By skyforbes 
New federal law cuts Medicaid and tightens healthcare access, sparking backlash from disability advocates nationwide.
In early July 2025, the U.S. enacted a major budget reconciliation law known as the One Big Beautiful Bill Act of 2025 (OBBBA). Passed by razor-thin margins in Congress and signed into law on July 4, 2025, this sweeping legislation implements many of the administration’s top priorities [1]. Critically, the OBBBA carries significant implications for healthcare access, especially for Americans with disabilities. The law includes nearly $1 trillion in cuts to Medicaid, the nation’s public health insurance program for low-income and disabled individuals, which could put coverage for an estimated 17 million Americans at risk [1]. Given that people with disabilities disproportionately rely on programs like Medicaid for essential medical care and support services, disability advocates warn that this development may have far-reaching, negative consequences on healthcare equity and outcomes [2].
The new law imposes stricter Medicaid eligibility requirements and administrative hurdles. It mandates work requirements for certain enrollees and other conditions that individuals must meet to obtain or maintain Medicaid coverage [1]. States are also restricted in how they can finance their Medicaid programs (for example, limits on provider taxes), and overall federal Medicaid funding will be curtailed. The Congressional Budget Office projected that these Medicaid provisions alone would cause millions to lose coverage in the coming years [1]. Because Medicaid is a lifeline for many disabled Americans, providing everything from general medical care to long-term services and supports, such changes pose a direct threat to disability healthcare access. Advocates fear that some people with disabilities — especially those not already formally classified as “disabled” by program rules — could be “weeded out by strict, difficult-to-keep-up-with administrative requirements” and lose needed coverage [2].
Beyond Medicaid, the OBBBA also tightens rules for the Affordable Care Act insurance marketplaces. It adds new income verification steps for people receiving ACA premium subsidies and effectively ends automatic re-enrollment in marketplace health plans [1]. These changes mean that individuals (including people with disabilities who do not qualify for Medicaid and rely on ACA plans) could more easily slip through the cracks and become uninsured if they cannot navigate the extra red tape each year. The Kaiser Family Foundation and others estimate that, combined with separate expiring ACA subsidies, the law’s changes may contribute to roughly 16–17 million people losing health coverage by the end of the decade [1].
While the law’s proponents insist it “does not cut Medicare”, it does impact Medicare indirectly. Notably, the OBBBA delays implementation of certain new Medicare rules intended to help very low-income seniors and people with disabilities afford out-of-pocket costs [5]. Analysts point out that blocking these improvements will disproportionately affect people with disabilities, since disabled Medicare beneficiaries are more likely to have low incomes and thus stood to benefit from the enhanced assistance [5]. Outside of healthcare, the legislation also introduces work requirements for nutrition assistance (SNAP) and other safety net programs, which disability advocates note could harm disabled individuals and families who rely on those benefits to stay healthy [2]. In sum, the broad scope of the law means its impact will be felt across multiple programs vital to the disability community [5].
People with disabilities are at particular risk under these policy changes. Medicaid is a cornerstone of health and independence for over 11 million Americans with disabilities, covering medical services, prescriptions, personal care attendants, and more [2]. By adding work mandates and paperwork barriers, the law may cut off coverage for those unable to meet new requirements or who fall behind in documentation — despite many such individuals having serious health conditions [3]. The White House has stated that “those with disabilities receiving Medicaid will receive no loss or change in coverage,” emphasizing that work requirements apply only to “able-bodied” adults [4]. However, disability rights organizations are deeply skeptical. They point out that many people with disabling chronic illnesses or undiagnosed conditions could be wrongly deemed “able-bodied” or could struggle with the administrative burden, leading to loss of services [2]. Even disabled individuals exempt from work rules could be affected if overall funding reductions force states to scale back optional Medicaid benefits (like home-based care) or tighten eligibility criteria [2].
Geography will likely further exacerbate the impact. Rural communities, which have higher rates of disability, stand to lose healthcare infrastructure under the Medicaid cuts. Medicaid is a significant payer for rural hospitals; with the OBBBA reducing Medicaid funds, analysts warn that hundreds of rural hospitals are at risk of closure [3]. At least 300 rural hospitals face immediate risk of shutting down, and up to one-third of all rural hospitals nationwide could be in financial jeopardy in the coming years due to this law [3]. This is alarming for disability advocates because roughly 14 million Medicaid enrollees live in rural areas — including over 3 million people with disabilities [3]. If local hospitals close or cut services, rural residents with disabilities might have to travel dangerously long distances to get care, or they might forgo care altogether. In urban and suburban areas too, a surge of uninsured patients and reduced Medicaid revenue could strain remaining providers, potentially leading to longer wait times and fewer accessible services for people with disabilities [3].
