Despite clear warnings about the threats to health care access, food stability, and economic security, lawmakers ignored these concerns and voted to pass the action. The passage of the budget bill highlights the growing disconnect between lawmakers’ votes and the reality their constituents currently face. Now, a month since the Republican budget bill became law, Americans are experiencing the consequences of when lawmakers don’t prioritize their well-being.
Over the next decade the budget bill is projected to slash Medicaid by nearly $1 trillion, disproportionately affecting pregnant individuals, people with disabilities, seniors, and low-income families. This imposes new work reporting requirements for Medicaid recipients, complicates enrollment in the ACA Marketplace, and threatens food security by shifting the financial responsibility of the Supplemental Nutrition Assistance Program (SNAP) to the states. Rural communities are expected to suffer the most, including more closures of labor and delivery units, further jeopardizing maternal and child health services. It also targets Medicaid funding for family planning programs that provide abortions alongside other reproductive healthcare services, specifically targeting Planned Parenthood. Although this provision is currently being challenged in court, it is yet another step in limiting access to essential health services for low-income, medically underserved, and communities of color who disproportionately rely on Planned Parenthood clinics. Overall, the wide-ranging legislation stands to bring more harm than good.
Texas as a Case Study
When I think about the harmful effects of this legislation, I can’t help but focus on my home state, Texas. It is often viewed as a stronghold of support for the policies implemented by this administration. However, regardless of how popular President Trump may be here, Texas is an incredibly diverse state, home to many residents who do not align with the cruel policies of the current administration, including large communities of immigrants of various legal statuses, who are unable to voice their concerns. All Texans stand to lose.
It is projected that roughly 1.7 million Texans are expected to lose their health insurance due to changes in the ACA Marketplace, which is notable considering that nearly 4 million Texans enrolled in ACA health plans this year. Texas already has the highest uninsured rates in the country, far above the national average. In a state that never expanded Medicaid, the ACA Marketplace has served as a critical lifeline for lower-income individuals and families.
The impact of the ACA is evident: Texas’ uninsured rate dropped 6.3 percent from 2010 to 2023, with ACA enrollment playing a major role. Of those nearly 4 million enrollees in 2024, about 2.5 million earn between 100% and 150% of the federal poverty level, or $15,650 to $23,475 for a single-person household. In other states that have expanded Medicaid, these individuals would likely qualify for that program. However, in Texas, the ACA helped fill this gap.
While much of the focus surrounding the budget bill has been on Medicaid cuts, Texas is somewhat shielded from those changes because it never expanded Medicaid in the first place. Medicaid coverage losses in Texas are still significant as an estimated 300,000 people could lose coverage, but the larger crisis is unfolding within the ACA Marketplace. The expiration of enhanced premium tax credits at the end of 2025 threatens to drive up premiums dramatically. Without these tax credits, many Texans may struggle to maintain their health coverage. While this glance into Texas doesn’t capture the full harm this bill inflicts. However, it depicts how the legislation doesn’t just erode safety nets, but removes vital anchors Texans have relied on for health care access.
Following Trump’s urging, Texas Governor Greg Abbott recently called a special legislative session to alter congressional districts in a non-census year. This concerted action is especially egregious as it could silence the very communities most affected by this legislation and disproportionately harms Black and Brown communities, effectively erasing their voices. Ultimately, the combination of the budget bill’s harmful effects and the deliberate suppression of marginalized voices will have profound and lasting ramifications for Texas.
Public Backlash
The Trump administration and congressional lawmakers have faced growing public criticism, not only for the bill itself, but for a broader pattern of actions, including mass firings of federal workers, drastic defunding of government programs, and a harsh immigration crackdown. Public dissatisfaction has been most visible through major events like the nationwide No Kings protest, which drew an estimated 4 to 6 million people across the country. Similarly, town halls have become key sites where constituents are holding lawmakers accountable and voicing their frustration. Advocates are stepping up demonstrations, such as the 60-hour Medicaid Vigil that was held twice in Washington, D.C., to highlight the critical importance of our health care programs.
As the administration and lawmakers brace for continued public criticism from the budget bill, attempts to deflect have begun. Nevertheless, Congress is now reckoning with how constituents will respond when their health care and economic security are directly threatened by those in office.
The Bottom Line
The projected consequences of this bill are no longer theoretical – they are becoming the lived reality for millions. Americans are paying attention, and they won’t remain silent as their health and economic security are systematically dismantled. We need Congress to pass the Protecting Health Care and Lowering Costs Act, which would reverse all health care cuts in the budget bill and would permanently extend the ACA premium tax credits.
The author would like to thank Stephanie Green, Lorena Bonet Velazquez, Erin Mackay, Sarah Coombs, and Llenda Jackson-Leslie for their contributions.
