Editor’s note: President Donald Trump signed the so-called One Big Beautiful Bill Act (OBBBA) into law Friday, a day after it was narrowly passed by Congress. On Monday, reactions included a statement from LeadingAge President and CEO Katie Smith Sloan, who said the legislation’s consequences “will not be pretty,” and warned that “Bandaids” such as – freezing, but not reducing, nursing home taxes and creating a rural health fund touted as a protection for older adults – will prove “ill-equipped to stop OBBBA’s damage” as states face budget “craters” from reduced Medicaid support.

The House passed the reconciliation bill on Thursday with the Senate-passed version largely intact. While the bill included some nursing home-friendly provisions – such as a 10-year delay on the federal staffing mandate and no change on nursing home provider taxes – it introduces sweeping spending cuts that will indirectly impact skilled nursing facilities (SNFs).

The bill slashes health care and food assistance spending by over $1 trillion, with cuts that could average $120 billion per year, and is projected to increase the national deficit by $3.4 trillion by 2034.

Advertisement

“Due to the level of deficit this bill will create, Medicare payments to providers may be reduced by 4% for the next ten years. Bandaids included in the bill – such as only-freezing-but-not-reducing nursing home provider taxes, and the creation of a rural health transformation fund–touted as protections for older adults and aging services providers – will soon prove ill-equipped to stop OBBB’s damage,” said Katie Smith Sloan, president and CEO, LeadingAge, in a statement. “And, as states respond to OBBB-created craters in their budgets due to reduced federal Medicaid contributions, the suffering will begin.”

Operators are also concerned about the state-level impact of the bill.

“There’s a pot of money that comes from the feds to the state for Medicaid [and] the state has to decide, ‘Do we want to let those people [previously on ACA] go without health care, or do we want to shore up this program with more state funding?’” Ron Nunziato, senior director of policy and regulatory at the Health Care Council of Illinois, told Skilled Nursing News earlier. “That’s the fear – we never really know until it’s all done, and how it’s going to affect us and what the state is going to do in response to that cut, or potentially more cuts.”

Advertisement

One major concern stems from reduced Medicaid support to hospitals, which, according to the American Hospital Association, will increase uncompensated care and strain already-stretched systems. As a result, these cuts are expected to ripple across the health care continuum, ultimately affecting long-term care, including SNFs.

“It will force hospitals to make service line reductions and staff reductions, resulting in longer waiting times in emergency departments and for other essential services, and could ultimately lead to facility closures, especially in rural and underserved areas,” the AHA noted in a statement issued ahead of the House’s passage of the bill.

States can fund Medicaid using sources like provider taxes. The reconciliation bill’s limitations on hospital provider taxes will weaken a key financing tool for Medicaid. And these changes could reverberate across the health care system, including skilled nursing and long-term care sectors that depend on hospital referrals and state Medicaid stability.

For states that have expanded Medicaid under the ACA, hospital provider taxes are still set to be reduced from the current federal ceiling of 6% to 3.5%. The reduction will proceed gradually, decreasing the allowable provider tax rate by 0.5% point each year until it reaches the new 3.5% threshold.

Despite initial resistance from Republican lawmakers worried about the bill’s high cost and deep health care cuts, they reversed course after political pressure and amid promises of future executive actions from the White House. Only two Republican Congressmen – Rep. Brian Fitzpatrick of Pennsylvania and Rep. Thomas Massie from Kentucky, remained opposed in the end.

Perhaps most significantly for skilled nursing facilities (SNFs), the bill’s $940 billion in Medicaid reductions over 10 years threatens home- and community-based services (HCBS), which are not federally mandated. As states face funding shortfalls, HCBS could be scaled back, pushing more individuals – particularly seniors and people with disabilities – into nursing homes. This shift would increase demand on nursing homes, potentially without proportional reimbursement increases.

Advertisement

Clif Porter, president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), called out the underfunding of Medicaid.

