President Donald Trump recently signed a significant reconciliation package into law, known as the One Big Beautiful Bill Act, marking what some consider the first successful rollback of major health care programs in the United States.
This legislative move, celebrated on July 4th, introduces sweeping changes, including the cessation of taxes on tips and the extension of tax cuts initiated in 2017.
However, it also entails a reduction in federal Medicaid spending by approximately $1 trillion over the next decade, stirring concerns among healthcare providers and experts across the nation, particularly in Nevada.
According to Larry Levitt, executive vice president for health policy at KFF, this legislation represents the most significant alteration to the U.S. healthcare system since the Affordable Care Act was enacted 15 years ago.
While the immediate repercussions may not be evident, experts indicate that the effects of these changes will gradually unfold over time.
Levitt commented that there is no immediate wake-up call leading to millions losing their coverage, emphasizing that alterations to Medicaid and the Affordable Care Act will manifest incrementally over the next ten years.
In Nevada, Democratic lawmakers predict that over 110,000 residents risk losing their health coverage due to this new legislation.
Nationally, the Congressional Budget Office estimated that approximately 11.8 million individuals could find themselves uninsured by 2034.
The White House has defended the bill, asserting it “protects and strengthens” Medicaid while focusing on eliminating waste, fraud, and abuse.
In contrast, healthcare professionals warn that the new requirements associated with maintaining Medicaid coverage could indirectly lead to increased loss of coverage among eligible populations.
Among the most notable changes is the requirement for Medicaid coverage renewals to occur every six months, instead of annually, coupled with the implementation of a new work requirement.
Starting January 1, 2027, most adults under 65 who joined Medicaid via the Affordable Care Act will be mandated to show proof of “community engagement” through activities such as working, volunteering, or participating in educational programs for at least 80 hours each month.
Exemptions are made for individuals with disabilities, pregnant women, and parents with children under 13.
Concern arises regarding the administrative burdens this creates for vulnerable populations. Sharon Chamberlain, CEO of Northern Nevada HOPES, expressed worries that those eligible may lose coverage due to difficulties in proving compliance with the new requirements.
Chamberlain highlighted that many affected individuals are integral to the community, working in the service sector but may struggle to navigate these new rules to maintain their health care access.
The legislation also presents challenges for some immigrants, particularly refugees and asylum seekers, who will face eligibility cancellations for Medicaid starting October 1, 2026.
Other immigrant groups, such as those with temporary protected status, may become ineligible for Medicare roughly 18 months after the bill’s enactment.
Republican leaders in Congress advocate for these changes as necessary reforms. In a June 3 press release, House Speaker Mike Johnson referenced an analysis from the American Enterprise Institute, demonstrating that non-disabled, childless Medicaid recipients often do not engage in work and are said to spend their time on leisure activities.
This perspective frames the changes as a way to ensure that Medicaid serves those who genuinely need it, such as single parents with young children, rather than other demographics.
While there’s concern about the loss of coverage for a significant portion of Nevadans, local hospitals are adjusting to the anticipated financial impacts as well.
Patrick Kelly, president and CEO of the Nevada Hospital Association, mentioned that Medicaid patients comprise 31 percent of inpatient care statewide, and the expected revenue cuts could compel hospitals to reduce staff and services.
Consequently, hospital operators are reviewing financial structures and preparing for potential changes, although definitive actions have not yet been implemented.
The new law’s adjustments to state-directed payments and the provider tax program—important mechanisms for addressing the underpayment issues hospitals face with Medicaid care—are also causing unease.
With limits imposed on state-directed payments in Nevada that cap reimbursements to 100 percent of Medicare rates, hospitals anticipate reduced funding for Medicaid care.
This alteration will undoubtedly impact Nevada’s healthcare landscape, especially for public facilities like Southern Nevada’s University Medical Center.
Additionally, changes to the provider tax program, which currently allows the taxation of hospitals to redistribute funds, will see a gradual decrease from a maximum of 6 percent of net patient revenues down to 3.5 percent by 2032.
Such cuts are expected to save the federal government over $600 billion within the next decade, a shift noted by Blayne Osborn, president of Nevada Rural Hospital Partners, who warned of the dire consequences for rural hospitals.
Osborn suggested the Rural Health Transformation Program, allocated $50 billion over five years to enhance healthcare for rural populations, is a temporary fix rather than a comprehensive solution.
While some improvements for rural residents may arise from this program, Osborn worries it won’t fully mitigate the cuts rural hospitals are facing.
Despite the uncertainty, local healthcare leaders stress that there is no reason for immediate alarm among Nevada residents.
Most provisions of the legislation will not take effect right away, leading to the belief that healthcare services will remain stable in the near term.
Both hospital representatives and public health officials maintain that there is still time for advocacy and potential amendments to the law.
Senator Josh Hawley, R-Mo., has proposed separate legislation aiming to repeal certain provisions of the new Medicaid regulations while also seeking to enhance funding for the Rural Health Transformation Program.
Nevada Medicaid Administrator Stacie Weeks is currently reviewing the legislation to understand its impacts comprehensively, ensuring that any alterations to existing eligibility and coverage are communicated effectively.
In a recent email addressed to Medicaid members, Weeks assured that there would be no immediate changes for the next nine to twelve months regarding eligibility or benefits due to the new law.
In response to inquiries about the implications of the bill, a spokesperson for Governor Joe Lombardo indicated the administration is still exploring the legislation’s impacts.
The focus remains on potential benefits stemming from tax cuts, investments in small businesses, and efforts surrounding border security.
Concerns regarding the healthcare impacts of the legislation have not gone unnoticed, with members from the Nevada Health Authority planning a public workshop on July 28, aimed at detailing the implications of the new law.
Despite the looming changes, healthcare experts express optimism for Nevada’s Public Option, set to launch on January 1, 2026.
The public option is designed to provide Nevadans with an opportunity to purchase health insurance plans through the Silver State Health Insurance Exchange or directly from participating carriers, potentially filling gaps created by Medicaid losses.
Concluding remarks from health providers hint at a preparedness to adapt to the evolving landscape, stressing that patients should not fear immediate disruptions to care.
Osborn reinforced the resilience of hospitals, affirming their commitment to maintaining services within their communities.
Despite the challenges ahead, health officials emphasize a careful and systematic approach to navigating these changes, steering clear of panic while laying the groundwork for future adaptations.
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