SACRAMENTO, United States, July 11 (Xinhua) -- U.S. President Donald Trump’s One Big Beautiful Bill will strip millions of low-income Americans of health coverage and exacerbate healthcare inequality, health policy experts have warned.
At a press briefing on Wednesday, analysts from KFF, a nonprofit health policy research organization formerly known as the Kaiser Family Foundation, said the Republican-backed measure constitutes the largest rollback ever of Medicaid, the public insurance program for low-income citizens, and Affordable Care Act (ACA) coverage, and threatens to widen the country’s healthcare divide.
"This is the first rollback ever of our major health-care programs ... and it will add up to 17 million uninsured people when the bill is fully phased in," KFF President Drew Altman said, citing internal analysis and actuarial modeling that projects an additional 4.2 million people would lose coverage in 2026.
Altman warned that health insurance premiums would "skyrocket by more than 75 percent, and by 90 percent in rural areas," while enrollment could plunge by as much as 50 percent.
Larry Levitt, KFF’s executive vice president for health policy, noted that the Congressional Budget Office, the non-partisan fiscal referee of the U.S. Congress, projects the law will cut federal health spending by more than 1 trillion U.S. dollars over the next decade and leave 11.8 million additional people without insurance.
Most of the savings, Levitt said, come from a nationwide work requirement aimed at adults covered by the ACA Medicaid expansion. Although many already work or qualify for exemptions, he warned that complicated paperwork could still knock eligible people off the rolls.
KFF analysts stressed the burden will fall disproportionately on low-income families, older workers and rural communities.
"For people living close to the poverty line, even a small monthly bill can be the difference between staying covered and dropping insurance," said Cynthia Cox, who heads KFF’s ACA program.
Under the legislation, Medicaid recipients above the poverty line will face new co-payments, and states will be required to re-verify eligibility every six months. The law also restricts a key funding mechanism that states use to finance Medicaid, which may force governors to raise taxes, cut essential programs or reduce healthcare services. Optional home- and community-based services for people with disabilities are particularly at risk.
Hospitals are bracing for the fallout. Temporary aid for rural facilities, Levitt said, "won’t fully compensate for permanent cuts," and closures or service reductions could spread.
KFF experts added that mental health facilities may be especially hard hit, as Medicaid is a major source of funding for behavioral health care.
Further inequities are expected in women’s health and immigrant communities.
Alina Salganicoff, director of women’s health policy program at KFF, said a one-year funding cutoff for Planned Parenthood could leave patients in medically underserved regions with no alternative provider.
Meanwhile, lawfully present immigrants would lose eligibility for premium assistance and, in many cases, Medicaid altogether, forcing states to decide whether to use scarce local funds to fill the gap.
Altman described the legislation as a textbook strategy: wrap sweeping cuts "in a giant reconciliation bill that moves fast," advertise work requirements that sound fair, and claim to eliminate waste while deferring the pain until after elections.
Polling indicates that much of the American public already recognizes the bill’s deep cuts to Medicaid and food assistance and opposes them. KFF experts expect healthcare policy to be a major issue in the coming election cycle.
For now, the timeline may blunt public outrage, but the experts agreed the law sets the stage for a long-term erosion of coverage and a widening divide between rich and poor.
"We are just at the beginning of analyzing what this means," Altman told reporters. "The story will unfold piece by piece, but the direction is clear: the people who can least afford it will pay the highest price."
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