“The reality remains that Medicaid is underfunded, and there are limited resources available to meet the growing demand for care. Provider taxes are a necessary tool in supporting states’ ability to fund daily services and supports for those on Medicaid, and any reduction in resources within the overall care continuum cannot be taken lightly,” Porter said in a statement. “We are grateful to the many leaders who have worked diligently to hear the concerns of our profession and who have advocated to protect long-term care throughout the process.”

The bill also extends the 2017 tax cuts introduced during Trump’s first term, while making the significant cuts to Medicaid. It introduces new tax breaks for tipped income, increases the defense budget by $150 billion, reduces clean energy tax credits implemented under President Joe Biden, and allocates $100 billion to Immigration and Customs Enforcement (ICE).

The “One Big Beautiful Bill” has passed Congress and is now awaiting the president’s signature. The legislation combines permanent extensions of the 2017 federal tax cuts with major reductions to healthcare and nutrition assistance programs. For Georgia residents, especially those who rely on Medicaid, the Affordable Care Act marketplace, or rural hospitals, these changes could begin impacting healthcare access starting in 2026.

What Is in the ‘Big Beautiful Bill’?

The bill was passed through budget reconciliation, with a 51–50 vote in the U.S. Senate, and is considered one of the most sweeping pieces of social policy legislation in years. According to the Congressional Budget Office, the bill will increase the federal deficit by between $2.4 trillion and $2.8 trillion over the next decade.

The bill includes more than $1 trillion in cuts to Medicaid, the largest rollback of the program since its creation. It also significantly changes how low-income Americans qualify for and maintain access to public health coverage and food assistance.

How Much is A Trillion?: One trillion dollars is a one with twelve zeroes after it — that’s $1,000,000,000,000. It’s such a big number, it’s hard to understand. If someone spent one million dollars every single day, it would take nearly 3,000 years to spend it all. A stack of one-dollar bills worth a trillion dollars would stretch almost all the way to the moon. That’s how massive one trillion dollars really is.

That massive amount of money is being cut out of Medicaid, a system that provides health care to individuals and children in the United States.

Who Could Lose Coverage in Georgia?

While exact state-level numbers have not been released by the Congressional Budget Office, the Georgia Budget and Policy Institute projects that up to 750,000 Georgia residents could lose health coverage due to the combined effects of Medicaid cuts and changes to the federal insurance marketplace. This includes people currently covered by traditional Medicaid and others who use the federal marketplace to buy insurance.

These numbers are estimates based on modeling and are not confirmed by federal agencies, but they are consistent with national projections from the CBO that between 10.9 and 11.8 million Americans will lose coverage under the bill.

Changes to Marketplace Insurance Coverage

The bill also impacts the federal insurance marketplace, also known as the Affordable Care Act, where more than 1.5 million Georgians get their health insurance. It tightens income verification and identity documentation rules for enrollees and phases out premium tax credits. Those tax credits are part of what makes the Affordable Care Act affordable for many Georgians who either don’t have insurance through their employer or who are self-employed.

The Congressional Budget Office estimates that about 4 million Americans could lose coverage through the federal marketplace by 2030 as a result.

Work Requirements and Eligibility Changes

A major provision of the bill imposes new federal work requirements for Medicaid recipients between the ages of 19 and 64. These individuals must work, volunteer, or attend job training for at least 80 hours per month to remain eligible.

The bill also introduces six-month eligibility redeterminations for Medicaid, replacing the current annual schedule. These changes increase paperwork burdens, which advocates say could lead to coverage losses even among those who remain eligible.

Georgia already operates a limited work requirement program called Pathways to Coverage. The federal expansion of this model would apply the requirements more broadly and with fewer exemptions.]

At issue with the work requirement is the fact that many Georgians who are on medicaid are sick and are either in the hospital or at a specialist multiple days per week, making it difficult to work traditional hours.

