WASHINGTON – President Trump labeled it “the One Big Beautiful Bill Act,” but it’s also the most comprehensive health care reform legislation passed by Congress since the Affordable Care Act became law in 2010.

But to hear health care experts tell it, the massive bill that congressional Republicans just passed might as well be called the Unaffordable Care Act. Upward of 17 million Americans, including 1.5 million New Yorkers, are projected to lose their health insurance by 2034 because of the bill’s changes to Medicaid and Obamacare. That means the health care providers of last resort – hospital emergency rooms – would bear the cost of caring for newly uninsured patients who put off seeking treatment.

It’s all led to grave concern among medical professionals.

“The medical community, I think, is worried,” said Dr. Iris R. Danziger, president of the Medical Society of Erie County. “Will we be able to sustain these sweeping changes – the hospitals, the primary care providers, all physicians in practice? And then there’s the impact on our community, and potentially the lives lost because of this.”

The Trump administration, of course, begs to differ.

“The One Big Beautiful Bill protects and strengthens Medicaid for those who rely on it – pregnant women, children, seniors, people with disabilities, and low-income families – while eliminating waste, fraud and abuse,” the White House said in a statement.

One thing critics and supporters of the bill’s health care provisions can agree upon, though, is their complexity. So here’s a closer look at what those provisions will mean to different groups of people, as well as to hospitals.

Medicaid recipients

The bill’s most sweeping health care changes will affect those on Medicaid, the federal-state insurance plan for low-income families and individuals. Starting in 2027, childless, able-bodied people between the ages of 18 and 64 will have to work, volunteer, go to school or be in job training at least 80 hours a month to receive benefits. They will also have to prove their eligibility for Medicare at least every six months.

The Congressional Budget Office said the move would save the federal government upward of $1 billion over a decade.

Hochul says state ‘could not have foreseen’ $750M budget hole that threatens health insurance coverage Budget Director Blake Washington said the new law will force the state to backfill $750 million in Medicaid-related costs for the final three months of the current fiscal year, which ends April 1, and at least $3 billion in the subsequent fiscal year.

But it will be harder to enroll – and stay enrolled – in Medicaid. Proof can be found in Arkansas, which implemented a Medicaid work requirement for eight months starting in June 2018. More than 18,000 people lost their coverage in that brief period of time, the Kaiser Family Foundation reported in a recent analysis. That’s about a quarter of the people subject to the work requirement.

“In Arkansas, lack of awareness and confusion about the requirements were common,” Kaiser reported. “Despite robust outreach efforts, many enrollees were not successfully contacted. Lack of computer literacy and internet access were also barriers, as individuals were required to report on their work or exemption status monthly using an online portal.”

Given that the same factors will likely be in play in New York, Kaiser projected that 1 million New Yorkers will lose their Medicaid coverage over the next decade. Projecting that 14% drop onto Erie and Niagara counties, more than 43,000 people would lose Medicaid coverage in the Buffalo metro area.

That’s one key reason Rep. Tim Kennedy, a Buffalo Democrat, strongly opposes the bill.

“It’s going to cause emergency rooms to be bursting at the seams,” he said. “The bad old days are forthcoming. … You’re going to have health care premiums going up because somebody has to pay for those emergency room visits by the uninsured. You’re going to have co-pays going up, deductibles going up.”

But Rep. Nick Langworthy, a Republican who represents Buffalo suburbs and the Southern Tier, defended the Medicaid changes.

“We are not taking coverage away from people who truly need it,” he said. “We are incentivizing work and self-sufficiency while protecting those who rely on Medicaid as a lifeline.”

Essential Plan recipients

New Yorkers who earn too much or otherwise don’t qualify for Medicaid often enroll in New York’s “Essential Plan,” a health insurance offering that, thanks to an anomaly in the law, has long been an unintended federal gift to New York.

