By skyforbes 
Sweeping Budget Act Slashes Safety Net Programs
InJuly 2025, President Donald Trump signed a sweeping budget reconciliation law that delivers an estimated $4.5 trillion in tax cuts while slashing over $1 trillion from federal health care and nutrition programs over the next decade [1]. Officially titled the 2025 Budget Reconciliation Act — though nicknamed by supporters as the “One Big Beautiful Bill Act” — the legislation represents the largest rollback of America’s social safety net in modern history. Central to this rollback is a dramatic restructuring of Medicaid, the joint federal-state insurance program that currently serves over 70 million low-income and disabled Americans. The law also enacts deep cuts and stricter eligibility rules for Medicare, Affordable Care Act (ACA) subsidies, and the Supplemental Nutrition Assistance Program (SNAP), aligning with long-standing conservative goals to reduce the federal role in public welfare [1].
Passed by razor-thin margins — 51–50 in the Senate with Vice President J.D. Vance casting the tie-breaking vote, and 218–214 in the House — the bill was signed into law on July 4, 2025, in a ceremony billed by the administration as a “birthday gift to American taxpayers.” But for millions of vulnerable citizens, especially those with disabilities or chronic health conditions, advocates argue that the gift comes at a devastating cost [1].
Republican leaders framed the legislation as a return to “fiscal responsibility,” with House Speaker Mike Johnson proclaiming, “We’re making the first changes to the welfare state in generations” — a statement that underscores the historical weight of the measure [1]. Supporters of the law argue that massive tax relief and trimmed entitlement spending will reduce inflation, cut national deficits, and encourage personal responsibility. Yet across the healthcare and disability sectors, alarm bells are ringing. Public health experts, hospital administrators, and civil rights groups warn that the bill could destabilize healthcare access, deepen poverty, and reverse decades of gains in disability rights and social equity.
A central — and highly controversial — component of the new law is the implementation of a federal work requirement, branded a “community engagement” mandate, for many Medicaid recipients. Beginning in 2027, most adults aged 19 to 64 who receive Medicaid will be required to work, volunteer, or attend school at least 80 hours per month to maintain their health coverage [2]. These individuals must also submit proof of their hours every month, with failure to do so resulting in automatic suspension or termination of benefits. While the law provides exemptions for certain groups — such as people with disabilities, caregivers of disabled relatives, and parents of children under six — the exemption process itself is heavily bureaucratic, and many worry it will not be applied consistently or compassionately across states [2].
Experts caution that these changes are not merely symbolic but could lead to a massive purge of eligible individuals from Medicaid rolls, not because they don’t meet the criteria, but because of reporting burdens, misinformation, and technical barriers [2]. Gerard Anderson, a health policy professor at Johns Hopkins, explained: “These requirements could result in people losing coverage even if they technically qualify. Many recipients live in areas with few jobs, unreliable internet access, or lack the transportation needed to meet the hourly mandate. Others may simply struggle to complete the complex monthly reporting paperwork.” [2]
This administrative complexity, coupled with rigid compliance deadlines, has raised fears that millions of people — including disabled individuals caught in procedural confusion — will lose access to critical care. As past Medicaid experiments in states like Arkansas and Kentucky have shown, even brief lapses in documentation can lead to abrupt terminations, with devastating consequences for people managing chronic illness, addiction recovery, or unstable housing [2].
Analysts project that millions will lose health insurance as a direct result of the 2025 budget overhaul. The nonpartisan Congressional Budget Office (CBO) estimates that approximately 10 million additional people will become uninsured over the next decade due to the combined effects of Medicaid restrictions, reduced ACA subsidies, and newly imposed compliance requirements [2]. The Center on Budget and Policy Priorities (CBPP) warns that the long-term fallout could be even more severe — projecting up to 15 million Americans losing health coverage by 2034, with millions more likely to be underinsured or unable to access timely care [2]. While the most significant driver is Medicaid retrenchment, the ripple effects will extend to food security and public health, as people simultaneously lose SNAP benefits, preventive services, and continuity of care.
As CBPP President Sharon Parrott emphasized, “The cuts are really big, they are really broad, and they are deeply damaging… The consequences are millions of people losing health care coverage [and] food assistance… [resulting in] higher poverty, more hardship” [2]. These cascading effects threaten to reverse decades of progress toward inclusive health access and economic stability, particularly for the nation’s most vulnerable groups.
