The “One Big, Beautiful Bill Act” that Republicans are trying to ram through Congress is being billed as President Donald Trump’s tax and immigration bill, extending the 2017 tax cuts that overwhelmingly favor the rich while funding Trump’s evil immigration crackdown.
But in reality, the dogshit legislation is just a backdoor way for Trump and the GOP to repeal the Affordable Care Act, President Barack Obama’s signature legislative achievement that has helped tens of millions of Americans get health insurance or Medicaid coverage.
“They’re not calling this ACA repeal and replace, but the coverage losses would be among many of the same people who would have lost their insurance under ACA repeal,” Larry Levitt, KFF executive vice president for health policy, told the Washington Post.
If it passes, the “One Big, Beautiful Bill Act” would force nearly 14 million people to lose their insurance coverage so the GOP could—partially—offset the cost of tax cuts for the rich, which it would do in a few ways.
First, the bill essentially scales back the ACA’s Medicaid expansion by limiting the amount that states can get reimbursed, leaving states to find millions in funding to cover those costs or scale back who is covered. Groups like the American Hospital Association strongly oppose the bill, as changes to Medicaid’s reimbursement could lead to hospital closures, especially in rural areas that supported Trump in 2024.
“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. 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,” AHA President and CEO Rick Pollack said in a statement.
“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,” he added.
Republicans are also trying to impose work requirements on Medicaid recipients, which experts say will force eligible people to lose their Medicaid due to onerous paperwork issues.
Meanwhile, Republicans are also refusing to extend an expansion of subsidies that congressional Democrats passed in their first COVID-19 relief bill in 2021, which helped millions of people afford insurance. Without an extension, costs will increase for millions of Americanseventually causing 5 million people to lose their insurance
But this could spell political doom for Republicans in the 2026 midterms.
An April poll from Navigator Research shows that the Obamacare subsidies are overwhelmingly popular, with 79% of people in support. And a March Civiqs poll for Daily Kos found that 63% of registered voters oppose cutting programs like Medicaid and food stamps.
Democrats, for their part, plan to make this a focus in the 2026 midterms, with Senate Democrats drawing attention to the bill’s health care cuts to gin up public backlash.
Similarly, Protect Our Care, a group seeking to expand health care access, is already running ads in 11 GOP-held House districts attacking Republicans who voted for the “One Big, Beautiful Bill Act.”
“By slashing health care, Republicans dared to touch the third rail of American politics,” Protect Our Care President Brad Woodhouse said in a news release.
“Republicans know how indefensible their tax bill is: that’s why they held hearings in the dead of night and wrote the bill behind closed doors. We’re making sure the American people know the dire consequences of what their elected officials voted for and, undoubtedly, Republicans will pay a heavy price for putting billionaires ahead of their constituents’ health,” he continued.
History shows that this can be extremely potent for Democrats in 2026. Remember, health care was the issue that helped win back the House in 2018 when Democrats ran ads attacking GOP lawmakers for voting to repeal Obamacare, leading dozens of Republicans to lose their seats. And now they’re hoping that history will repeat itself.
“Their entire agenda can be boiled down to this: billionaires win and families lose,” Senate Minority Leader Chuck Schumer wrote in a letter to Senate Democrats on June 1. “Billionaires win and families lose when Republicans kick millions of Americans off their health insurance by dismantling the ACA and proposing the largest cut to Medicaid in American history.”
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