President Donald Trump signs his signature bill of tax breaks and spending cuts at the White House, Friday, July 4, 2025, in Washington, surrounded by members of Congress. (AP Photo/Evan Vucci) AP

Oregon’s health care landscape faces a major upheaval under the landmark federal tax and spending bill signed into law last week by President Donald Trump.

The legislation delivers the largest tax cuts in U.S. history and gives more money to immigration enforcement and border security, paying for it in part with some of the deepest reductions ever to federal health care funding. It calls for an estimated $1 trillion in cuts to Medicaid, the joint federal-state program that ensures health coverage for America’s poorest and those with disabilities.

More than 1.4 million Oregon residents — roughly one in three — receive coverage through the Oregon Health Plan, the state’s Medicaid program. It provides health coverage for more than half of the state’s children.

State health officials warn the new federal mandates could strip coverage from as many as 200,000 Oregonians and force tough decisions for lawmakers, health care providers and insurers.

New work requirements could disenroll thousands

One of the most immediate impacts of the law is the tightening of Medicaid eligibility requirements — particularly in states like Oregon that expanded coverage under the Affordable Care Act.

Under the new rules, able-bodied adults between the ages of 19 and 64 who became eligible under the 2010 Affordable Care Act’s Medicaid expansion will have to prove that they are working, volunteering, or attending school for at least 80 hours per month to remain eligible.

Certain groups — such as parents of children 13 and younger, people with certain chronic medical conditions and caregivers — are exempt. The Oregon Health Authority estimates about 462,000 Oregonians will be subject to the new work and reporting requirements.

Dr. Emma Sandoe, director of Oregon’s Medicaid Division, said the new rules could result in 200,000 people losing coverage — not necessarily because they fail to meet the work requirements, but because of stumbles keeping up with the paperwork.

The work requirement takes effect at the end of 2026, though states can request a delay of up to two years.

More frequent income checks could also kick off Medicaid enrollees

The law will also increase the frequency with which Medicaid enrollees must confirm their eligibility. Under the new law, income verification checks — along with the work verification — must be conducted every six months starting at the end of 2026.

Oregon currently conducts Medicaid eligibility reviews every two years — a timeline state officials say is intended to minimize administrative burden and maintain continuous coverage.

This approach, unique among states, was made with federal approval and backed by research on the problem of “churn” — when people lose coverage temporarily due to paperwork issues rather than a change in eligibility.

State health officials say the resulting decline in Medicaid enrollment will lead to a significant loss of federal funding for Oregon. The Oregon Health Authority estimates that the state could lose up to $1.4 billion annually — or up to $16 billion over 10 years.

Implementing the checks will also be costly. Sandoe said updating computer systems and hiring more administrators could cost hundreds of millions of dollars.

Cuts will reduce payments to hospitals, adding to financial strain

The law severely curtails two ways Oregon supplemented Medicaid reimbursements through additional federal payments. Without them, hospitals could lose millions of dollars annually providing treatment to Medicaid patients at a loss.

A 6% provider tax, which Oregon levies on hospitals, allows the state to draw down more federal dollars. The state returns the taxes to hospitals through higher reimbursements, and most hospitals recoup more than they pay.

Under the new law, states that expanded Medicaid under the Affordable Care Act — including Oregon — will see a cap on the provider tax reduced from 6% to 3.5% between 2028 and 2033. (States without Medicaid expansion will be allowed to maintain the higher cap.)

The Oregon Health Authority estimates the change will cost the state at least $4 billion in lost state and federal Medicaid funding by 2032, and more than $11 billion over a 10-year period.

Additional supplemental payments to hospitals, known as “state-directed payments,” will be capped at 100% of Medicare rates for states like Oregon that have expanded Medicaid. These payments are used to boost Medicaid reimbursement rates for hospitals and other providers.

Both were controversial — particularly the provider tax, which some saw as allowing the states to game the system — but were long tolerated by a federal government that recognized hospitals would struggle to make ends meet without them.

The Hospital Association of Oregon warns that the state will have to find ways to backfill the loss of billions of dollars in federal Medicaid funding.

“For Oregon hospitals, these changes are coming at a time when the health care system is teetering on the brink of financial failure,” Becky Hultberg, CEO and president of the hospital Association of Oregon said in a statement.