Early analyses predict significant coverage losses and worse health outcomes. The non-partisan Congressional Budget Office estimates that by 2034 the law’s health provisions will result in about 11.8 million fewer Americans with health insurance, even before accounting for ancillary policy changes [1]. Other projections that include the law’s ripple effects put the potential coverage losses closer to 16–17 million people [1]. The American Medical Association cautioned that “care will be less accessible” and patients may forego needed treatment because “the lifelines of Medicaid and CHIP are severed” [1]. The American Association of People with Disabilities (AAPD) warned that this policy shift could cause 51,000 preventable deaths per year due to loss of care [2]. In the words of AAPD President Maria Town, “This is a devastating day for disabled Americans… The catastrophic effects of this bill will reverberate for generations” [2].
The passage of the OBBBA in July 2025 set off a strong response across the healthcare and disability advocacy landscape. Disability rights groups, healthcare organizations, and many non-partisan analysts have sounded alarms about the law’s impact [2][3]. In addition to AAPD’s forceful rebuke, organizations like Community Catalyst and Families USA have issued statements denouncing the Medicaid cuts, predicting higher uncompensated care costs, medical debt, and a “worsened health outcomes” cascade for vulnerable populations [7][8]. The consensus among patient advocacy groups is that the law’s approach represents a major step backward for an inclusive healthcare system [6]. Many note the painful timing: July 2025 marks both the 35th anniversary of the Americans with Disabilities Act (ADA) and the 60th anniversary of Medicaid, yet policies are being enacted that, in advocates’ view, undermine the very progress those milestones represent [2].
On the other hand, federal officials and supporters of the law defend it as a necessary reform. The administration argues that the OBBBA will “protect and strengthen Medicaid” for those who truly need it by rooting out abuse and tightening eligibility to focus resources on “pregnant women, children, seniors, people with disabilities, and low-income families” [4]. They contend that able-bodied adults who can work should do so, and that the law’s work requirements include reasonable exemptions (such as for individuals with disabilities) [4]. Furthermore, proponents highlight other aspects of the massive bill, such as tax cuts and economic provisions, suggesting these will improve quality of life and income stability for many families (including some with disabled members) [4]. This stark divergence in narratives — one side emphasizing cost savings and program integrity, the other warning of human costs and reduced access — sets the stage for continued debate and scrutiny as the law is implemented [5].
Looking ahead, most of the healthcare changes in the OBBBA will phase in gradually, with major Medicaid provisions not taking effect until late 2026 and beyond [5]. This delayed rollout means there is time for further federal or state action. Disability advocates and healthcare coalitions are mobilizing to monitor the implementation and to fight for mitigating measures [6]. Some are exploring legal challenges or state-level strategies to buffer the impact on vulnerable populations [6]. Meanwhile, policy experts note that if political leadership changes in the future, portions of the law could be revisited or reversed before the most dramatic cuts take hold [6]. In the interim, stakeholders are striving to educate people with disabilities about the coming changes and to ensure they maintain coverage. The National Disability Navigator Resource Collaborative, for example, is providing updates and tools to help individuals understand new requirements and find assistance [6].
By restructuring Medicaid and related programs, the OBBBA has sparked a national conversation about the balance between cost control and the commitment to healthcare access for society’s most vulnerable. If projections hold, millions could lose health coverage, and the disability community fears bearing a disproportionate share of that burden [5]. As the country marks the ADA’s 35th anniversary, this development is a sober reminder that disability rights in healthcare remain an active, evolving battleground [2]. Policymakers, providers, and advocates alike will be closely watching how these reforms unfold, striving to ensure that the promise of accessible, equitable healthcare — enshrined in laws like the ADA and Medicaid over past decades — does not backslide in the years to come.
Katelynn Humbles is a Staff Writer at Cabin Fever. She discusses public health through the lens of accessibility and disability.
References
1. [1] American Medical Association — “Budget reconciliation bill worsens access to care, includes significant health care funding cuts.” AMA Advocacy Update, July 11, 2025.
2. [2] American Association of People with Disabilities (AAPD) — “Devastating Day for Disabled Americans” (Press Release on Budget Reconciliation Bill Passage). July 3, 2025.
3. [3] AAPD — Press Release (continued). Details on rural hospital risks and disability impact.
4. [4] The White House — “Myth vs. Fact: The One Big Beautiful Bill.” June 29, 2025. (Administration claims on protecting Medicaid for people with disabilities)
5. [5] Center for American Progress — “The Truth About the OBBBA’s Cuts to Medicaid and Medicare.” July 3, 2025. (Analysis by disability policy experts)
6. [6] National Disability Navigator Resource Collab. — “July 11, 2025 Newsletter: More Work To Be Done…” (NDNRC update on Medicaid cuts in H.R.1 and advocacy responses)
7. [7] Community Catalyst — “New Law Slashes Health Coverage” (Press statement, July 2025)
8. [8] Families USA — “Statement on Budget Bill Vote” (Press statement by Anthony Wright, July 2025)