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Trump’s “One Big Beautiful Bill” Ends Medicaid for Undocumented Immigrants
President Donald Trump has signed the sweeping “One Big Beautiful Bill” (OBBB), a landmark piece of legislation that eliminates Medicaid coverage for undocumented immigrants and imposes stricter eligibility conditions on millions of legal recipients. Hailed by Trump as a promise fulfilled, the bill is being described as a major shift in federal healthcare and immigration policy.
The new law officially bars the use of federal Medicaid funds for undocumented immigrants. Roughly 1.4 million such individuals who had been receiving emergency or state-extended healthcare will be cut off from federal assistance. Furthermore, states that choose to fund healthcare for these individuals using their own budgets—particularly under humanitarian exceptions—will face a reduction in federal reimbursements. Reimbursement rates in such states will drop from 90% to 80%, directly affecting programs in places like California, Oregon, and New York.
Beyond immigration, the OBBB tightens rules for existing Medicaid beneficiaries. From 2027, able-bodied adults aged 19–64 without dependents will be required to complete at least 80 hours per month of employment, vocational training, or approved volunteer work to maintain eligibility. Additionally, the law mandates biannual eligibility re-verification and introduces increased copayments—up to $35—for certain income brackets, especially those just above the federal poverty line.
The bill is part of a larger Republican legislative package that combines austerity with conservative policy priorities. Among other provisions, it extends Trump-era tax cuts, increases funding for military and border security, allocates $50 billion toward continued construction of a border wall, slashes subsidies for green energy programs, and raises the federal debt ceiling to accommodate long-term spending goals.
Supporters argue that the bill reorients federal spending toward American citizens and fiscal responsibility. Critics, however, warn it could cause millions to lose coverage. Health analysts project that 8 to 11 million Americans could become uninsured over the next decade, potentially overwhelming emergency care systems and forcing cuts at rural hospitals.
States that have expanded healthcare access to undocumented immigrants or humanitarian parolees are preparing for legal and financial battles. Governors and attorneys general in several Democratic-led states have already signaled intentions to challenge the bill in court, citing its potential violation of state rights and its impact on public health outcomes.
The One Big Beautiful Bill marks a significant pivot in U.S. domestic policy, blending healthcare reform with aggressive immigration control. While it energizes Trump’s political base, it opens up contentious legal and humanitarian debates that are far from over.
