Publication
Article
Issues
Author(s):
President Donald J. Trump signed the One Big Beautiful Bill Act (OBBBA) into law on July 4, 2025. Several provisions are expected to significantly reduce the number of Americans with health insurance and, over time, limit access to providers and health systems that care for patients nationwide. The Congressional Budget Office (CBO) projects that the law, together with recent proposed regulations, will increase the number of uninsured Americans by about 16 million over the next decade.1
Medicaid Coverage and Eligibility Changes
Medicaid is an important source of health care coverage for patients with cancer. In 2023, 10% of adults with a history of cancer relied on Medicaid for their coverage. Additionally, over one-third of children newly diagnosed with cancer are on Medicaid or the Children’s Health Insurance Program.2 Increasing barriers to Medicaid coverage, or removing eligibility, will make it harder for patients with cancer who rely on Medicaid to access screenings, diagnostics, and treatment when they need them most.
Several OBBBA provisions relating to Medicaid are predicted to increase the number of Americans without insurance. The law requires individuals aged 19 to 64 applying for coverage or enrolled through the Affordable Care Act (ACA) expansion group (or a waiver) to work or participate in qualifying activities for at least 80 hours per month or attend school at least half-time. There is an exemption for certain adults, including parents with children aged 13 and younger, those who are medically frail, and those who are participating in a treatment program for substance use disorder. States must verify that applicants meet the requirements for 1 to 3 consecutive months before applying, and that enrolled individuals demonstrate ongoing compliance for at least 1 month between eligibility redeterminations. If a person is denied or disenrolled due to work requirements, they are also ineligible for subsidized Marketplace coverage. CBO estimates that these provisions will increase the number of uninsured by 5.3 million in 2034.3
The law also requires states to conduct eligibility redeterminations for adults covered under Medicaid expansions. According to CBO, this change will increase the uninsured by 700,000 in 2034. Additionally, the law prohibits the imposition of new state provider taxes or increases in the level of existing provider taxes and makes other changes in this area. CBO anticipates these tax-related changes will increase the number of uninsured by 1.1 million in 2034.3
Affordable Care Act Coverage and Subsidy Provisions
The law adds new verification requirements for the ACA subsidies and cost-sharing reductions. It also ends automatic renewals. In addition, it eliminates subsidy eligibility for many categories of legally present immigrants who are lawful permanent residents. This will increase the uninsured by 900,000 in 2034, according to CBO. Finally, the enhanced premium tax credits will expire at the end of 2025 and, unless extended, will result in 4.2 million more uninsured individuals.1
Rural Hospitals and Provider Funding Impact
The provision to end or cap the taxes states can impose on hospitals and other health care providers raises serious access concerns. It threatens a critical funding source for rural hospitals and certain community providers and could lead to closures of facilities that serve as a vital lifeline for their communities.4
Implications for Patients and Cancer Care Access
Together, these changes could make it more difficult for millions of Americans, including many patients with cancer, to obtain and maintain health coverage. ACCC will continue to monitor the implementation of the OBBBA and related regulations, and advocate for policies that protect access to quality, affordable cancer care across all settings.
Nicole Tapay, JD, is the director of cancer care delivery and health policy for the Association of Cancer Care Centers in Rockville, Maryland.
References
1. Congressional Budget Office. Letter to Senator Ron Wyden, Representative Richard E. Neal, and Representative Frank Pallone Jr, Re: Estimated Effects on the Number of Uninsured People in 2034 Resulting From Policies Incorporated Within CBO’s Baseline Projections and H.R. 1, the One Big Beautiful Bill Act. June 4, 2025. Accessed October 16, 2025. https://www.cbo.gov/system/files/2025- 06/Wyden-Pallone-Neal_Letter_6-4-25.pdf
2. American Cancer Society Cancer Action Network. Medicaid cuts put people with cancer at risk. February 17, 2025. Accessed October 15, 2025. https://www.fightcancer. org/policy-resources/ medicaid-cuts-put-people-cancer-risk
3. Kaiser Family Foundation. Health provisions in the 2025 budget reconciliation law. August 22, 2025. Accessed October 15, 2025. https://www.kff.org/medicaid/ health-provisions-in-the-2025-federal-budgetreconciliation-law/#2ca666ac-5d15-4454-8973- 241566e22bb5--h-eligibility-and-cost-sharing-policies
4. Constantino AK. Medicaid cuts in Trump’s “big, beautiful bill” will leave millions uninsured, threaten rural hospitals. CNBC. Updated July 2, 2025. Accessed October 17, 2025. https://www.cnbc.com/2025/07/01/how-trump-billmedicaid-cuts-will-impact-us-health-care.html