Many hospitals have already begun cutting costs, citing uncertainty around federal funding. Providence Health & Services recently eliminated 600 positions, including 134 workers in Oregon, and that more layoffs could come. Samaritan Health Services is considering closing two maternity health units.

Obamacare plans will get more expensive

The bill fails to extend federal subsidies put in place during the COVID-19 pandemic to lower the cost for Affordable Marketplace plans, which could further shrink enrollment in Oregon’s health insurance marketplace.

The subsidies are set to expire at the end of the year. Without them, state health officials estimate that Oregonians enrolled in Marketplace plans will have to pay an average of $960 more per year for health insurance premiums starting next year.

In response, several insurers have proposed premium increases, warning that the reduction in subsidies may push healthier individuals out of the market — leaving behind a smaller, higher-risk pool of enrollees and driving costs even higher.

What didn’t make the cut

Some cuts outlined in earlier versions of the bill were stripped before it won final approval.

A House-passed provision to ban federal funding for gender-affirming care was stripped in the Senate version. That’s not for lack of support among majority Republicans, but because Senate rules required provisions of the budget reconciliation bill to relate to spending. A more expansive bill would have needed approval from 60 senators.

A proposal to penalize states like Oregon that offer state-funded health insurance to undocumented immigrants also failed. Similarly, the provision was ruled impermissible under Senate budget rules.

In summary Lower-income people will be the hardest hit. Over the next 10 years, 3.4 million Californians could lose coverage.

The new federal budget signed into law by President Donald Trump is expected to raise some health care insurance premiums and force millions off coverage, reverberating the most in lower-income families and communities that are already struggling.

Trump’s new budget reduces spending for Medicaid — called Medi-Cal in California — by $1 trillion over the next 10 years. These savings would happen in part because new requirements will result in people falling off coverage.

In addition, some people enrolled in Covered California, the state’s marketplace for subsidized health plans, can expect new rules and higher costs, which means more people will be unable to afford the insurance.

Over the next 10 years, the federal changes are estimated to cost the state $28.4 billion and result in 3.4 million Californians losing coverage, according to an estimate from Gov. Gavin Newsom and state health officials.

Less federal funding for Medi-Cal means California will have to make decisions on who is covered and which services are offered. That loss of coverage could be a big blow to California, where lawmakers like to boast about having one of the nation’s lowest uninsured rates.

Alex Rossel, CEO of the community clinic Families Together of Orange County, says as people lose coverage, they’ll get sicker and be left in debt. “All that hard work that clinics have been doing to help people manage their chronic illnesses… is going to be in jeopardy,” he said.

And the effects of these changes could be felt beyond people enrolled in Medi-Cal and Covered California as clinics and hospitals warn that their financial challenges are likely to be exacerbated. Some may have to reduce services or close their doors.

Here are five things to know about how the new federal budget will affect Californians:

Some Medi-Cal enrollees will have work requirements and co-pays

Most notably, the new law requires adults ages 19 to 64 to report at least 80 hours a month of “community engagement,” which could be employment, school or volunteer work.

People who fail to do so will no longer qualify for Medi-Cal. Parents of children 13 and under and people with mental and physical disabilities will be exempt from the work requirements. The new requirement takes effect Dec. 31, 2026, although states could choose to start sooner.

The Urban Institute estimates that this rule alone could force up to 1.4 million Californians off their Medi-Cal insurance in the first year of implementation — not necessarily because they don’t work, but because filing paperwork is likely to pose a challenge for many enrollees. Enrollment counselors say some workers, such as housekeepers and gardeners, don’t have regular paychecks or documentation to prove their employment.

This same group of adults will have to reapply for coverage every six months, instead of once a year. And those who earn more than $15,060 a year, starting in October 2028, may have a co-pay of up to $35 per visit — although the exact amount will be up to states. Some visits will be exempt, such as prenatal and primary care, pediatric care and emergency room visits. (A single adult qualifies for Medi-Cal with an annual income of up to $21,597.)

Higher premiums for Covered California

One of the most significant changes is by omission: The Republican-led Congress opted to not renew some Affordable Care Act subsidies that will expire at the end of this year.

Nearly 90% of Californians who purchase insurance through Covered California, the state’s Affordable Care Act insurance exchange, receive financial assistance from federal subsidies that help lower monthly premiums.

