Tens of thousands of low-income residents in Central Texas could lose access to Medicaid, marketplace health insurance or food benefits if the Senate passes President Trump's "One Big Beautiful Bill Act" as is.
The would advance many elements of Trump’s domestic policy agenda. It includes new restrictions on Medicaid that the bill's supporters say will cut down on waste and fraud.
"What we're doing is shoring up this program so that it will survive in the long term for the core population who needs it," Texas Congressman Brandon Gill, a Republican from Flower Mound who voted for the bill, said in an interview with CBS News.
Critics, however, said many of the changes amount to red tape that keeps coverage from people who desperately need it.
More than 4 million low-income Texans rely on Medicaid for routine doctor’s appointments and other health coverage, according to Texas Health and Human Services. Congressman Lloyd Doggett, an Austin Democrat, estimated 36,000 people in his district alone could lose their benefits if the bill passes as written.
"Even in a city as prosperous as Austin, about half the babies that are born out at Ascension Seton have their birth financed through Medicaid," he said at news briefing last month.
The bill includes several provisions that would impact Texas Medicaid directly, including a rule that would prevent states from adding new taxes on health care providers to defray costs. Medicaid recipients would also have to re-establish their eligibility twice a year instead of once, adding more paperwork to the process.
The health policy research organization predicts Texas would lose around $28 billion in federal Medicaid dollars over the next 10 years if the current bill passes.
Lynn Cowles, a health policy expert at the public policy organization Every Texan, said states will want to look for ways to offset those losses. Funds that go to nursing homes and long-term care services for disabled Texans could be one vulnerable area, she said.
“Those tend to be the first services that get cut by states when there are large federal reductions in Medicaid funding, and it's because those are optional services by federal law,� Cowles said at a May press briefing.
Also included in the bill are work requirements for able-bodied adults enrolled in Medicaid. That provision would primarily impact states that opted to expand Medicaid benefits to low-income adults following the passage of the Affordable Care Act. Texas doesn’t fall in that category. Medicaid recipients in Texas are most often children from low-income families, along with seniors, pregnant and postpartum women, and people with disabilities.
It’s not just Medicaid that would be affected by the bill. The Supplemental Nutrition Assistance Program, known as SNAP, would see $300 billion in cuts nationwide, and would increase how much states pay in administrative costs for the program. Critics of the bill fear that, facing increased costs, some states might choose to scale back benefits.
Beth Corbett, vice president of government affairs for the Central Texas Food Bank, said her nonprofit is bracing for more demand if the legislation passes.
“Our organization knows from experience that when access to those programs decreases, demand for the food bank services significantly increases,� she said.
Insurance purchased through the Affordable Care Act marketplace , too. The bill doesn’t extend premium tax credits that were implemented back in 2020. That means premiums would go up for most people.
“People that have coverage right now in the marketplace and like it are going to get sticker shock."Walter Moreau, Foundation Communities
The local nonprofit Foundation Communities helps thousands of Central Texans sign up for health insurance each year. Walter Moreau, the organization’s executive director, said he is bracing for many folks to be surprised by prices in the next enrollment period.
“People that have coverage right now in the marketplace and like it are going to get sticker shock,� he said.
Moreau said he is also concerned about a provision that would shorten the marketplace enrollment period from around 10 weeks to six. Folks would also have to produce more documentation to prove their eligibility for remaining enhanced tax credits each year. That means, unlike before, people could not be automatically re-enrolled.
“I fully expect that [demand] is going to increase this year because of confusion around coverage,� Moreau said. “And now, we’ve only got six weeks to provide help for people.�
KFF estimates around 1.7 million Texans could lose insurance due to the proposed ACA changes.
While Foundation Communities is anticipating higher demand for its services, the organization has also lost federal funding it relied on to provide health care navigation services. Moreau said he’s working to find local partners who can help fill the funding gap before enrollment season � but right now, the organization is undergoing layoffs.
Moreau said he is hopeful the Senate will make changes to the bill to soften the impact on health coverage. With a narrow majority in the chamber, Republicans need every vote to pass the bill.
Certain conservatives, like Sen. Josh Hawley of Missouri, have said they oppose cuts to Medicaid. Others have criticized the bill for not actually lowering the U.S. budget deficit � a professed priority of the Trump administration. Although the bill would cut costs through programs like Medicaid, it also extends Trump’s 2017 tax cuts, which give the greatest cuts to high earners.
In fact, the nonpartisan estimates the bill will raise the deficit by about $3 trillion over the next 10 years.
Doggett said he wants senators to look to those tax cuts if they are looking for areas to save.
“If we made changes on the revenue side, we would not have to make the draconian cuts that are being proposed here in health care and food security, and we could still deliver some tax benefits to those in the middle class,� he said.
President Trump has urged Congress to have the bill on his desk before July 4.
KUT's Katy McAfee contributed to this story.
