The so-called 'One Big Beautiful Bill (OBBB)' reflecting major national policy tasks of Donald Trump's second administration has passed the Senate on the 1st (local time) after many twists and turns, raising concerns that at least 17 million Americans are at risk of losing their health insurance. There are also criticisms that the American health insurance system improved during Barack Obama's previous administration is regressing.
This bill includes various tax cut measures such as lowering personal income tax rates and the highest corporate tax rate enacted during Trump's first term in 2017, as well as cuts to welfare budgets like Medicaid (public medical aid for vulnerable populations) to offset these expenses. The bill, which passed the House last month, underwent several revisions after moving to the Senate, and is now awaiting another passage in the House.
The Washington Post (WP) reported, citing the Congressional Budget Office (CBO), that if the bill, which includes the Medicaid cut measures, is enacted, 11.8 million people could lose their health insurance by 2034. Additionally, the bill is set to terminate the health insurance subsidies provided under the Affordable Care Act (ACA), also known as 'Obamacare,' by the end of this year, potentially rendering 4.2 million people ineligible for health insurance. There are also forecasts that an additional 1 million people could become uninsured due to the impacts of other budget cuts.
Obamacare is a health insurance reform led by former President Obama, which mandates health insurance enrollment for all citizens and provides subsidies to the middle class to reduce their medical expenses. Medicaid was also expanded through Obamacare. According to the health policy research organization KFF, approximately 44 million Americans are enrolled in health insurance thanks to Obamacare.
President Trump has advocated for the repeal of 'Obamacare' during his first term and made comprehensive revisions a campaign promise ahead of last year's election. The Republican Party has continuously claimed since the passage of Obamacare in 2010 that they would repeal it, and efforts to dismantle Obamacare continued during Trump's first term. However, due to public backlash and opposition from certain Republican senators including John McCain, efforts to amend Obamacare were halted.
The addition of 'work requirements' to Medicaid eligibility in the Senate bill is also a concerning aspect. Experts warn that healthy adults aged 19 to 64 will have to work at least 80 hours a month in qualifying jobs to maintain their insurance, which could severely impact the poor, who rely on seasonal and part-time jobs.
WP stated, 'If OBBB is implemented as is, it would constitute the largest cut in Medicaid history in nearly 60 years.' It added that 'since the 1990s, federal spending to expand the social safety net could significantly decline.' The Senate bill aims to cut federal spending by $1.1 trillion for Medicaid, Medicare (health insurance for the elderly), and Obamacare, with more than $1 trillion of that attributed to cuts to Medicaid.
There is a barrage of criticism from all walks of life regarding the passage of this bill, which will have a severe impact on low-income and middle-class individuals. Joan Alker, director of the Georgetown University Center for Children and Families, noted, 'If this bill passes and subsidies actually end, it will very seriously undermine the vision of Obamacare,' stating that 'Obamacare was the result of a century-long struggle.' Senator Mark R. Warner (Democrat-Virginia) stated in an interview with CBS that 'this bill will take us back to the rates of uninsured individuals before Obamacare.'
Even within the Republican Party, criticism has been raised. Senator Thom Tillis (North Carolina) expressed early opposition to the bill, stating that if it passes as is, it will cause significant harm to his constituents in North Carolina. Senator Tillis remarked, 'This bill can only betray President Donald Trump’s promises,' referring to Trump's past assurances not to reduce Medicaid. After his confrontation with President Trump, Senator Tillis declared that he would not seek re-election.