBBA) has unleashed backlash from public health advocates, who are urging renewed leadership at the state and local levels to push back against Medicaid cuts projected to hit vulnerable communities.
Passed by Congress and signed into law by President Trump last July, the OBBBA brings sweeping new changes to federal spending levels by stripping funding for millions of benefits that support at-risk Americans. These programs not only include Medicaid, but also Medicare, the Supplemental Nutrition Assistance Program (SNAP) and other provisions that have provided financial assistance to many underserved populations.
The OBBBA is estimated to cut federal spending on Medicaid by nearly $1 trillion, resulting in 16 million people losing health care coverage, as reported by the Congressional Budget Office. The megabill places new federal limits on enrollment eligibility, including a work requirement, while also eliminating eligibility for lawful immigrants already enrolled in the program.
These new provisions will have far-reaching consequences on the American health care system, from risking rural hospital closures to threatening workforce layoffs. Disabled individuals, the elderly and those with low-income will be disproportionately affected by coverage losses. Fewer visits to primary care and more visits to the ER may become the new normal, as rising costs are likely to deter many from seeking regular preventative services. With premiums also expected to increase by 75%, physicians warn that medical complications and illnesses are anticipated to worsen.
At an August 1 news briefing hosted by American Community Media to mark Medicaid’s 60th anniversary, speakers addressed the grim but also potentially hopeful road ahead for health care justice.
Anthony Wright, Executive Director at Families USA, emphasized that individual states may mitigate harm by shaping their own implementation of the new provisions. These state-by-state decisions may help determine the severity of the OBBBA’s impact and offer an opportunity to soften its concerning aftermath.
“States do have choices about what they do,” Wright said. “They can decide whether they implement these cuts and make awful decisions, or whether they raise their own revenues. They can decide whether they’re gonna have a harsh version of these bills.”
Wright said these choices will include whether states impose more severe bureaucratic barriers, work reporting requirements or semi-annual status reports. Some solutions may be as simple as making it easier for individuals to sign up electronically or using AI tools for streamlining enrollment. He said these state-level decisions will mean the difference between people keeping or losing coverage.
The significant impact of state policy highlights the bill’s potentially uneven consequences across blue and red states. As health care becomes increasingly politicized, geographic policy divides may play a growing role in shaping a patient’s medical outcome.
Cary Sanders, Senior Policy Director at California Pan-Ethnic Health Network, discussed how California’s Medi-Cal, the state’s own version of Medicaid, may serve as a blueprint for other states.
After the passage of the Affordable Care Act, the state went further to protect health care access and advance the fight for equity through various other expansions. Now recognizing health care as a fundamental right, California is 6% away from achieving universal coverage.
“We expanded health care to all Californians, regardless of immigration status. We brought down premium costs in our state marketplace and zeroed out co-pays for our lowest income Californians,” Sanders said. “We also codified stronger consumer protections into law.”
Now, California Gov. Gavin Newsom estimates a loss of $30 billion as a result of federal cuts, an amount that Sanders said the state cannot raise its way out of. However, there remain other ways to raise revenue and backfill some of the cuts. These include closing corporate loopholes that allow many large employers to avoid providing health care for their workers.
Health care advocates also underscore the importance of education to promote existing resources, such as hospital charity care, available to those in need of financial support. Some states, including California, have laws that require hospitals to provide financial assistance to uninsured or underinsured patients facing significant medical expenses. Raising awareness about these options and ensuring hospitals properly screen uninsured patients may reduce barriers to care.
As states and health workers continue to grapple with the bill’s impact on medical care, policy strategists stress that political forces must not be ignored when charting the path forward. Accountability, constituency organizing and effective political messaging can be key drivers in securing a better roadmap to health equity.
“We need to make these people accountable for this vote. There’s all these bad consequences: rising premiums, people losing coverage, services being scaled back or closed,” Wright said. “We need to make sure that people connect the dots back to this bill.”
Through the OBBBA, Congressional Republicans voted to extend tax cuts for the wealthy and large corporations without extending tax credits that help individuals afford health care. In response, Wright says Medicaid must be made politically resilient by building a strong constituency of people who prioritize affordable health care. When members of Congress hear from this base, it could draw a clearer line of accountability between electoral success and supporting Medicaid.
As Democrats begin to lay out political strategy for the 2026 midterm elections, putting forward a clear vision for an improved, affordable and accessible health care system may be key. Sanders said that the more people know about the bill, the less popular it is, suggesting the continued importance of education during the campaign cycle.
The simultaneous attacks on Medicaid and civil rights are also not a coincidence, Sanders said. While Medicare is a health care program, she emphasized that it is also an “anti-poverty program” foundational to advancing health and racial equity. With healthcare being a key force behind personal bankruptcy, she calls for continued protection of the program that has “beat the odds” and helped lift people out of poverty for the past 60 years.
“Medicaid has really allowed families to inoculate them from poverty, redistribute resources, and to be able to live healthy lives,” Sanders said.
Dr. Ilan Shapiro Strygler, Chief Health Correspondent and Medical AffairsOfficer at AltaMed Health Services, calls for community innovations to dismantle the fear and distrust that has rippled through low-income and immigrant communities. His White Coats for a Change program is working to elevate the voices of patients and move forward a hopeful narrative of accessible healthcare.
“Understand and be part of the conversation. Make sure that we share the stories of our communities to empower,” Strygler said. “Putting a face and a concrete action by sharing stories with community members and NGOs can have a big impact on hope and better resources for our community.”
As the Trump administration cracks down on immigration enforcement with ICE raids spreading across the country, the personal safety of immigrants within the health care system has been jeopardized. The personal data of millions of Medicaid recipients have been shared with the Department of Homeland Security, creating fear and uncertainty among immigrants seeking medical care.
Investing in community resources, such as connecting patients with physicians who speak their language and expanding access to telehealth and mobile clinics, can help strengthen both civic and physical health by making individuals feel more secure obtaining treatment. The repercussions of the OBBBA, however, will continue to be a shadow that will challenge the fight for equity.
“This is a moment that we need to share the stories of our patients,” Strygler said. “We need to actually elevate the voices of us as providers, because I promise you, as a healthcare provider, a community physician that has been working since 2008 with every community that you can imagine across the country — we see the reality of Medicaid. It’s a lifeline. It’s an opportunity builder.”
