In the wake of President Donald Trump’s recently signed "One Big Beautiful Bill Act," communities and health officials across the United States are bracing for what many describe as the most sweeping—and potentially devastating—Medicaid cuts since the program’s inception in the 1960s. The legislation, which became law on July 3, 2025, has sparked outcry from public health leaders, hospital executives, and local officials who warn that the $1 trillion in projected healthcare cuts over the next decade will ripple through every facet of the nation’s healthcare system, with the most vulnerable citizens bearing the brunt.
According to The Trace, the bill’s impact will be particularly acute for victims of gun violence, a population that is disproportionately covered by Medicaid. Dr. Kyle Fischer, policy director for the Health Alliance for Violence Intervention, didn’t mince words: “Ultimately, we know that this legislation will cost people their lives.” Fischer’s research shows that Medicaid, since the Affordable Care Act’s passage in 2010, has become the single largest insurer for people who have been shot. Better outcomes for gun violence victims have been documented in states with expanded Medicaid coverage—a trend now threatened by the new law.
The Kaiser Family Foundation estimates that up to 17 million Americans could lose their health insurance as a direct result of the bill, while others will likely struggle to maintain coverage amid new bureaucratic hurdles. Medicaid, which currently insures over 70 million Americans—including nearly half of all children in the country—will be significantly defunded, jeopardizing not only individual health but also the survival of hospitals and clinics that serve as safety nets.
Communities already facing economic hardship are expected to be hit hardest. Households below the federal poverty line, who are four times more likely to be victims of fatal gun violence, often rely on Medicaid for both emergency and long-term care. Ruth Zakarin, CEO of the Massachusetts Coalition to Prevent Gun Violence and a former trauma clinician, lamented the setback: “As a former Medicaid provider myself, because I was permitted to provide clinical services to the victims of violence through public funding, it feels as if we are backtracking all of the progress that we have made.” She underscored the importance of hospital-based violence intervention programs and wraparound recovery care, services now in jeopardy. “For folks to be touched by violence and not be able to get the support that they need in the aftermath of trauma is just devastating to think about.”
During the Biden administration, Medicaid funds were increasingly used to support community violence intervention initiatives in at least eight states, and plans were in place to allow state Medicaid agencies to reimburse providers who screened patients for firearm risk. The Trump bill, while not directly cutting community funding, threatens the overall financial stability of the healthcare sector, putting recent progress at risk. “In these last several years, the healthcare initiatives aimed at gun violence reduction are working and driving down rates of gun violence across the country in historic ways,” Fischer told The Trace. “By cutting health funding, we’re ultimately moving backwards.”
In New York, the reaction has been swift and pointed. At a roundtable in Flushing on August 1, 2025, Congresswoman Grace Meng and State Senator John Liu joined healthcare and community leaders to warn of the "catastrophic impact" the bill could have on more than 1.5 million New Yorkers—about 7.5% of the state’s population—who stand to lose health coverage. Meng called the decision to slash Medicaid "cruel and unacceptable," emphasizing that around 280,000 people in her district alone rely on the program, including over 88,000 children and 50,000 seniors. "We all support rooting out waste, inefficiencies and fraud, but this is not the way to do it," Meng said, criticizing the bill’s new work requirements and its removal of eligibility for certain immigrant groups, including refugees and survivors of trafficking.
Liu was equally blunt, challenging the administration’s claim that the cuts target only “waste, fraud, and abuse.” Instead, he argued, the savings are being funneled into military expansion, a larger ICE, and tax cuts for the wealthiest Americans. “We don’t leave sick people out,” Liu said, noting that hospitals will still treat patients, but at greater financial strain. “This [bill] doesn’t reduce the overall cost of health care. It actually increases health care costs because it discourages or prevents people from seeking preventive care just to stay healthy in the first place.”
Healthcare providers in immigrant communities are especially alarmed. Kaushal Challa, CEO of the Charles B. Wang Community Health Center in Queens, which serves more than 65,000 patients annually, said, “Majority of our patients are vulnerable in some way, whether it’s economically, linguistically, transportationally, or insurance coverage-wise.” Challa worries that bureaucratic red tape will cause many to lose coverage, not because they’re ineligible, but because the paperwork is daunting. “Our community is not always the most equipped at handling complicated, legalistic paperwork, so we are concerned that a lot of people will drop out of coverage just because of the bureaucracy and the red tape and the paperwork.”
The impact on hospitals is expected to be severe. According to a joint analysis by the Greater New York Hospital Association and the Healthcare Association of New York State, the bill will result in $8 billion in cuts to New York hospitals and health systems, with the state projected to lose 34,000 hospital jobs and another 29,000 jobs in related industries. State lawmakers are considering restoring higher taxes on the wealthiest residents to help fund safety net programs, but Liu cautioned, “It’s just impossible for New York State to step up.”
The story is much the same in rural America. In Missouri, 67 rural hospitals are preparing for a dramatically different future. The new law could cause between 130,000 and 170,000 Missourians to lose Medicaid coverage under MO HealthNet over the next decade, according to the Missouri Foundation for Health. Sheldon Weisgrau, the foundation’s vice president of health policy, warned, “We are likely going to see rural hospital closures because they operate on the financial edge.”
Rural hospitals, which already have lower operating margins than their urban counterparts, face even sharper challenges. As more people lose insurance, they’re expected to delay care until absolutely necessary, leading to overcrowded emergency departments and increased uncompensated care. John Mohart, executive vice president and chief operation officer for Mercy—a major hospital system in the region—explained, “We give away about half a billion dollars of uncompensated or unreimbursed care. Some of that is for Medicaid patients already, because it doesn’t cover the costs that we have.” Smaller hospitals lack such flexibility, and as Weisgrau noted, “These costs are passed on to the rest of us. We will see private insurance premiums going up. Even folks who have good coverage from their employers and think they might be immune from some of these Medicaid cuts will see impacts of this down the line.”
To soften the blow, Congress included a $50 billion rural hospital stabilization fund in the budget, but experts say it’s a drop in the bucket compared to the $137 billion in Medicaid spending expected to be lost in rural areas nationwide. In Missouri alone, federal funding for Medicaid will drop by about 20% annually as the plan moves forward, and four rural hospitals are already considered at risk of closure. The consequences are far-reaching: after a rural hospital closes, studies show low-income and elderly patients are more likely to skip care, and communities lose not just healthcare providers but also jobs and economic stability.
The new law’s ripple effects—on gun violence victims, low-income families, immigrants, children, seniors, and rural residents—are only beginning to be felt. As officials and advocates scramble to mitigate the damage, the future of American healthcare hangs in the balance.