Yep… it’s a law now. The newly passed federal legislation, branded by Republicans as the “Big, Beautiful Bill,” promises broad tax cuts but delivers sweeping rollbacks to healthcare access — changes experts warn could leave millions uninsured and balloon the national deficit by trillions.

While the bill is touted as a tax relief package, health policy analysts say it represents the most significant retrenchment of coverage since the Affordable Care Act (ACA) was enacted in 2010.

In a media briefing on July 11, hosted by American Community Media, a panel of experts discussed the setbacks the country faces as Trump’s “Big, Beautiful Bill” comes into play. 

Speakers

  • Larry Levitt, Executive Vice President for Health Policy at KFF
  • Bill McKibben, writer, environmentalist, and founder of Third Act, which organizes older adults to act on climate change
  • Natasha Sarin, Professor, Yale Law School and Yale School of Management
  • Richard Prisinzano, Director of Policy Analysis at The Budget Lab at Yale

“This bill wasn’t labeled healthcare reform,” said Larry Levitt, “but that’s exactly what it is. It amounts to a partial repeal of the ACA, cutting more federal support for coverage than any legislation we’ve seen before.”

According to Congressional Budget Office estimates, the law will slash over $1 trillion from federal healthcare spending — primarily by reducing Medicaid funding and eliminating insurance subsidies. As a result, 11.8 million Americans could lose coverage within the first year, with that number rising to 16 million once ACA tax credits expire later this year.

Red Tape, Lost Coverage

Among the most controversial changes is a new Medicaid work requirement for adults covered under ACA expansion. Though nearly 90% of those individuals are already working or exempt, administrative hurdles are projected to strip 4.8 million people of coverage simply due to compliance failures.

Other provisions include:

  • Requiring Medicaid recipients to re-enroll every six months instead of annually;
  • Authorizing co-pays up to $35 for low-income individuals above the poverty line;
  • Tightening restrictions on how states fund their share of Medicaid, likely leading to reduced provider payments.

Rural hospitals are especially vulnerable. While the bill includes a one-time $50 billion rural health fund to soften the blow, experts warn that temporary funding won’t match the permanent nature of Medicaid cuts.

“Hospitals won’t close overnight,” Levitt said. “But as payments shrink, closures will accelerate — and in some communities, healthcare access could vanish entirely.”

Immigrant Communities Targeted

Major changes to ACA marketplace rules are also on the horizon. Tighter income verification requirements will make enrollment more difficult and eliminate automatic renewals. In a particularly controversial move, many legally present immigrants — including refugees, asylees, and individuals with Temporary Protected Status — will no longer be eligible for ACA coverage, Medicare, or Medicaid.

“These are not undocumented immigrants. These are legal residents,” Levitt emphasized. “And they’re being excluded from programs they’ve long relied on.”

Real Human Cost

The stakes are life and death, according to Natasha Sarin, a health and economic policy expert.

“Previous expansions saved an estimated 28,000 lives over ten years,” she said. “This rollback could result in 100,000 to 200,000 additional preventable deaths over the next decade.”

The impacts will fall hardest on vulnerable groups — the elderly, chronically ill, and immigrant communities already on the fringes of the healthcare system.

A Fiscal Time Bomb

Despite promises of deficit reduction, the bill’s tax provisions tell a different story. If temporary tax cuts are extended — as they often are — the bill could add $4 trillion to the national debt, pushing the debt-to-GDP ratio from 100% to 135% by 2035.

“It’s a massive expansion of the deficit,” Sarin warned. “And as the government borrows more, everyday interest rates — for mortgages, student loans, business lending — will rise. That will slow economic growth for everyone.”

Wealth Gains at the Top

The bill delivers substantial tax breaks to the wealthiest Americans, extending Trump-era tax cuts and creating new deductions for tip and overtime income. Meanwhile, the lowest-income households face major losses due to cuts in Medicaid, SNAP, and other safety net programs.

“The bottom 40% of earners are losing around $700 a year,” Sarin said. “The top 1%? They’re gaining $30,000. This is a reverse Robin Hood bill — it redistributes wealth upward.”

