Medicaid cuts in 'Big Beautiful Bill' could spell 16,000 preventable deaths

(CN) — The Trump administration’s One Big Beautiful Bill Act would reduce federal Medicaid funding by at least $100 billion over 10 years, and a research team calculated the cost to low-income Americans in its study published Monday in Annals of Internal Medicine.

After reviewing the Congressional Budget Office’s analysis of the issue and other relevant documents, study author Adam Gaffney and his colleagues said that by 2034, the six largest BBB Medicaid cuts would reduce federal Medicaid expenditures by $625 billion, reduce Medicaid enrollment by 10.3 million people and increase the uninsured population by 7.6 million. One policy alone would lead to between 651 and 12,600 medically preventable deaths annually, while executing all six would increase that number to between 8,200 and 24,600 deaths, per Gaffney via email.

“When you take away people’s health coverage, they go without medical care,” said Gaffney, a pulmonary and critical care physician and an assistant professor at Harvard Medical School. “They skip doctors’ visits, they go without needed medications like inhalers or blood pressure drugs, they even avoid the hospital when it’s an emergency because they fear medical bills. The results are unsurprising — people get sicker, their conditions progress and they may even die.”

Work requirements

Among the BBB policies is the second Trump administration’s intent to implement the first Trump administration’s proposed Medicaid work requirements. Arkansas enacted work requirements in 2018 and disenrolled many who met the work requirements or qualified for an exemption. Per the team, this updated policy would also apply an age range requirement of 19 to 64 years, compared to the Arkansas program’s age range of 30 to 49 years, and the broad requirement would result in 2.5 million uninsured people.

Provider taxes

The team said that increasing state funds for Medicaid expenditures increases federal assistance via the federal medical assistance percentage, the statutory percentage of each state’s Medicaid service costs. Traditionally, states implement provisions increasing Medicaid reimbursements, so the taxes don’t financially harm providers. One BBB policy would freeze provider taxes and reduce those provisions from 6% to 4% in 2026 and then to 3% from 2028 onward, disenrolling 8.6 million people and increasing the uninsured population by 3.9 million.

Delayed eligibility determination

In 2024, the Biden administration finalized a rule that simplified enrollment and improved state processes to determine Medicaid eligibility by requiring states to contact enrollees at updated addresses and making more efforts to contact beneficiaries before disenrolling them. The team said this rule came after Medicaid beneficiaries lost coverage due to frequent eligibility determinations and other administrative hurdles.

One BBB policy would repeal this rule, reducing $170 billion in Medicaid expenditures and 2.3 million people in Medicaid enrollment while increasing the uninsured by 600,000. The team predicts that the BBB increasing eligibility determinations from once a year to every six months will also increase coverage losses.

Overall cost

Despite its shortfalls, Gaffney said that Medicaid serves as a safety net for the nation’s health care, and its various expansions boosted enrollment to over 90 million people, but the BBB will harm low-income Americans overall.

“Some Americans rely on Medicaid more than others on average, such as women. Some 40% of all births are covered by Medicaid,” said Gaffney via email. “Certainly, chronically ill and disabled Americans are more likely to rely on Medicaid. Individuals of racial minorities may use Medicaid more often than others, but the reality is that working class Americans of every racial background heavily rely on Medicaid.”

He added, “My larger hope is that policymakers reconsider whether thousands of medically preventable deaths is a price worth paying for tax cuts that predominantly benefit the wealthy.”

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