By: Sydney Myers-Obrien
Published: February 4, 2026
The next time you take a trip to the doctor, you may be hit with a higher than average medical bill. This could be due in part to changes enacted under the “One Big Beautiful Bill”, which became law on July 4, 2025.[1] The One Big Beautiful Bill (hereinafter “the Bill”) covers countless topics ranging from agriculture to homeland security to health.[2] One major area legislated by the Bill falls under Title VIII,[3] which institutes changes to Medicaid funding and eligibility requirements.[4]
Medicaid is the joint federal and state health insurance program that covers medical costs for low-income and qualified disabled individuals.[5] Nationwide compliance policies are prescribed by the federal government, but each state is responsible for administering its own Medicaid program—resulting in various interstate eligibility requirements and benefits.[6] However, the Bill introduces new national eligibility rules that will limit the number of individuals that qualify to receive benefits under Medicaid.[7]
In July 2025, the Congressional Budget Office (hereinafter “the CBO”), a nonpartisan agency that produces cost estimates to inform proposed legislation, estimated that 10 million people would lose health insurance coverage with the passage of the Bill.[8] If the expanded premium tax credit is allowed to expire under the Bill, an additional 4.2 million are expected to lose coverage.[9] The coverage losses will drastically impact the accessibility to and affordability of health care.[10] A study by the Urban Institute found that between 2000 and 2006, 137,000 people died due to lack of health insurance,[11] which, put simply, means insurance coverage saves lives.
One demographic expected to encounter the greatest hardship from the potential loss of health insurance coverage is people diagnosed with chronic conditions.[12] For example, diabetes is a particularly susceptible condition; approximately two million Americans are diagnosed with type 1 diabetes and require consistent access to medication.[13] Given the high price of insulin, health insurance coverage makes diabetic supplies accessible and affordable. A 2019 survey found that adults living with diabetes aged 18-64 are more likely to be on public insurance (Medicaid, Medicare, or otherwise) than a person living without diabetes.[14] Diabetic individuals are also more likely to purchase health insurance through the ACA Marketplace, which is threatened by the Bill.[15] The Bill shortens the period for open enrollment by approximately a month, restricts what would qualify as a Special Enrollment Period, charges a monthly fee for those who are automatically re-enrolled until they confirm eligibility, and imposes new documentation and restriction requirements which would all result in lower numbers of eligible ACA Marketplace participants.[16]
For the short term, healthy individuals are more likely to leave the private health insurance market rather than face the new hurdles imposed by the Bill, whereas patients with chronic diagnoses are more likely to stay.[17] This will leave a smaller pool of individuals paying insurance premiums with a greater amount of health needs, thereby increasing premiums moving forward.[18] In the long term, eligibility restrictions will restrict or eliminate coverage for patients altogether.[19] A lack of access to medication—particularly for young patients—may be life threatening.[20] These challenges are further exacerbated by the reduction in Federal Navigator program funding, a free resource which helps users navigate the complexities of health insurance programs.[21]
The Bill will make it more challenging for patients across the U.S. to afford and access health care. Some states have attempted to counteract the limitations on chronic conditions through coverage requirements, limitations on cost sharing—thereby limiting the patients’ out of pocket expenses—and changes to prior authorization requirements. [22] However, this may not be sufficient to overcome the sweeping changes caused by the Bill.[23] Ultimately, patients with diabetes and other chronic conditions will face a trying few months and may be hit with more expensive medical bills at their next doctor visit. As the Bill makes sweeping changes to accessibility of healthcare and affordability of drugs, doctor visits, and other healthcare needs, patients will suffer from the costs and loss of care. State law reforms may counteract some of the changes, but many of the changes remain to be seen in practice, which will make for a harrowing and stressful experience for any patient under federal health insurance programming.
[1] See generally One Big Beautiful Bill Act, 139 Stat. 72 (2025).
[2] See id. at 72-80 (identifying the components of the Act).
[3] See id. at 78 (identifying Title VIII).
[4] See id. at 290-321 (describing changes to the funding process and eligibility requirements).
[5] See What’s the Difference Between Medicare and Medicaid?, U.S. Dep’t of Health and Hum. Servs., https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html.
[6] See id.
[7] See Billy Dering, Amy Killelea, & Christine Monahan, New Federal Budget Law Spells Trouble for Patients with Insulin-Requiring Diabetes, Geo. Univ. (Aud. 1, 2025), https://ccf.georgetown.edu/2025/08/01/new-federal-budget-law-spells-trouble-for-patients-with-insulin-requiring-diabetes/.
[8] See Estimated Budgetary Effects of Public Law 119-21, to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14, Relative to CBO’s January 2025 Baseline, Cong. Budget Off. (July 21, 2025), https://www.cbo.gov/publication/61570.
[9] See 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, Cong. Budget Off. (June 4, 2025) (stating “[t]he premium tax credit is an advanceable, refundable credit that reduces enrollees’ out-of-pocket cost for premiums for health insurance obtained through the marketplaces”).
[10] See Shanoor Seervai & David Blumenthal, Insurance Coverage Saves Lives, The Commonwealth Fund (Aug. 9, 2019), https://www.commonwealthfund.org/blog/2019/insurance-coverage-saves-lives#:~:text=A%20new%20study%20shows%20that,link%20between%20insurance%20and%20mortality.
[11] See id. (finding that Medicaid expansions in 3 states were associated with a significant reduction in mortality).
[12] See Dering et al., supra note 7.
[13] See id.
[14] See id.
[15] See id. (stating “data also show that individuals with diabetes purchase private health insurance through the ACA Marketplaces at a higher rate (10.6%) than people without diabetes (6.9%)”).
[16] See Jared Ortaliza et al., How Will the One Big Beautiful Bill Act Affect the ACA, Medicaid, and the Uninsured Rate?, Kaiser Fam. Found. (June 18, 2025), https://www.kff.org/affordable-care-act/how-will-the-2025-budget-reconciliation-affect-the-aca-medicaid-and-the-uninsured-rate/.
[17] See id.
[18] See id. (identifying a preliminary study finding that Marketplace insurers would increase premiums by 15-20%).
[19] See id.
[20] See Amy Killelea & Christine H. Monahan, Health Insurance Transitions for Young People with Diabetes Can Be Life Threatening, Health Affs. (May 15, 2025), https://www.healthaffairs.org/content/forefront/health-insurance-transitions-young-people-diabetes-changing-coverage-can-life?utm_medium=social&utm_source=linkedin&utm_campaign=forefront.
[21] See CMS Announcement on Federal Navigator Program Funding, Ctr. for Medicare and Medicaid Servs. (Feb. 14, 2025), https://www.cms.gov/newsroom/press-releases/cms-announcement-federal-navigator-program-funding.
[22] See Dering et al., supra note 7.
[23] See id. (stating although states are attempting to make changes “the disruptions under the new federal budget law could very well limit their progress as attention and funding turns to responding to coverage churning, reductions in individual market enrollment, and skyrocketing premiums”).