On average, for all enrollees, premiums are expected to increase by 66%, or $101, per month starting next year. Lower-income people will see the biggest premium increase because they receive more subsidies, said Covered California Executive Director Jessica Altman.

Those making less than 400% of the federal poverty level (about $60,240 per year for an individual) are projected to pay an average of $191 more monthly, according to Covered California data.

More than 170,000 middle-income enrollees will lose financial assistance entirely.

Other changes made in Trump’s sweeping budget and policy bill include the elimination of automatic renewal, more income verification requirements and limiting special enrollment periods. The groups most likely to forego coverage because of administrative barriers are those who are young and healthy, Altman said.

Combined, the added enrollment complexities, along with higher out-of-pocket costs, are expected to drive nearly 600,000 Californians off of coverage, according to Covered California projections.

Hospital cuts could impact everyone

When people lose coverage, they are likely to skip routine care; they wait until they are very sick and then visit an emergency room. And without insurance, most people cannot afford to pay their hospital bills.

For hospitals, more uninsured patients means less compensation.

The law also adds new restrictions on provider taxes that states levy on hospitals and insurers to draw down matching federal funds to help pay for Medi-Cal. Hospitals receive payments from the revenue generated by these taxes that help them fill the gaps from traditional reimbursement.

Rural and community hospitals that care for a large share of low-income patients enrolled in Medi-Cal may have an especially difficult time absorbing the losses, so they may have to cut services, reduce staff or close, hospital leaders say.

“Hospitals will be forced to make difficult decisions, and access to vital health care services will be jeopardized for all Californians — not just those who rely on Medi-Cal for their health care coverage,” Carmela Coyle, the president of the California Hospital Association said in a statement.

In a recent press briefing, Newsom noted that a number of hospitals in California have been struggling for some time. In 2023, California rolled out $300 million in interest-free loans to bail out 17 distressed hospitals. The state, currently dealing with a budget deficit, would have a harder time helping hospitals again.

“Those distressed hospital loans came at a time of abundance. Those distressed hospital loans came at a time when we had much more stability with state funds and federal funds, and they were 3x the request for support,” Newsom said.

A funding ban for Planned Parenthood

Effective immediately after Trump signed the bill, Planned Parenthood clinics were banned from receiving federal Medi-Cal payments. Three days later, a federal judge temporarily blocked the funding cut after Planned Parenthood sued.

But as the litigation plays out, advocates say the move could be financially devastating to clinics across the country. In California, a million people use Planned Parenthood clinics each year, and Medi-Cal makes up 80% of its patients.

Federal law already prohibits the use of federal dollars to pay for abortions except in extremely limited instances. But Planned Parenthood does much more than that for patients. While it’s the largest abortion provider in the state, abortions account for less than 10% of its services. Contraceptives, sexually transmitted infection testing and treatment and check ups account for the vast majority of patient visits.

California Planned Parenthood clinics stand to lose more than $300 million, jeopardizing their ability to remain open. The national Planned Parenthood association estimates that 200 clinics across two dozen states are at risk of closure.

All clinics are open and taking patients, said Jodi Hicks, affiliate CEO and president. But the funding cuts could amount to a de facto abortion ban because in many California communities, Planned Parenthood is the only provider that performs abortions.

“People should be angry,” Hicks said. “We will fight back with every tool that we have to ensure that patients are able to be seen at our health centers, but the damage of defunding an entity that has such a large footprint in California is deep.”

Some kids will lose health care and food stamps

The vast majority of health and social services cuts in the federal budget are aimed at adults, but experts say kids will suffer as well. That’s because many of the changes implemented for adults, like work requirements and more frequent income eligibility checks can impact the eligibility of the entire family.

“There are a lot of ways that kids can fall through the cracks,” said Mike Odeh, senior health policy director for Children Now.

About 5.5 million children in California, half of the state’s youths, use Medi-Cal. The state insurance program also pays for some school-based health services, such as counseling and speech therapy.

One of the biggest health cuts targeting children specifically restricts eligibility for the Children’s Health Insurance Program to legal permanent residents, meaning other immigrant children with temporary legal status such as visas or refugee status could not qualify. California already provides health care for all children regardless of immigration status, but the federal prohibition means the state will have to pay more if it wants to continue covering them.

