Health Impact of the "Big Beautiful Bill"

The Republicans are making America sick.

Yesterday morning, the U.S. House of Representatives passed a 1,100-page budget proposal by a single-vote margin. This sweeping bill consolidates a wide array of Republican priorities to deliver tax cuts to the ultra-wealthy—at the expense of everyone else.

In my previous post, I focused on the massive transfer of wealth this bill represents—and what that means for our society and our democracy. But every section of this bill has serious implications for our lives, our economy, and our future. Each demands scrutiny.

In the weeks ahead, we’ll break down what this bill means for our health, education, environment, safety, immigration, foreign policy—and how, across every area, it hurts millions of Americans just to fund more benefits for billionaires.

Today, we focus on health—both individual and collective. Given the administration’s slogan to “Make America Healthy Again,” it’s critical we understand the truth behind the rhetoric.

Healthcare Access

TL;DR:

• 13.7 million more Americans projected to lose insurance.

• Medicaid cuts threaten hospitals, school health services, and senior care.

• Triggers automatic 4% Medicare cut ($36B) via PAYGO rule.

• Cuts likely to reduce provider payments, limit services, and shrink access.

Changes to Medicaid and the Affordable Care Act (ACA) will leave 13.7 million more Americans uninsured over the next decade. But the damage goes far beyond those individuals. Medicaid helps keep hospitals open, funds school-based health services, and pays for long-term care for seniors. Cuts of this scale weaken the entire healthcare system.

While the bill includes no direct cuts to Medicare benefits or premiums, it will trigger the statutory PAYGO rule—resulting in an automatic 4% cut to Medicare spending. That’s about $36 billion in one year alone. Experts warn these cuts could reduce payments to providers, causing some to stop accepting Medicare patients and forcing hospitals to scale back services like rehabilitation, skilled nursing, and elective procedures. The current bill does not exempt Medicare—or any public health agency—from PAYGO, making these cuts likely if passed as written.

Drug Prices

TL;DR:

• U.S. drug prices already 2.78x higher than other countries.

• Bill repeals Medicare’s drug negotiation power.

• Ends Medicaid Drug Rebate Program that keeps prices in check.

• New tariffs and FDA cuts expected to raise drug prices 4.1%+.

Americans already pay 2.78 times more for prescription drugs than people in other developed countries. Instead of offering relief, the budget repeals Medicare’s drug negotiation authority and replaces it with limited reforms to pharmacy benefit managers—changes experts say won’t meaningfully reduce prices.

It also eliminates the Medicaid Drug Rebate Program, which helps control costs for low-income patients. On top of that, new tariffs on pharmaceutical imports are expected to increase prices by 4.1%, while deep cuts to the FDA will likely delay approval of new medications.

Bottom line: drug costs will rise—for everyone.

Gun Safety and Violence Prevention

TL;DR:

• Ends $200 tax and background checks on silencer purchases.

• Projected sale of 7 million silencers, $1.4B in lost revenue.

• Eliminates all federal funding for gun violence prevention.

The bill repeals the longstanding $200 federal tax on silencers and eliminates background checks, fingerprinting, and other requirements for purchasing them. The budget estimates this will result in $1.4 billion in lost federal revenue over 10 years—implying the sale of 7 million silencers. Meanwhile, it eliminates all federal funding for gun violence prevention.

Nutrition and Food Safety

TL;DR:

• $290B in SNAP cuts—dropping daily food benefits by 22%.

• School lunch reimbursements cut by 5–10%, hurting food quality.

• FDA faces 17% cut; food inspection burden pushed to states.

The budget cuts $290 billion from SNAP, reducing daily benefits from $6.20 to $4.80 for 42 million recipients. It also eliminates funding for programs that help food banks purchase fresh, nutritious food.

School meal programs are also hit. While the core school lunch program remains, grants for local produce are cut. Meal reimbursements drop by 5–10%, forcing schools to serve more processed, lower-cost foods.

The FDA faces a 17% budget cut. Responsibility for food inspections is shifted to under-resourced states, and quality-control programs are suspended—weakening food safety nationwide.

Environmental Health and Climate

TL;DR:

• EPA cut by 55%—guts air, water, chemical safety enforcement.

• Fossil fuels boosted; clean energy tax credits eliminated.

• $1T in clean energy investment lost; 300,000 jobs cut.

• Pollution-related health harms increase, especially for children.

The EPA faces a 55% cut, gutting its ability to enforce protections for air, water, and chemical safety—especially in low-income and minority communities.

Fossil fuel companies benefit from expedited permitting and legal shields. Drilling on public lands becomes cheaper and more accessible.

Meanwhile, clean energy investments are slashed. Tax credits for clean energy, EVs, and home efficiency upgrades are eliminated. This will reduce clean energy investment by more than $1 trillion by 2050, eliminate an estimated 300,000 current and future jobs, and raise household utility bills by $43 billion.

And the public health impacts will be severe: higher pollution, worsened asthma, increased cardiovascular disease, and thousands of additional premature deaths—especially among children and vulnerable populations.

Immigration and Public Health

TL;DR:

• Adds $12B for deportation operations and expanded fast-track removals.

• Cuts make immigrant families less likely to seek care.

• Detention conditions worsen, risking disease outbreaks.

The bill adds $12 billion to reimburse states for deportation and enforcement operations, while expanding fast-track removals and detention authority. These policies are cruel and also have serious downstream health effects:

- Immigrant families may avoid Medicaid, WIC, or public clinics out of fear.
- Detained individuals often face overcrowded, unsanitary, and unsafe medical conditions.
- Public health experts warn that these policies undermine vaccination efforts and basic care access—risking future outbreaks and long-term disparities.

Public Health Infrastructure

TL;DR:

• $33.3B cut (26.2%) from HHS.

• 40% cut to disease surveillance and injury prevention.

• Programs slashed: mental health, HIV, maternal care, research.

• 93% staff cut at workplace safety agency.

The budget cuts $33.3 billion—26.2%—from the Department of Health and Human Services (HHS), undermining efforts to monitor disease, conduct research, and deliver essential care.

Funding for public health surveillance is slashed by 40%, eliminating the Preventive Health and Health Services Block Grant and the Center on Injury Prevention. Other targeted reductions include:

- Mental health and family planning programs
- HIV/AIDS and maternal health services
- Medical research (cut by 40%)
- Elimination of the Agency for Healthcare Research and Quality
- 93% staffing cut at the National Institute for Occupational Safety and Health—effectively ending workplace health monitoring

And because the bill does not waive PAYGO rules, even deeper automatic cuts may follow.

Conclusion

The House-passed budget does not make America healthy again. It makes us sicker, hungrier, and more vulnerable to crisis—from pandemics to pollution to rising drug costs. It dismantles the systems that keep us safe and shifts the burden onto those least able to bear it.

If passed by the Senate and signed by the President, this bill won’t just change how our government spends money—it will reshape how we live, how we care for each other, and what kind of country we become.