A new Senate Finance Committee Democratic memo documents the immediate damaging effects of Trump’s reconciliation bill and provides information on taxpayer-funded slush funds, established to pay back Republicans for supporting the legislation.
The legislation all but destroys the Affordable Care Act and its health insurance exchanges. It drives up health care costs, makes it harder to enroll and ends coverage for millions of Americans. It lets premium subsidies for people who cannot afford coverage to expire effective January 2026.
About 20 million people who get help paying their premiums today will face an average of $700 more in premiums. In some cases, they will see their premiums double. And about seven million Americans will lose coverage as a result of these higher costs and enrollment challenges.
Rural America is becoming a health care desert. Rural hospitals are struggling to stay afloat. Medicare Advantage plans don’t pay them adequately and Trump’s tax bill cuts deeply into their revenues. It cuts $1 trillion in Medicaid dollars, a significant portion of which goes to them.
Some hospitals are shutting down entirely. Others are closing units. Or, they are not investing in cybersecurity. As many as 330 of them could close any day as a result of the Trump bill. The health care of rural Americans is at serious risk.
For that matter, health care for everyone is at serious risk. There’s a domino effect when hospitals close. Inner city hospitals are in the same position as rural hospitals and many of them are likely to close. Hospitals that are somewhat healthier financially will be forced to deliver uncompensated care. The consequences are likely to be pretty ugly.
A shorter open enrollment period in ACA health plans and new enrollment red tape will make it harder for people to get coverage in state health insurance exchanges. More people will need to pay $5 premiums. And, insurers will be able to sell less comprehensive policies.
Nursing homes will have fewer nurses thanks to the Trump tax bill. Understaffed nursing facilities will not be able to meet residents’ needs. With fewer staff and less Medicaid revenue, more than 570 nursing homes could immediately close.
Nearly 200 women’s health care centers could close because Trump’s tax bill defunds Planned Parenthood. Sixty percent of the closures will be in areas serving poorer populations. The lives of one million people are endangered. The effect is a backdoor abortion ban, even in states that permit abortions.
Requirements for states to help people enroll in Medicaid and CHIP are being rolled back. States will be able to make it harder for people with Medicare to enroll in Medicare Savings Programs, which cover their premiums and sometimes their out-of-pocket costs as well.
As of July 4, states no longer have to help people enroll in Medicaid, CHIP or Medicare Savings Programs. Nursing homes do not need nurses on staff 24/7. Planned Parenthood will not receive Medicaid funding.
As of August 25, people will need to jump through more administrative hoops to keep their ACA coverage in 2026. They will need to follow new rules for verifying their income and will have less time to enroll. People with low incomes will no longer have a special enrollment period for enrolling.
As of October 1, states will be able to try to get some of the $10 billion available for rural health. They might have to wait for it though. And, only $5 billion must be distributed to states whose applications are approved. Dr. Oz decides whether the remaining $5 billion is distributed and to which states.
As of December 1, CMS will determine whether and which states get access to the rural slush fund. And CMS must issue rules around reapplying for Medicaid every six months, as now required.
As of January 1, 2026, no more help for many people with ACA premiums. People will pay an average of $700 more in premiums in 2026. Anyone who gets help with premiums by mistake will be billed for it when they file their 2026 taxes. And people will see higher copayments.
As of October 1, 2026, federal Medicaid funding ends for many immigrants in the US lawfully.
As of January 1, 2027, working families must reapply for Medicaid every six months.
As of January 1, 2028, Medicare cannot negotiate prices of additional drugs treating rare diseases. This will put $5 billion in the pocket of the drug industry and drive up drug prices for people with Medicare with rare diseases.
Also, people with assets of more than $1 million in their homes will not be able to qualify for Medicaid.
And Medicaid dollars are cut 10 percent each year.
And, there’s much more. . .
Here’s a recap dollar by dollar, directly from the minority staff in Senate Finance:
- Blocking rules to help low-income seniors afford Medicare (Sec. 71101) $1,000,000
- Carrying out bipartisan program integrity in Medicaid (Sect. 71103) $30,000,000
- Adding red tape for people with Medicaid every six months (Sect. 71107) $75,000,000
- Taking Medicaid away from lawfully-present immigrants (Sect. 71109) $15,000,000
- Cutting Medicaid funding for emergency services (Sect. 71110) $1,000,000
- Taking away retroactive Medicaid benefits (Sect. 71112) $10,000,000
- Defunding Planned Parenthood (Sect. 71113) $1,000,000
- Cutting Medicaid funding for states (Sect. 71115) $20,000,000
- Cutting Medicaid funding for states (Sect. 71116) $56,000,000
- Putting needless checks on state flexibility (Sect. 71118) $10,000,000
- Adding red tape and terminating Medicaid for millions (Sect. 71119) (CMS) $200,000,000
- Forcing new copayments on people with Medicaid (Sect. 71120) $15,000,000
- Testing home-based care models for new populations (Sect. 71121) $150,000,000
- $50 billion rural health slush fund5 (Sect. 71401) $200,000,000
Here’s more from Just Care:
- Trump’s tax bill keeps Social Security taxes
- Trump’s tax bill means a $500 billion cut to Medicare
- Trump signs his tax bill, leaving 17 million Americans uninsured
- 2025: Programs that lower your costs if you have Medicare
- Millions safely import low-cost drugs from abroad