Created under the Affordable Care Act, the Essential Plan is paid for almost entirely by the federal government. What’s more, the law allows it to cover all sorts of people who wouldn’t qualify for Medicaid, including refugees, asylum seekers and undocumented young people brought to America by their parents.

All that is about to change. The Big Beautiful Bill Act shrinks the number of immigrants who qualify for the Essential Plan, largely to those who hold green cards. For that reason, the state projects that more than 730,000 individuals will lose their Essential Plan coverage. Of those people, 506,000 are expected to go on Medicaid while 224,000 will be uninsured.

Projecting those estimates onto metro Buffalo, that would mean 18,011 local Essential Plan members would go on Medicaid while 7,973 would lose their insurance.

Many of the uninsured would be refugees and other immigrants, which would put a strain on providers such as Jericho Road Community Health Center.

“At Jericho Road, our faith in God compels us to provide care to the most vulnerable and especially to the poor, the widow and the alien and refugees,” said Dr. Myron Glick, Jericho Road’s co-founder and CEO. “We believe that all are created in the image of God and everyone deserves health care. This is our core mission. We cannot turn folks away. No matter what.”

Seniors

The health care provisions in the bill have the potential to affect seniors in two big ways: through Medicare and through changes that could lead to nursing home closures.

The Medicare changes will initially affect only a small segment of recipients: legal immigrants who do not have a green card or U.S. citizenship, who will no longer be eligible for Medicare.

But the bill also contains provisions that could affect far more Medicare recipients in the long run. The Medicare Rights Center estimates that the bill includes changes that could increase Medicare Part B premiums by upwards of $185 a month. And because the bill threatens to violate the Pay-As-You-Go Act of 2010, the Congressional Budget Office said it could trigger automatic Medicare cuts of up to $490 billion between 2027 and 2034.

Then there’s the potential impact on nursing homes that would lose income because of the Medicaid cuts. A Brown University study found the bill could threaten the future of 579 nursing homes nationwide, although none of those are in Western New York.

How looming Medicaid cuts are complicating Kaleida Health contract talks In the ongoing, tense talks between two labor unions and Kaleida Health, that outside factor is no doubt the massive cuts to Medicaid being weighed by lawmakers in Washington, D.C.

The bill also delays the implementation of new federal standards for nursing home staffing – a move that AARP said “will perpetuate unsafe conditions in many facilities across the country.”

Hospitals

Given the cuts to Medicaid and the Essential Plan, New York hospitals expect to face the financial burden of caring for the newly uninsured. Hospitals in rural areas, as well as urban hospitals that largely serve low-income communities, expect to face the most dramatic burden.

The bill will prompt 34,047 hospital job losses across the state, including 2,130 in Western New York, Gov. Kathy Hochul predicted.

Rural hospitals often serve many patients who are on Medicaid. That’s why a University of North Carolina study found that nearly 300 rural hospitals could be at risk of closure under the bill, including two in Western New York: Westfield Memorial Hospital and Wyoming County Community Hospital.

Asked about that report, Langworthy said: “I believe the fearmongering is misguided.” He said the bill will get people working and out of poverty and into private insurance, thereby benefiting community hospitals. And besides, the bill includes a $50 billion fund aimed at helping rural hospitals.

But large urban hospitals such as Erie County Medical Center also expect to face financial pressures.

“We’re still assessing how that may impact us, but there are so many unknowns at the state level as to how they will react to the losses in funding that they may see related to Medicaid,” said Jonathan Swiatkowski, ECMC’s chief financial officer.

That reaction may be determined by a special session of the State Legislature later this year.

For her part, Hochul sounds as if she may try to do something to counter the One Big Beautiful Bill’s impact on health care.

“All New Yorkers deserve access to high-quality health care,” Hochul said. “Republicans in Washington, including seven representing New York, are trying to rip away this basic human right from New Yorkers and I will not stand by and watch it happen. I’m standing up for our hardworking hospitals and families who rely on this care to survive.”