On top of the Medi-Cal cuts, the budget bill makes significant changes to the Supplemental Nutrition Assistance Program, often referred to as food stamps. It institutes stricter work requirements for many adults including veterans and parents of teenagers, ties future spending to inflation and shifts more of the cost-sharing onto states. Similar to the immigration requirement for children’s Medi-Cal, food stamp eligibility will also be restricted to legal permanent residents.

Newsom’s office estimates that 735,000 people will lose food stamps. Early estimates from the Urban Institute project that 3.1 million California families will lose at least some of their food assistance. About a third of all newborns in California are enrolled in food stamp programs, according to the Public Policy Institute of California.

Alabama State Rep. Rex Reynolds, R-Huntsville chair of the Alabama House Ways and Means General Fund Committee, said changes in President Trump’s “big, beautiful” bill were needed to control the cost of Medicaid and SNAP. John Sharp

An Alabama lawmaker who leads a state budget committee said President Trump’s tax cut and spending bill means Alabama will have to tighten programs that hundreds of thousands of families depend on for health care and food.

Rep. Rex Reynolds, R-Huntsville, chairman of the House Ways and Means General Fund committee, said the changes made by what Trump dubbed the “big, beautiful bill” were needed.

“Unfortunately, I think it was a very necessary piece of legislation at the federal level to make some much needed corrections,” Reynolds said.

“Take for instance Medicaid. It was simply an unsustainable program the way that program was growing.”

‘Very few healthy men on Medicaid’

Alabama’s budget for next year allocates more than $1 billion from the state General Fund to Medicaid, one-third of the total spending from the General Fund.

Overall, Alabama’s Medicaid program will cost about $10 billion next year, with federal dollars covering about 70%.

Reynolds said he would support an audit by a third party to review who receives Medicaid benefits in Alabama.

“It may be a good time to really pull back the covers and look at who is on Medicaid,” Reynolds said. “We know that about 52% of our Medicaid recipients are children. We have a lot of people on Medicaid that have disabilities and cannot work.

“But I suggest there may be some on there that don’t need to be on Medicaid.”

“We’ve just really got to do our due diligence to ensure that we are providing Medicaid only to those that need it,” Reynolds said.

Trump’s 900-page bill, passed by Republican majorities in Congress over united opposition from Democrats, cuts federal spending for Medicaid and for the Supplemental Nutrition Assistance Program, or SNAP.

The savings are intended to offset the extension of tax cuts from Trump’s first term, new tax breaks for individuals and businesses, and increased spending on defense, immigration enforcement, and border security.

Alabama Arise, which advocates for policies that benefit people in poverty, says Trump’s bill will hurt hundreds of thousands of Alabamians who depend on SNAP and Medicaid, including for temporary setbacks such as a job loss.

The Congressional Budget Office estimated that the changes in the bill would result in almost 12 million people nationally losing their health insurance coverage by 2034.

The CBO said the bill would cut federal spending on healthcare by about $1 trillion over a decade.

Sen. Greg Albritton, R-Atmore, who chairs the General Fund committee in the Senate, said Trump’s bill will have more impact on states that expanded their Medicaid programs under President Obama’s Affordable Care Act than it will on Alabama, one of 10 states that did not expand.

“The overall picture, I believe, is Alabama is going to be in fairly good shape,” Albritton said. “The doom and gloom I don’t think is going to hit the fan.”

Medicaid expansion would have added hundreds of thousands of working people to the rolls.

Still, Alabama’s unexpanded Medicaid program is large, serving an average of about 1 million people each month.

Slightly more than half are children up to age 18. Other main groups are the blind and disabled, pregnant women, and people 65 and older in poverty.

Albritton said he does not expect many to lose coverage because of Trump’s bill.

“If there is, it’s going to be very, very few,” Albritton said. “Alabama is already in compliance with this in that we cover mostly women and children and the disabled.”

“There are very few healthy men on Medicaid at this point.”

The senator said there is still not a full understanding of everything the bill does because some of it depends on new federal regulations that will be written.

“We won’t know that for another year,” Albritton said.

‘Better than we thought’

The National Academy for State Health Policy said states that did not expand Medicaid, like Alabama, can expect to see reduced federal funding for Medicaid of 6% to 11%.

Reynolds said the state’s Medicaid professionals are trying to determine how much will be cut. He does expect a reduction in federal Medicaid dollars.