Even benefits touted by Republicans, like the expanded child tax credit and a tax break for seniors, fall short: the child tax credit increase excludes families too poor to qualify, and the senior tax cut is modest and temporary.

Rural Fallout

Though most cuts phase in after the 2026 midterms, rural communities are already feeling the effects. In places like Bakersfield, California — where over 60% of residents depend on Medicaid — local hospitals are on edge.

Levitt pointed to recent closures in Nebraska and warned more will follow. “Not every closure will have a direct line to this bill. But many will.”

More Than a Budget

“This isn’t just a fiscal policy,” Sarin said. “It’s a redefinition of who is protected in America — and who is left behind.”

FEMA’s Faltering Response Raises Alarm

As the nation grapples with the health and economic fallout of the “Big, Beautiful Bill,” another crisis is testing federal capacity: disaster response. The Federal Emergency Management Agency (FEMA) is facing sharp criticism for its sluggish and uneven handling of the recent Texas floods — the worst in the state’s history — which killed 132 people, including children at a summer camp, and left more than 400 families displaced.

“The FEMA director hasn’t even bothered to show up in Texas yet,” said Bill McKibben. “Every state and local official is now in suspense about whether there will be FEMA funding when the next disaster strikes.”

As of July 15, over 100 people remained missing. And in the wake of mounting frustration, many states are questioning whether they can still rely on FEMA at all.

Can States Handle Disaster Relief Alone?

The Trump administration has floated the idea that disaster response should fall to individual states — a notion McKibben dismissed as unrealistic.

“There are disasters every year in the U.S., but not in every state. It makes no sense for each state to fund and maintain its own disaster response core,” he said. “This is something we should be doing together as a country.”

McKibben warned that the emerging pattern suggests federal disaster aid may now be granted based on political favoritism. “That may sound strange and un-American, but it seems to be the path we’re on.”

FEMA’s Call Center Collapse

According to a New York Times investigation, FEMA initially answered 99.7% of calls from flood survivors on July 5. But just hours later, the agency terminated contracts with four major call center contractors, resulting in the immediate firing of hundreds of workers.

The next day, FEMA’s response rate dropped to just 35.8%. By July 7, only 15.9% of over 16,000 calls were answered.

While President Trump has previously threatened to eliminate FEMA entirely, Department of Homeland Security Secretary Kristi Noem said on July 13 that the administration now plans to “remake” the agency — dismissing the Timesreport as “fake news.”

Climate Change Accelerates Disasters

McKibben emphasized that disasters like the Texas floods are not isolated events but symptoms of a warming planet. “Warm air holds more water vapor, which increases the frequency and severity of floods. What we’re seeing in Texas is the new normal,” he said.

To prevent further damage, McKibben called for a rapid transition away from fossil fuels, the primary driver of climate change. Carbon emissions from oil and gas also release deadly particulate pollution, which contributes to 1 in 5 global deaths annually.

Clean Energy on the Chopping Block

Despite global momentum toward renewable energy, McKibben warned that the U.S. is moving in the opposite direction. The “Big, Beautiful Bill” includes sweeping rollbacks of clean energy incentives, cutting short tax credits for solar, wind, and electric vehicles that were included in the Inflation Reduction Act.

“These credits were supposed to last a decade. Now many will disappear by the end of the year, and some as early as September,” said McKibben. The outcome, he said, will be job losses in the clean energy sector and halted investment in renewable projects.

The effects will also hit consumers. “Solar power is now the cheapest way to produce electricity — that’s why even red states like Texas have embraced it,” he noted. “But under this bill, families will end up paying hundreds more on their utility bills.”

‘Sun Day’ and the Road Ahead

McKibben announced plans for a national day of action called “Sun Day,” to be held on September 21, the fall equinox.

“It will be a celebration and a protest — a way to emphasize that solar and wind aren’t alternative energy anymore. They’re common sense. They’re cheap. And they’re the best path forward for this country and the planet.”

 

All images provided by ACoM.