US healthcare providers are bracing for 1 January 2027, the date Republicans scheduled for the most controversial elements of their healthcare reform law to take effect, with midterm elections approaching.
The changes flow from HR 1, the "One Big Beautiful Bill Act", signed by Donald Trump on 4 July 2025. The law cuts roughly $1tn in federal spending from the healthcare industry, described as the biggest clawback of federal health spending ever. Paired with Republicans' refusal to extend subsidies for plans sold on the Obamacare marketplaces, the cuts are expected to result in about 17 million newly uninsured individuals through 2034, according to the Kaiser Family Foundation.
The scale of the cut is significant in context: Medicaid, the public insurance program for low-income Americans, spent $937bn in 2024. Medicare and Medicaid together accounted for nearly 40% of US health spending that year, according to the Centers for Medicare and Medicaid Services.
Advocates, researchers, hospital leaders and doctors expect more medical debt, more delayed care and more people losing coverage for which they technically qualify.
"The costs to the family, and society as a whole, cannot be overstated," said Dr Andrew Racine, president of the American Academy of Pediatrics.
Dr Luke Messac, an emergency physician at Mass General Brigham who has written about medical debt, said the link was direct. "We saw that when Medicaid eligibility was expanded the flow of medical debt rapidly declined and sustained that decline. The easiest way to reverse that trend, to make medical debt more of a problem, is to yank people off Medicaid and leave them uninsured and unprotected."
The work requirements trace back to the Affordable Care Act of 2010, which required states to expand Medicaid to cover people earning up to 138% of the federal poverty level, about $16,000 a year for a single person today. Republicans resisted that expansion for the better part of a decade.