“That’s why we’ve got to work on ensuring that our programs are lean as they can be and that we are providing Medicaid to those that really need it,” Reynolds said.

His Senate counterpart, Albritton, said that overall he does not expect major negative consequences for the state budget or for those who depend on Medicaid.

“I think on both sides we’ve come out better than we thought we would. I think we’re going to be able to handle this,” Albritton said.

Reynolds said the addition to the bill of $50 billion intended to help rural hospitals and health providers should help.

Reynolds said he has been in meetings with other legislative leaders and is sharing information with the budget committee members to prepare for the impact of the bill.

“We have talked about Medicaid for weeks now about what potentially could happen there,” Reynolds said.

He said the discussions have included what to do about those who lose health insurance.

“We certainly have to begin to have that conversation as well because that too can impact our hospitals and our nursing homes,” Reynolds said.

According to the Kaiser Family Foundation, the bill will make it harder for people to obtain and keep their health insurance policies purchased through the marketplace established by the Affordable Care Act, partly by shortening the annual open enrollment period and requiring more documentation.

Also, the cost of premiums will rise about 75% after this year because enhanced tax credits to help pay for premiums during the COVID pandemic will expire, the KFF said.

No more candy or Cokes through SNAP?

The bill is intended to save federal dollars by shifting more of the cost of SNAP, formerly called food stamps, to the states.

Federal dollars now pay 100% of SNAP benefits. In Alabama, that amounted to about $1.8 billion last year.

An average of 750,000 people received SNAP benefits in the state last year, an average monthly benefit of about $200.

The bill will require states to pay a portion of SNAP benefits beginning in 2028. States can avoid that if they keep payment error rates below a certain target.

Reynolds said Alabama should begin to look at cost-savings. One possibility is to tighten the rules on SNAP purchases and exclude sodas and candy.

“That may be something we have to consider in Alabama to ensure again that we are providing the SNAP benefits to the kids that need it,” Reynolds said.

According to Alabama Arise, the changes to SNAP will result in the most negative consequences from the bill.

Alabama Arise said the new cost-sharing for SNAP would cost Alabama about $200 million if it was implemented now.

The bill also imposes new 80-hour a month work requirements on many SNAP recipients.

“Federal SNAP cuts will leave more Alabamians unable to afford to keep food on the table,” Alabama Arise Executive Director Robyn Hyden said in a news release.

“That is a step in the wrong direction, and it will undermine the benefits of the state grocery tax reduction that Alabama legislators enacted unanimously this year.”

Education budget could benefit

Rep. Danny Garrett, R-Trussville, chairman of the education budget committee in the House, said he does not expect the “big, beautiful” bill to have a major impact on school funding.

As a general rule, when Alabamians pay less in federal income taxes, they pay more in state income taxes.

That’s because Alabama allows taxpayers to use their federal taxes as a deduction to reduce what they owe in state taxes. Alabama is the only state that allows taxpayers to deduct all their federal taxes paid.

“Generally, if the federal taxes go down, which the big beautiful bill says it will, then our state receipts go up,” Garrett said.

State income taxes are the largest source of money for Alabama’s Education Trust Fund.

The bill creates federal income tax deductions for overtime pay, tips, and taxable income for people age 65 and over.

Alabama approved a state income tax exemption on overtime pay that was in effect from January 2024 through June of this year.

But lawmakers chose to let it expire because it reduced revenues to the Education Trust Fund more than expected.

Garrett said a larger concern for the education budget than the Trump bill is the delay of $68 million in federal funds for Alabama school systems for after-school, English learner and professional development programs.

The money is typically sent out July 1 every year, but federal officials notified the state that it was on hold pending a review.

“It’s my understanding, that they’re just reviewing that to make sure it’s compliant with the overall administration initiatives,” Garrett said. “But the longer that money is delayed being released, then it doesn’t get to the local level as soon as it needs to.”

Garrett said the Legislature passed the education budget for the upcoming school year with the expectation that the federal funds would be available.

The Legislature is not in session now and will begin the 2026 session in January.

Garrett said he expects hearings on the state budgets to happen in the fall.

Cuts to service might be coming

Reynolds said the tax revenues that support the General Fund are strong overall.

He said the extension of the 2017 federal tax cuts should help the economy.

Still, Reynolds acknowledged that the state might have to reduce some services because of the changes coming.