For people with disabilities, the loss of Medicaid cannot be overstated. Medicaid doesn’t just pay for doctor’s visits or prescriptions — it funds the personal care attendants, speech and physical therapies, durable medical equipment, and community-based support systems that allow millions of disabled people to live independently and participate in work, education, and family life. Disability rights organizations were among the most vocal opponents of the 2025 bill, labeling the cuts “devastating” and “inhumane” [3].
The American Association of People with Disabilities (AAPD) reported that the bill threatens the health coverage of up to 17 million Americans, the majority of whom are seniors or people with disabilities [3]. AAPD President Maria Town issued a stark warning: “I am crushed for every single disabled person who will no longer be able to work because they will lose coverage for the personal care attendant who ensures they can get ready for the office” [3]. In a country that already ranks low among wealthy nations for disability access and inclusion, advocates fear these cuts may entrench poverty, segregation, and dependence, pushing people out of the workforce and into institutional care.
These are not just theoretical consequences. The structural integrity of the broader healthcare system is also at risk. Medicaid is the financial backbone for many rural hospitals, federally qualified health centers, and nursing facilities. According to one policy analysis, at least 300 rural hospitals are at immediate risk of closure as a direct consequence of the Medicaid cuts, with hundreds more facing staff layoffs and service reductions [3]. For people in rural and medically underserved regions, this could mean losing the only nearby emergency room, birthing center, or dialysis clinic — forcing long travel or abandonment of care altogether.
Public health researchers also expect that the rollback will lead to worsening health outcomes across the board. Preventive screenings will be missed. Chronic conditions will go untreated. Emergency care will be sought too late. One alarming projection estimates over 50,000 additional preventable deaths per year, as uninsured Americans forgo or delay care due to cost or logistical barriers [2]. For people with disabilities, these interruptions in care may result in permanent loss of function, institutionalization, or premature death. As many experts note, when lifesaving services are defunded, people die.
The law’s passage has galvanized backlash from disability and healthcare advocacy organizations across the country. “This is a devastating day for disabled Americans,” Maria Town stated bluntly after the bill was signed [3]. Protests, petitions, and social media campaigns surged in the weeks leading up to and following the legislation. Over 20,000 public comments were submitted in response to a related federal rule change — an outpouring of concern that, while unable to halt the law, reflects the depth of opposition to its measures [3].
Advocacy groups are now turning their efforts toward damage control and mobilization. Legal scholars anticipate court challenges — especially in states with strong disability rights laws that may conflict with federal mandates. Others are focusing on state-level implementation, urging governors and Medicaid administrators to apply the law as flexibly as possible. For instance, how “disability” and “exemption” are defined at the state level will determine whether people with chronic conditions or mental health disabilities can retain coverage without burdensome paperwork or re-certification cycles [3].
Importantly, the 2025 budget law will not be implemented all at once. The Medicaid work requirements are scheduled to take effect in 2027, and many of the associated funding cuts will be phased in over a 10-year horizon [2]. This slow rollout gives stakeholders a critical window to prepare, challenge, or adapt to the changes. Organizations like AAPD are working to ensure that disabled individuals and their families have access to navigators, employment supports, and emergency assistance as the public safety net shrinks [3].
Despite the gravity of the moment, advocates remain committed to long-term systemic change. “Disabled people will keep fighting and working to build systems that allow us to lead full, dignified lives,” Town affirmed in a statement of resilience [3]. That fight may now depend not only on activism and policy innovation, but on solidarity across movements — from disability rights to labor justice to rural healthcare access.
In summary, the July 2025 budget law represents a watershed moment in U.S. healthcare and disability policy. By placing severe limitations on Medicaid and related programs, the law threatens to dismantle crucial infrastructure that enables millions to live, work, and thrive. As implementation begins, the stakes are not merely political — they are existential.
Katelynn Humbles is a Staff Writer at Cabin Fever Magazine. She discusses public health through the lens of accessibility and disability.
References
1. [1] Julia Nikhinson, Associated Press: “Trump’s big bill chisels back Medicaid 60 years after its creation.” AP News, July 2025.
2. [2] Aliza Rosen, Johns Hopkins Bloomberg School of Public Health: “How New Federal Legislation Will Affect Health Care Costs and Access for Americans.” Published July 30, 2025.
3. [3] AAPD (American Association of People with Disabilities): “This Is A Devastating Day for Disabled Americans” — AAPD Responds to Budget Reconciliation Bill Passage. Press release, July 3, 2025.
4. [4] Robert Freedman, Facilities Dive: “DOE to drop accessibility requirement for buildings receiving federal funds.” Published July 17, 2025.