One Big Beautiful Bill Act: Fiscal reform that Americans want, or gutting the health care system?

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The One Big Beautiful Bill Act will offer tax breaks for Americans while targeting waste, fraud and abuse, but with dire consequences for U.S. health care.

Lawmakers, health industry experts and advocates focused on different elements in their responses to a House of Representatives vote early May 22 on the One Big Beautiful Bill Act that outlines federal spending.

House Ways and Means Committee Chair Rep. Jason Smith (R-Missouri) praised the bill for “delivering lasting tax relief to the American people.” The bill locks in the 2017 tax cuts advocated by President Donald J. Trump. For a family of four, taxes will drop by $1,300, with pro-growth policies that will help businesses and raise wages for American workers, he said in a statement.

Opponents have criticized a number of provisions in the bill. For health care, there will be an estimated $625 million cut from Medicaid spending from 2025 to 2034.

Medicaid cuts and more

The bill has significant problems that will affect health care, said American College of Physicians (ACP) President Jason M. Goldman, MD, MACP. Those need to be fixed when the Senate takes up consideration of the bill approved May 22 in the House of Representatives.

“The American College of Physicians is extremely concerned that the budget reconciliation bill that passed the House this morning will harm access to care for patients across the country,” Goldman said in a statement. “The changes proposed to the Medicaid program will cause millions of Americans to lose their health insurance and be unable to afford necessary health care.

“Additionally, the bill makes significant changes to federal student loan programs that will place a medical education further out-of-reach for potential medical students, worsening the already existing physician shortage in our country,” he said.

Delivering on promises

Two House committee leaders focused on health care specifically in their statements about the bill.

Rep. Brett Guthrie (R-Kentucky)

“House Republicans have delivered on the promises we and President Trump made to the American people,” said Rep. Brett Guthrie (R-Kentucky), chair of the House Energy & Commerce Committee. That panel was one of the key committees to deliberate on the legislation.

“The bill includes provisions passed by the Energy & Commerce Committee that strengthens Medicaid for those who need it most, establishes work requirements for able-bodied individuals, and ensures American energy dominance,” Guthrie said. “This bill will provide vital support to communities and families across the country. I look forward to working with the Senate to pass the bill and deliver it to the president’s desk.”

Stealing from the poor

His Democratic counterpart, committee Ranking Members Rep. Frank Pallone (D-New Jersey), said the legislation essentially repeals parts of the Affordable Care Act and cuts Medicaid and Medicare.

Rep. Frank Pallone (D-New Jersey)

“The GOP Tax Scam takes health care away from at least 13.7 million Americans so they can give giant tax breaks to billionaires and big corporate interests. It’s a shameful reverse Robin Hood scheme – they are stealing from you to give to the rich,” Pallone said in his remarks prepared for delivery in the House.

“Republicans are stripping health care away from people by putting all sorts of burdensome and time-consuming roadblocks in the way of people just trying to get by,” Pallone said. “The vast majority of people on Medicaid already working. This is not about work – it’s about burying people in so much paperwork that they fall behind and lose their health coverage.”

Cutting Medicare spending

The bill could result in a cut to Medicare spending, according to the nonpartisan Congressional Budget Office. CBO Director Phillip L. Swagel wrote about federal budget rules in a May 20 letter to Rep. Brendan F. Boyle (D-Pennsylvania), the ranking member of the House Budget Committee.

The spending rules were part of the Statutory Pay-As-You-Go Act of 2010, known as S-PAYGO, regarding federal budget deficits, budgetary sequestration, and the scorecards estimated through the federal Office of Management and Budget, Swagel wrote. If the legislation increases the federal budget deficit by $2.3 trillion from 2025 to 2034, it would trigger a sequestration order to reduce spending by $230 billion a year.

Medicare reductions are limited to 4%, estimated at $45 billion for fiscal year 2026 and increasing to $75 billion by 2034. For the 2027 to 2034 period, Medicare cuts would total an estimated $490 billion, Swagel wrote.

Hospital leaders say bill will hurt health care

The night before the vote, American Hospital Association (AHA) President Rick Pollack issued a lengthy statement for 5,000 member hospitals, health systems, and other organizations representing more than 270,000 physicians, 2 million nurses and 43,000 executives, leaders and professionals.

There are “significant concerns” regarding reductions to Medicaid and the Affordable Care Act Health Insurance Marketplaces, Pollack said. He urged a “no” vote in the House.

“The sheer magnitude of the level of reductions to the Medicaid program alone will impact all patients, not just Medicaid beneficiaries, in every community across the nation,” Pollack’s statement said. “Hospitals — especially in rural and underserved areas — will be forced to make difficult decisions about whether they will have to reduce services, reduce staff and potentially consider closing their doors. Other impacts could include longer waiting times to receive care, more crowded emergency departments, and hospitals not being able to invest in technology and innovations for clinical care.

“In particular, the Medicaid legislative proposals severely restrict the use of legitimate state funding resources and supplemental payment programs, including provider taxes and state directed payments, under the guise of eliminating waste, fraud and abuse,” Pollack said. “We reject this notion as these critical, legitimate and well-established Medicaid financing programs are essential to offset decades of chronic underpayments of the cost of care provided to Medicaid patients. These new policies are estimated to decimate federal support for the Medicaid program by more than $700 billion over 10 years and will displace health care coverage for millions of Americans, moving them from insured to uninsured status.”

‘A direct assault’

The bill has at least five policies that hurt health care, said Mona Shah, senior director of policy and strategy at Community Catalyst, a national health care access advocacy organization.

• Work requirements are unnecessary and punitive.
• Maternal and reproductive care are slashed.
• There are deliberate barriers to enrolling in health insurance plans.
• Attacks on gender-affirming care are discriminatory.
• Health care eligibility requirements target immigrant communities.

"Don't believe the spin about reform — this is a direct assault on our historically excluded communities to protect corporate profits,” Shah said in a statement. “The consequences will be catastrophic: rural hospitals closing, medical debt skyrocketing, and health outcomes worsening — especially in communities already facing deep inequities due to racism, classism and other forms of oppression."