Romney on June 17, 2025, an aerial view of Valley Health Hampshire Memorial Hospital in WV
Ricky Caroti | Washington Post | Getty images
chairman Donald TrumpThe “big, beautiful bill” will make a broader change in American health care, leave millions of weak Americans without health insurance and threaten hospitals and centers that provide them care.
Senate on Tuesday 51-50 voted to pass Remedy for controversial expenses after a marathon overnight on modifications. But the bill will have to face another major test in the House, where Republican has a razor-thread majority and some members have already objected to the law.
Recent changes in the bill will reduce the cost of health care in the next decade by about $ 1.1 trillion. New estimate From the budget office of Nonpartison Congress. More than $ 1 trillion of those deductions will come from a joint federal and state health insurance programs for medical, disabled and low -income Americans. Funding cuts are beyond coverage: loss of that funding can affect many rural hospitals that inconsistently rely inconsistent on federal expenses.
The CBO estimates that the current version of the bill will result in 11.8 million people who lose health insurance by 2034, most of which are losing medicade coverage.
But the implications can be even bigger. The bill of Trump combined with different policy changes may be estimated 17 million people who lose health insuranceRobin Rudovitz said, the director of the program on Medicid and an interview in an interview is unpublished in the Health Policy Research Organization KFF. He said that other changes include new rules that will limit access to dramatically affordable care act market coverage and eliminate ACA tax credit.
“If all this comes to pass, it would represent the largest roll back of health insurance coverage due to the federal policy changes,” said Synthia Cox, director of the program KFF director on ACA. Analysis Published on Tuesday.
About 72 million Americans According to government data, about one-fifth of the total American population is enrolled in Medicade. Medicade Nursing Home is the primary payment for the majority of residents, and pays for it About 40% of all births,
The Trump administration and its collaborative bills aim to eliminate waste, fraud and abuse. Democrats have said that they break the President Repeated promises Not to touch the Medicade program. Medicade has been one of the most divisive issues in interactions in both chambers, and some House Republicans have expressed reservation of how deep the cut is.
“I think they want to cut fraud, but taking a swipe at the top is not going to solve the issue,” said Jennifer Menasic Kennedy, president of the American Nurse Association.
He said that deductions can shutter hospitals and health centers in rural areas and can cause job loss for health care employees such as nurses.
Will lose millions of American coverage
The bill cut comes from many different provisions, but the lion’s share of medicine savings will come from two changes.
One will install New, strict national work requirement For some Medicade beneficiaries for the age of 19 to 64 years. This will require childless adults to the parents of disabled adults and children over 14 years of age, they should work at least 80 hours a month to maintain their insurance coverage, unless they qualify for the exception.
According to the current law KFF, the work requirements or work on the work reporting rules prohibit the basis of the basis of eligibility.
The CBO said that the need for new work in the bill will not be kicked till 2026. It is estimated to save about 325 billion dollars in a decade.
One Analysis Published last week by UC Berkeley Labor Center said that most people will lose insurance due to the need for work and “especially create a drkeian barrier for older adults.” The Center said that there is a stable decline in employment after the age of 50 due to factors. [people’s] Control, “to increase responsibility for deteriorating health, age discrimination and aging family members.
“These similar factors make old adults especially weak for coverage loss under Medicade work requirements,” analysis said.
People living in rural communities, such as seasonal farmers, can also struggle to find employment for some parts of the year, said the manic Kennedy of the American Nurse Association.
AARP, a advocacy group, which focuses on issues affecting 50 and more in the US, in the weekend, the Senate majority leader John Theuns, Rupees, and the Senate minority leader Chak Shumar, DN.Y. Sent to a letter to, opposing another provision, which will fail to meet the Medicade Work requirements to get a premium tax credit through the ACA Marketplace.
“This creates a steep coverage rock for those in the 50s and early 60s-especially for the retirement or working part-time people who can be left with a cheap coverage option,” the group said.
Patients in hospital, health center, rural areas are at risk
Another driving source of medicade savings will come from a provision that will reduce the cap and gradually the tax that can impose on state hospitals, health plans and other medical providers. Those provider taxes are designed to help in state medicine programs, in which the federal government matches a part of the state’s expenses.
Some members of Trump Administration And conservative MPs argue that it is to get more federal funds for states than to get more federal funds.
According to the CBO report, the provider will spend another strategy up to $ 375 billion jointly called the bill ban on taxes and the state-directed payment.
But some GOP senators and experts expressed concern that capping provider taxes would threaten a significant funding stream for rural hospitals, forcing them and other health centers to shut down. Mennsic Kennedy said that in rural RES, healthcare providers, especially important access hospitals, rely more on medicade funding to support them in urban areas than those in urban areas.
“You are going to shut up rural hospitals that are the backbone of their community and were already struggling financially. You are going to see half a million job loss,” said Mennsic Kennedy.
He said that pregnant women in rural areas may be forced to drive at a distance of 30, 40 or 60 miles to distribute a child, while emergency medical services may have to drive an hour to reach a patient.
Patients from rural communities already have higher chronic diseases and mortality rates because they have limited access to care Disease Control and Prevention Center,
The Senate Republican has added a $ 25 billion fund to the bill to help rural hospitals to be open in front of medicid cuts.
But Mainesic Kennedy said that the fund is “putting a bucket of water on the fire of the house,” saying that this provider is not enough to offset the deduction from the cap on taxes and other provisions.
The cut in overall medicine funding for rural hospitals will be more than 20% in more than half of the states, according to A Report From the National Rural Health Association.
A win for pharma
The Senate Republican gave a win to drug manufacturers, as they added a provision back to the bill, which would exempt more drugs than the Medicare Drug Price Dialogue of Inflation Act.
Under the bill, drugs used to treat many rare diseases will be exempted from those price talks between medicines and manufacturers. The Senate initially abandoned the provision that was called the orphan Treatment Act in its first draft of the bill last month.
The drug industry argues that negotiations will encourage more investment in treatment for rare conditions, except for those drugs. Currently, drugs treating only one rare disease or condition can be exempted from price talks.
“Orphan Treatment Act will enable more options for Americans living with rare disease,” business group biotechnology innovation organizations Written in a post on X Last week. The group also stated that only 5% of rare diseases are an approved treatment, while the economic toll of rare conditions in the US increased more than $ 997 billion in 2019.
But on Tuesday, patients of the drug pricing group for cheap medicines now called the House to remove the orphan treatment Act from the bill and allowed the price talks of Medicare Drug to give more savings to patients.
The group’s executive director Merith Base said in a statement, “The decision to include it in the law takes us in the wrong direction, reducing the prices of the drug. ,
“Pharma lobbyists will not stop anything to maintain the profit of the industry, and when most of the caves of the Senate for their interests, it is a reminder to the Americans why they are paying the highest drug prices in the world. Simply say: It is because it is because the Congress allows it,” said Basis.
He called it a “completely unnecessary $ 5 billion cheaper” for the pharmaceutical industry, referring to the estimates of the CBO, how much taxpayers would cost in the orphan treatment act in the next decade.
