Overview

• President Trump signed the One Big, Beautiful Bill into law on July 4, coupling major tax cuts with nearly $1 trillion in federal Medicaid funding reductions over ten years.
• New work requirements and semiannual eligibility checks for able-bodied adults under 65 are slated to begin in late 2026 and 2027, postponing most impacts until after the 2026 midterm elections.
• Community Hospital in McCook, Nebraska, has announced plans to close amid uncertainty over the upcoming Medicaid cuts, highlighting the immediate threat to rural healthcare providers.
• The nonpartisan Congressional Budget Office projects the law will add $3.3 trillion to the federal debt, and analysts estimate it could strip coverage from more than 12 million low-income Americans and contribute to up to 200,000 preventable deaths.
• Governors and health experts—including Kentucky’s Andy Beshear—warn that states will face major budget strains as rural hospitals risk closure and hundreds of thousands of people lose access to care.