One Big Beautiful Bill: $1 Trillion in Medicaid Cuts and $295 Billion in SNAP Cuts

What Happened

The "One Big Beautiful Bill Act," passed by the House in 2025, contains the largest cuts to the American social safety net in modern history. The bill slashes an estimated $863 billion from Medicaid and $295 billion from SNAP (the Supplemental Nutrition Assistance Program) over fiscal years 2025 to 2034 — a combined reduction exceeding $1.15 trillion in healthcare and food assistance.

These cuts directly fund approximately $1 trillion in tax reductions overwhelmingly benefiting the wealthiest Americans, while simultaneously increasing the federal deficit by an estimated $3 trillion including higher interest costs.

Who Loses Health Coverage

The Congressional Budget Office projects that the bill will cause 10.9 million Americans to become uninsured, either through direct Medicaid cuts or through the erosion of Affordable Care Act marketplace coverage. The Urban Institute found that 3 in 10 young adults are particularly vulnerable to losing healthcare access.

The Medicaid provisions include mandatory work reporting requirements for adults ages 19 to 64 covered through Medicaid expansion, with a compliance deadline of December 2026. Historical evidence from state-level work requirements shows that these provisions primarily cause coverage losses through administrative complexity rather than actually increasing employment.

Who Loses Food Assistance

SNAP faces a proportionally deeper cut than Medicaid — 36% by 2034 compared to Medicaid's 15%. The bill raises the age limit for SNAP work requirements from 54 to 64. The CBO estimates that approximately 800,000 older adults will be cut off from food assistance in a typical month due to this change alone.

These are adults ages 55 to 64 who currently rely on SNAP to meet basic nutritional needs — many of whom face health conditions, limited employment options, or caregiving responsibilities that prevent them from meeting rigid work requirements.

The $1 Trillion Swap

The Center for American Progress documented what it called the bill's "budget math": approximately $1 trillion cut from healthcare and food assistance for low-income Americans, redirected to approximately $1 trillion in tax cuts concentrated among the richest 1% of earners. The Commonwealth Fund analyzed how these cutbacks would trigger significant job losses across every state, with healthcare and food service sectors hit hardest.

Legal Analysis

The right to adequate food and the right to health are enshrined in the International Covenant on Economic, Social and Cultural Rights (Articles 11 and 12), the Universal Declaration of Human Rights (Article 25), and the Convention on the Rights of the Child (Article 24). While the United States has not ratified the ICESCR, it is a signatory and these rights are recognized under customary international law.

The Convention on the Elimination of All Forms of Racial Discrimination (Article 5(e)), which the US has ratified, specifically protects the right to public health, medical care, and social services without discrimination. Given the disproportionate impact of these cuts on communities of color, the racial equity implications are direct.

Why This Matters

Stripping healthcare from 10.9 million people and food assistance from hundreds of thousands of older adults — to fund tax cuts for the wealthiest — represents a deliberate policy choice that will result in preventable suffering and death. The scale is not hypothetical: the CBO's projections represent real people who will lose access to medical care and food assistance, with predictable consequences for mortality and well-being.

Update: First Observed Losses From Work Requirements and SNAP Changes (July–September 2026)

The law's effects have begun to appear in administrative data rather than projections.

Medicaid work requirements in Nebraska. Nebraska began enforcing the law's Medicaid work reporting requirement on May 1, 2026 for new applicants and July 1 for existing enrollees at renewal — ahead of the national January 1, 2027 start date. Data the state presented to its Medicaid Advisory Committee and released in late September show that at least 1,090 people lost or were denied coverage under the requirement between May and August. KFF's analysis of the data found that 14% of 4,089 applications subject to the requirement were denied and 7% of 7,280 renewals lost coverage. The losses were overwhelmingly procedural: 92% of those who lost coverage at renewal, and 84% of denied applicants, were cut for failing to respond to requests for information, not for failing to meet the work standard. Georgetown's Center for Children and Families noted that when the state verified income itself from available data, 97% of those found to be meeting the requirement met the $580-a-month income threshold. KFF cautioned that additional documentation requirements beginning in 2028 could raise disenrollment further.

SNAP. Roughly 5 million people — including more than a million children — lost SNAP access in the year after the law took effect, a decline the Center on Budget and Policy Priorities says was "far deeper and far faster" than the Congressional Budget Office predicted. That observed loss is documented in a separate entry.