Last week, the U.S. House of Representatives passed a reconciliation package with significant changes for Medicaid and the Affordable Care Act (ACA) Marketplace as part of what President Donald Trump’s calls a “big beautiful” spending vision for his second term in office.
The Congressional Budget Office (CBO) estimates that the part of the legislation that passed the Energy and Commerce Committee would leave 8.6 million Americans uninsured through changes to the ACA and Medicaid programs. According to KFF, this represents a 3% increase in the number of uninsured Arizonans. The CBO estimate excludes other provisions in the reconciliation bill that could affect insurance premiums, as well as the expected expiration of enhanced ACA subsidies, which federal analysts project will leave 13.7 million more Americans uninsured in the next decade.
The CBO also reported the $2.3 trillion increase of national debt implied by the bill would trigger as much as $500 billion in Medicare cuts beginning as early as next year. According to Healthcare Innovation, the CBO made the announcement in response to a request from the Ranking Member of the House Budget Committee, Rep. Brendan Boyle (D-Pa.).
The Democrats on the Joint Economic Committee also published the CBO’s analysis of projected number of people who would lose health insurance by Congressional District. In Arizona, the CBO estimated about 600,000 people would lose insurance by 20234, with nearly 110,000 losing Marketplace coverage and about 191,000 losing AHCCCS coverage in the next decade. The Congressional Districts that stand to lose the most coverage are Representative Yassamin Ansari’s district, AZ03, and AZ07, which was formerly represented by Congressman Raúl Grijalva, who passed away earlier this year.
Another aspect of the budget bill includes a requirement of 80 hours of verified community engagement per month for able-bodied adult Medicaid recipients. Newsweek notes experts have warned that the requirements will remove members from the Medicaid rolls through the additional confusion of paperwork navigation. From Julie Marie Donohue, professor of School of Public Health at the University of Pittsburgh:
Evidence from states that have imposed work requirements shows that people have difficulty navigating reporting systems, especially when there are monthly requirements. Medicaid work requirements can be complex for individuals to understand and for states to implement.
Senator Mark Kelly (D-Ariz.) explained that more than 300,000 Arizonans are expected to lose health insurance coverage. He pointed out to Public News Service that those with major health complications and disabilities would be the most impacted by the additional paperwork required to prove they don’t qualify for the work requirement.
I’ve met folks in this situation as I’ve done these Medicaid town halls, and according to this bill you won’t be able to get insurance to see the doctor if you do not have a steady job.
The House bill will also cut $267 billion from the Supplemental Nutrition Assistance Program (SNAP), which is used for food assistance by 42 million Americans and 884,000 Arizonans. AZCentral notes that SNAP will also include work requirements.
Yuma County Recorder David Lara told KYMA that the cuts are merely refocusing wasteful spending away from fraud and abuse, and instead spending less money through more effective avenues.
You’re only making it more efficient. You’re taking that money to where the people actually need it.
With Medicaid as the single largest payor for nursing homes, Arizona’s long-term care industry is likely bracing for impact. Katie Smith Sloan, president and CEO of LeadingAge spoke with Skilled Nursing News about potential “ugly” consequences for the industry and America’s seniors:
If enacted, the policies in the House-passed bill will have a devastating impact on millions of older adults and their families who rely on Medicaid and Medicare for healthcare and long-term care and services, and on our nonprofit provider members who serve them.
At this point, it is still difficult to quantify the total impact the bill would have on the healthcare industry should it be signed into law in its current form. Advisory Board counts 22 different healthcare-related provisions including the ban or increase of state provider taxes or state-directed payments to pay beyond Medicaid rates, an increase in eligibility redeterminations to every six months, mandatory cost sharing for enrollees covered under Medicaid expansion, shortening the enrollment period for the ACA exchange and banning gender-affirming care as an Essential Health Benefit under the ACA, Medicaid and CHIP.
STAT notes that the bill is potentially the largest cut to federal healthcare programs in history, but the Senate could still implement changes before sending it back to the House. Notably, the bill also contains the national debt ceiling, which is likely to be hit by August, so lawmakers are anticipated to pass something prior to the summer season.
Members of The Hertel Report can learn more about the Arizona impact of the Big Beautiful Bill in the May 2025 Newsletter
Contact the Arizona Congressional Delegation
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