On July 4, 2025, President Donald Trump signed into law the One Big Beautiful Bill Act (OBBBA), the congressional budget bill that simultaneously exploded the federal budget deficit and slashed deep into the United States’ already-threadbare social safety net. The OBBBA delivers $4.5 trillion in tax cuts that will primarily benefit the very rich, while making severe cuts to Medicaid and food stamps (the Supplemental Nutritional Assistance Program, or SNAP).

To be precise, the bill cuts $935 billion in Medicaid benefits and $285 billion in SNAP benefits over the next decade. These cuts, of course, will mostly hurt the country’s poorest.

How individual states will deal with the austerity rolling downhill from the federal government is still to be seen. What is clear is that it will mean immense hardships for many people. The Congressional Budget Office, for instance, estimates that as many as 11.8 million Americans may lose their health insurance as a result of Medicaid cuts, which are set to go into effect at the end of next year. This, in turn, will create significant challenges for the health systems that serve large numbers of Medicaid-insured patients.