“Big Beautiful Bill” Turns One: Hospitals Are Closing and 4 Million Americans Lost Food Stamps

One year after President Trump signed the One Big Beautiful Bill Act into law on July 4, 2025, analyses published on its first anniversary document measurable early consequences from the law’s sweeping changes to Medicaid and the Supplemental Nutrition Assistance Program. SNAP participation fell by more than 4 million people — a 10% drop — between the law’s enactment and March 2026, according to Center on Budget and Policy Priorities analysis, with Arizona recording a 53% drop in participation, Florida a 17% drop, and Louisiana and Oklahoma both at 16% [1, 2]. In the health insurance marketplace, disenrollments ran 24% higher in the first quarter of 2026 compared to the same period in 2025, and average monthly net premium costs for marketplace enrollees jumped 58% — from $113 per month to $178 per month [2].

Real-world health system impacts are emerging: MercyOne Des Moines Medical Center announced layoffs directly citing federal Medicaid cuts, and the hospital system closed its clinic in Traer, Iowa in December 2025 and its Ottumwa, Iowa clinic in February 2026 [3]. The Congressional Budget Office had projected at the time of passage that the OBBBA would add $3.4 trillion to federal deficits over a decade and leave 10 million more Americans uninsured by 2034 [1, 4]. A RAND analysis projects the Medicaid provisions specifically could cause 7.6 million coverage losses nationally by 2034 [2].

Why It Sucks:

Conservatives and Fiscal Hawks

• The bill’s primary goal — stopping a massive 2025 tax hike — was achieved. Without the OBBBA, the 2017 Tax Cuts and Jobs Act provisions would have expired at year-end, representing the largest automatic tax increase in decades; conservatives argue the entitlement spending offsets are the necessary cost of preventing that outcome [1, 4].
• One year of transition data is too early to evaluate long-run structural effects. Past entitlement reforms — including the 1996 welfare overhaul — produced short-term disruption before delivering the employment gains and dependency reductions that their supporters predicted; fiscal hawks argue the OBBBA should be evaluated on the same timeline [4].
• Work requirements restore the original intent of programs that had expanded far beyond their mandate. SNAP and Medicaid spending had grown dramatically over the previous decade; supporters contend that requiring able-bodied adults to work or seek work in exchange for benefits is not cruelty — it is the basic social contract those programs were designed to enforce [1, 4].

Progressives and Healthcare Advocates

• Hospital closures are hitting the rural communities that voted most heavily for Trump. MercyOne’s clinic shutdowns in Traer and Ottumwa, Iowa — small agricultural communities in a state Trump won decisively — illustrate the gap between promises made during the campaign and the policy delivered through reconciliation [3].
• A 58% jump in insurance premiums is not reform — it is a cost shift onto working families. Adults who lost Medicaid eligibility and moved to the marketplace are now paying $65 more per month per enrollee than they were a year ago, a squeeze that falls hardest on people who were just above the Medicaid eligibility threshold [2].
• Four million fewer Americans on SNAP means four million more people relying on food banks. Food bank networks in Arizona, Florida, and Oklahoma — the states with the largest SNAP drops — have reported sharp increases in demand, with charitable supply chains unable to absorb the scale of sudden federal withdrawal [1, 2].

State Governors and Budget Directors (Bipartisan)

• States are absorbing federal costs Washington offloaded without transition funding. The OBBBA accelerated Medicaid work requirement deadlines, forcing states to stand up new eligibility verification bureaucracies at short notice and significant administrative expense — costs that fall on state budgets regardless of whether governors supported the law [4].
• The six-month redetermination cycle creates a permanent administrative bottleneck. Starting in late 2026, states must conduct Medicaid eligibility redeterminations every six months instead of annually — a requirement that forces continuous hiring of eligibility workers and rebuilds a bureaucratic bottleneck that contributed to the chaos of post-pandemic coverage losses [2, 4].
• Rural hospital systems in red states face closure without state backstop funding. Governors in states that expanded Medicaid under the ACA now face loss of expansion funding under the OBBBA’s phase-out provisions — putting rural and critical access hospitals that operate on thin margins at existential risk unless states appropriate replacement dollars their own budgets may not have [1, 3].

Sources & Citations:

[1] Forbes: One Year After Trump’s ‘Big Beautiful Bill,’ Here’s What Actually Happened
[2] Center for American Progress: On the First Anniversary of the OBBBA, Millions of Americans Have Been Left Behind
[3] Washington Monthly: Budget Cuts, Deaths, and the First Anniversary of Trump’s Disastrous Budget
[4] NTD: Big Budget Decisions for States in 2026 as Medicaid, SNAP, and Taxes Change Under ‘One Big Beautiful Bill’