“I can’t say that the General Fund can supplant all the federal dollars that we may lose,” Reynolds said.

“But we do a balanced budget and we’re going to work hard to continue to provide services to the Alabamians that need it.”

“We will work hard to not have a significant impact on the General Fund because we’ve got to make it work,” Reynolds said.

“And we’ve got to make it work within the parameters of this legislation.”

How Will Trump’s Big Bill Affect Your Wallet?

Congressional Republicans just passed President Trump’s sprawling domestic policy bill that extends and expands tax cuts, while slashing Medicaid, food benefits and clean energy initiatives to pay for them — but only partly. The bill favors the wealthy, and low-income Americans stand to lose the most.

What could the bill mean for your pocketbook? Answer these questions to learn more about the individual impacts of the wide-ranging legislation. (Your answers are not tracked by The Times.)

Jump to a section:

General tax policy Families Health care Education Clean energy Immigration 0 of 33 questions answered

General tax provisions At the heart of the bill is a roughly $4 trillion tax cut that extends the cuts Republicans passed in 2017. Without this extension, most Americans would see a tax increase. These tax cuts come at a cost. According to the Congressional Budget Office, the bill adds $3.3 trillion to the national debt over the next decade. Do you pay federal income taxes? Yes No Do you take the standard tax deduction? Yes No Are you 65 or older? Yes No Do you live in a high-tax state like California or New York? Yes No Are you a tipped worker? Yes No Do you receive overtime pay? Yes No Do you plan to buy a car? Yes No Do you pay interest on a mortgage? Yes No Have you experienced a big loss because of a storm, fire or other disasters? Yes No Do you donate to charity? Yes No Do you earn more than $500,000 a year? Yes No Do you own a business? Yes No Do you own or are you considering buying firearms? Yes No Are you a whaling captain or a fisher living in Alaska? Yes No

Family-related tax policies Despite reducing or eliminating certain safety net programs, the Trump administration has been exploring several options to encourage Americans to have more children, including tax cuts and other investments. Do you have a child younger than 17? Yes No Are you planning to have a baby soon? Yes No Do you intend to adopt a child? Yes No Will you inherit wealth or business worth $15 million or more soon? Yes No

Health care and food assistance To offset some of the tax cuts, the bill makes steep cuts to health care and food assistance benefits for low-income Americans. Are you on Medicaid? Yes No Do you use food stamps? Yes No Do you have health insurance under Obamacare? Yes No Do you have a health savings account, or want one? Yes No

Education The bill adds limits to student loan borrowing and makes changes to financial aid eligibility and uses. Have you already taken or will soon take out federal loans for college? Yes No Do you plan to borrow money for your child’s college education? Yes No Do you hope to borrow money for graduate school? Yes No Do you have a 529 savings account? Yes No Are you filling out the FAFSA? Yes No Do you plan to apply for a Pell Grant? Yes No Do you or your children attend a university with a large endowment? Yes No

Clean energy subsidies The bill rolls back tax credits for clean energy, a policy Mr. Trump campaigned on. Are you planning to make energy-efficient home improvements? Yes No Do you want to buy an electric or a plug-in hybrid vehicle? Yes No

Immigrant-related policies The bill has prioritized additional funding for immigration enforcement, and specifically includes collecting more fees from certain noncitizens. Are you a noncitizen without a green card? Yes No Are you an immigrant who sends money abroad to friends or family? Yes No

Many middle-class and wealthy families will see some benefits from the new legislation. But programs that help low-income families keep babies healthy have been cut back.

Advertisement What could Trump’s big tax law mean for the youngest Americans? Many middle-class and wealthy families will see some benefits from the new legislation. But programs that help low-income families keep babies healthy have been cut back. Editorial Standards ⓘ