Impact on Rural Healthcare in Georgia

Georgia has 120 rural counties that often rely on small hospitals with narrow operating margins. Medicaid accounts for between 15% and 20% of revenue for many rural hospitals, according to national industry averages. Reductions in that funding could threaten their survival.

While the bill includes a $50 billion rural hospital stabilization fund, health policy analysts say that amount is not sufficient to offset the scale of cuts. State-level actions may be required to prevent hospital closures, though no specific Georgia projections are available at this time.

Changes to Medicaid Provider Taxes

The bill gradually reduces the federal cap on Medicaid provider taxes from 6% to 3.5% by 2031. These taxes are used by states, including Georgia, to draw down additional federal Medicaid dollars.

While no precise state-level estimate is available, national experts expect this change to significantly reduce the amount of federal money Georgia hospitals can access. The outcome will likely be fewer providers accepting Medicaid, longer wait times, and increased financial strain on hospitals.

SNAP Changes and Health Implications

The bill also makes major changes to the Supplemental Nutrition Assistance Program (SNAP). Most adult recipients aged 18 to 64 will be required to meet the same 80-hour monthly work rule as Medicaid recipients.

Additionally, states with SNAP payment error rates over 6% will be required to pay up to 15% of program costs. Georgia’s current error rate exceeds that threshold, which could result in the state assuming more financial responsibility for food assistance programs. That shift could lead to tightened eligibility or reduced benefits, though no official announcement has been made.

How Georgia Residents Can Prepare

If you rely on Medicaid or marketplace insurance, here are immediate steps to protect your coverage:

Update your contact information with the Georgia Department of Community Health to receive notices

with the Georgia Department of Community Health to receive notices Track your work hours with pay stubs, time sheets, or letters from employers

with pay stubs, time sheets, or letters from employers Explore coverage options on Healthcare.gov — losing Medicaid or marketplace coverage qualifies you for a 60-day special enrollment window

on Healthcare.gov — losing Medicaid or marketplace coverage qualifies you for a 60-day special enrollment window Locate a Federally Qualified Health Center (FQHC) — Georgia has over 180 clinics that offer sliding-scale care

— Georgia has over 180 clinics that offer sliding-scale care Contact your state lawmakers to ask whether Georgia plans to expand Medicaid or offer additional state-level support to offset federal cuts

The Economic Ripple Effect

Georgia hospitals currently absorb more than $1.2 billion in uncompensated care annually, according to the Georgia Hospital Association. With reduced federal funding and more residents likely to lose insurance, that number could increase significantly. This could force hospitals to reduce services or raise costs for privately insured patients.

Medical debt is already a widespread issue in Georgia. According to recent surveys, about 28% of Georgia adults have some form of medical debt. Rising out-of-pocket costs and gaps in coverage could worsen that problem.

Meanwhile, the tax changes in the bill primarily benefit high-income earners. Analysts estimate that the top 20% of Georgia households, those earning more than $150,000 per year, will receive the majority of the state’s projected tax savings.

The Bottom Line

The “One Big Beautiful Bill” is one of the most significant changes to healthcare and public assistance policy in recent history. For Georgia, a state that has not expanded Medicaid and already has one of the nation’s highest uninsured rates, the consequences could be especially severe.

While supporters argue that the bill promotes self-reliance and reduces government waste, public health advocates warn it could trigger increased medical debt, reduced preventive care, and greater strain on the state’s hospital system.

For Georgia families, preparing now and staying informed may be the best way to avoid losing access to critical healthcare services.

How to Read and Understand The News When reading news, remember: Truth doesn’t change because we dislike it

Facts remain facts even when they make us uncomfortable

Events happen whether we accept them or not

Good reporting often challenges us Before dismissing news that bothers you, ask: What evidence supports this story? Am I reacting to facts or feelings? What would change my mind? Am I “shooting the messenger” because I don’t like what is happening? Smart news consumers seek truth, not just comfort.