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Who Will Be Affected If Medicaid and Medicare Cuts Pass the Senate?

May 23, 2025

Millions of Americans stand to lose coverage, care, and stability

The One Big Beautiful Bill Act, which recently passed the House by a narrow margin, is now headed to the Senate. Its sweeping proposals would reduce federal spending by slashing key social programs—most notably, Medicaid and Medicare. Supporters claim it’s about streamlining the system and cutting costs, but the real-world impact would be devastating for millions of Americans.

Here’s a breakdown of who stands to lose if the Senate approves these cuts—with sources to back it up.

1. Low-Income Adults and Families on Medicaid

Medicaid currently provides healthcare to over 85 million Americans, according to the Centers for Medicare & Medicaid Services (CMS) ¹. The bill proposes:

Work requirements for able-bodied adults, which have historically resulted in large coverage losses even among those who meet the requirements but get caught in bureaucratic red tape.
Per capita caps, limiting how much federal money states receive per enrollee. This would likely force states to cut services, reduce eligibility, or raise costs.

📌 Impact: A Kaiser Family Foundation (KFF) study estimates millions could lose coverage due to these restrictions, particularly in states that expanded Medicaid under the Affordable Care Act ².

2. Children

Roughly 40% of U.S. children are covered by Medicaid or CHIP ³. Changes to funding and eligibility would:

Result in coverage loss for children if their families are disqualified due to paperwork errors or new thresholds.
Threaten preventive services such as vaccinations and wellness visits.

📌 Impact: A Georgetown University Health Policy Institute report showed that when states increased paperwork burdens, child enrollment dropped sharply—even among eligible kids ⁴.

3. People with Disabilities

Medicaid is one of the largest providers of long-term services and supports for people with disabilities.

Home- and community-based services (HCBS) could be cut, reducing options for independent living.
Increased state financial strain could lead to waitlists or institutionalization.

📌 Impact: According to the National Council on Disability, federal funding caps would disproportionately harm those relying on Medicaid for disability-related services ⁵.

4. Seniors on Medicaid and Medicare

While Medicare isn't directly gutted, several provisions would:

Lower federal reimbursements to providers and Medicare Advantage plans, potentially reducing available services.
Affect dual-eligible seniors (those on both Medicaid and Medicare), who rely on Medicaid for nursing home and home health care.

📌 Impact: The Congressional Budget Office (CBO) projects that reductions in Medicaid spending would shift more of the long-term care burden to states, which may not have the resources to cover it ⁶.

5. Rural Communities

Many rural hospitals depend on Medicare and Medicaid reimbursement to stay financially viable.

A decrease in federal funds could force rural hospitals and clinics to shut down, creating care deserts.
Patients would have to travel farther for basic or emergency services, leading to worse outcomes.

📌 Impact: The Chartis Center for Rural Health reports that over 600 rural hospitals are at risk of closure, with Medicaid cuts being a top contributing factor ⁷.

6. Women and Pregnant People

Medicaid finances over 40% of U.S. births ⁸. Proposed cuts and coverage limitations would:

Decrease access to prenatal and postnatal care, leading to higher rates of maternal and infant mortality.
Undermine reproductive and gender-affirming care, especially in states where access is already limited.

📌 Impact: The March of Dimes reports that reduced access to Medicaid correlates directly with worse health outcomes for mothers and babies ⁹.

7. People of Color

Due to systemic inequalities, Black, Latino, and Native American individuals are disproportionately represented among Medicaid recipients.

📌 Impact: According to the Center on Budget and Policy Priorities, cuts to Medicaid would widen racial health disparities, further entrenching inequities in care, outcomes, and financial burden ¹⁰.

Final Thoughts

The One Big Beautiful Bill is more than a budget proposal—it’s a sweeping rollback of social protections that millions of Americans depend on. The people most affected by the cuts aren’t hypothetical—they’re your neighbors, your coworkers, your grandparents, and maybe even you.

As the Senate prepares to vote, now is the time to stay informed, speak out, and hold lawmakers accountable for the real human cost of these policies.

Sources

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Centers for Medicare & Medicaid Services (CMS). “Medicaid & CHIP Enrollment Data.” CMS.gov
Kaiser Family Foundation. “A Medicaid Per Capita Cap on the ACA Expansion Population.” kff.org
Medicaid and CHIP Payment and Access Commission (MACPAC). “Children's Coverage.” macpac.gov
Georgetown University Center for Children and Families. “Medicaid Enrollment Decline.” ccf.georgetown.edu
National Council on Disability. “Medicaid and Disability Services.” ncd.gov
Congressional Budget Office. “Budgetary Effects of the Big Beautiful Bill.” cbo.gov
Chartis Center for Rural Health. “The Rural Hospital Crisis.” chartis.com
Kaiser Family Foundation. “Medicaid’s Role in Maternal Health.” kff.org
March of Dimes. “Nowhere to Go: Maternity Care Deserts Across the U.S.” marchofdimes.org
Center on Budget and Policy Priorities. “How Medicaid Reduces Racial Disparities.” cbpp.org