Medicaid Cuts Expected to Reduce Coverage, Strain Hospitals Nationwide

President Donald Trump's "Big Beautiful Bill" represents the largest rollback of federal support for Medicaid and the Affordable Care Act (ACA) in U.S. history, with Congressional Budget Office estimates projecting over $1 trillion in federal spending cuts and nearly 12 million more uninsured Americans by 2034. The bill cuts approximately $930 billion from Medicaid over the next decade, imposing new work requirements of 80 hours per month and semiannual eligibility verifications for non-disabled, childless adults aged 19 to 64. It lowers caps on Medicaid provider taxes and limits state-directed payments, threatening hospital revenues, especially in rural and low-income areas, which may lead to closures of nearly 400 independent rural hospitals. States like North Carolina, with innovative and bipartisan health policies, express strong concern about coverage losses and the destabilization of Medicaid expansion and pilot programs. While Republicans argue these cuts reduce fraud and preserve Medicaid's integrity, Democrats and state leaders warn of a looming crisis in health coverage access and increased costs. Concurrently, federal agencies like CMS are responding with proposed regulatory changes to Medicaid provider tax waivers to address perceived loopholes, and ongoing advocacy and strategic planning efforts aim to influence final implementation.