The impact of the massive spending bill President Donald Trump signed into law on Independence Day is expected to filter down to infants and toddlers — a segment of the population that’s particularly vulnerable to cuts to the federal social safety net.Related video above: Trump says his bill is the ‘most popular’ in history but polls say otherwiseMany middle-class and wealthy families will see some benefits from the legislation, but programs that help low-income families keep babies healthy have been cut back. While state money funds public schools and preschool in some cases, programs supporting the youngest children are largely backed by the federal government.The law extends tax cuts Trump passed during his first term and pours billions more dollars into border security as he seeks to broaden his crackdown on immigration. To pay for these initiatives, the law cuts Medicaid and food stamps — programs relied upon by poor households with children — by more than $1 trillion.The legislation Republicans called Trump’s “big beautiful bill” is set to deliver some gains for families with children. It increases tax credits, including one that now allows parents to deduct up to $2,200 per child from their tax bills. And it introduces investment accounts for newborns dubbed “Trump Accounts,” each seeded with $1,000 from the government.Still, advocates say they don’t make up for what children are likely to lose under the law. And they fear what comes next, as the next Trump budget proposes more cuts to programs that help parents and babies.Medicaid cuts could add to strains on familiesMore than 10 million Americans rely on Medicaid for health care. About 40% of births are covered by Medicaid. Newborns, too, qualify for it when their mothers have it.The new law doesn’t take little kids or their parents off Medicaid. It institutes Medicaid work requirements for childless adults and adults with children over the age of 13. But pediatricians warn the cuts will be felt broadly, even by those who don’t use Medicaid.The Medicaid cuts are expected to put a financial strain on health care providers, forcing them to cut their least profitable services. That’s often pediatrics, where young patients are more likely to use Medicaid, said Lisa Costello, a West Virginia pediatrician who chairs the federal policy committee for the American Association of Pediatrics.The ripple effects could exacerbate an existing shortage of pediatricians and hospital beds for children.“Any cuts to that program are going to trickle down and impact children, whether that’s pediatric practices who depend on Medicaid to be able to stay open or children’s hospitals,” Costello said.States also use Medicaid to pay for programs that go beyond conventional medical care, including therapies for young children with disabilities. Under the law, states will foot a greater portion of the bill for Medicaid, meaning optional programs are at risk of getting cut.While parents of young children are exempt from the work requirement, recipients must verify they’re in compliance or exempt from the requirement every six months. Critics fear eligible adults will lose their coverage because of the new reporting requirements.If an adult loses Medicaid coverage, it could ratchet up household stress and make it more difficult for parents to make ends meet, both of which can negatively impact youngsters. And parents who lose their health insurance are less likely to take their children to the doctor.“When parents lose their health insurance, they often think that their children also are no longer eligible, even if that’s not the case,” said Cynthia Osborne, a professor of early education and the executive director of the Prenatal-to-3 Policy Impact Center at Vanderbilt University.The law increases tax credits for parents who qualifyThe law increases the child tax credit to $2,200 per child, up from $2,000. But parents who don’t earn enough to pay income tax will still not see the benefit, and many will see only a partial benefit.The measure also contains two provisions intended to help families pay for child care, which in many places costs more than a mortgage. First, it boosts the tax credit parents receive for spending money on child care. It also expands a program that gives companies tax credits for providing child care for their employees.Both measures have faced criticism for generally benefiting larger companies and wealthier households.“It’s a corporate business tax break,” said Bruce Lesley, president of the advocacy group First Focus on Children. “It makes their child care dependent upon working for an employer who has the credit.”‘Trump Accounts’ will be opened with $1,000 for newbornsThe law launches a program that creates investment accounts for newborns. The “Trump Accounts” are to be seeded with $1,000 from the government, and children will be able to use the money when they become adults to start a new business, put the money toward a house or go to school.Unlike other baby bond programs, which generally target disadvantaged groups, the federal program will be available to families of all incomes.The program’s backers have pitched the accounts as a way to give young people a boost as they reach adulthood and teach them about the benefits of investing. Critics argue families in poverty have more immediate needs and their children should receive a larger endowment if the goal is to help level the playing field.A food assistance program faces cutsThe Supplemental Nutrition Assistance Program faces the largest cut in its history under the law. It will, for the first time, require parents to work to qualify for the benefit if their children are 14 or older. But even households with younger children could feel the impact.The law kicks some immigrants — including those with legal status — off food assistance. It makes it more difficult for individuals to qualify by changing how it considers their utility bills.SNAP has historically been funded by the federal government, but under the new law, states will have to shoulder some of the financial burden. Cash-strapped governments could decide to implement new requirements that would make it more difficult for people to qualify, said Katie Bergh, a senior policy analyst with the Center on Budget and Policy Priorities. Some states may decide to exit the program altogether.“This bill fundamentally walks away from a long-standing nationwide commitment to making sure that low-income children in every state can receive the food assistance that they need,” Bergh said.