When Republicans ask voters to keep them in the majority, they frequently point to the most significant policy achievement of Trump 2.0 — the tax and spending cuts bill known as the One Big Beautiful Bill Act.
Among the main selling points Republican candidates cite are popular cuts to taxes on tips and overtime, things that have a populist appeal, although many of the tax savings are more likely to benefit wealthier Americans.
But the law offsets tax cut provisions by slashing federal funding for many programs that help make up the social safety net in the US, which means fewer Americans are getting aid from the government to afford food or obtain health insurance.
The administration has also cited fraud, frequently without evidence, to cut down on government programs.
Trump signed the law in July 2025, but some of the changes to government programs are just now coming into effect, while others won’t be felt until further down the road.
Chipping away at the Affordable Care Act After failing to repeal and replace the Affordable Care Act during his first term, Trump and congressional Republicans have sought to weaken it in a variety of ways.
The biggest blow was their decision to let Obamacare’s enhanced premium subsidies lapse at the end of last year. The more generous assistance, which was approved in 2021 during the Biden administration as part of its response to the Covid-19 pandemic, broadened the number of people eligible for help and provided them larger subsidies. Enrollment nearly doubled between 2021 and 2025.
The enhanced subsidies’ expiration, along with rising healthcare costs, sent premium payments soaring 58% for 2026. Many of those who signed up for coverage this year bought less expensive plans — though those come with higher deductibles.
But many others found they simply could not afford the heftier monthly payments. As of February, enrollment fell to 19.2 million, a drop of 2.6 million from the same period a year prior, according to the latest federal data. It was the first decline in seven years.
However, more people have dropped their coverage since then, according to states that run their own marketplace and CNN reporting.
Some states hit harder than others Enrollment in 18 states fell 8.5% as of May compared with a year prior, according to data collected by the State Marketplace Network. It had dipped only 1.4% at the start of the year.
In Mississippi, only 126,000 people were enrolled in Obamacare plans in August, a decline of 63%, the state insurance commissioner told CNN. More than 200,000 people have become uninsured.
Kara Windeler, a Florida resident who has health conditions, told CNN that she must give up her Affordable Care Act coverage in November because she cannot afford the premiums. She is trying to see doctors and receive treatment before she becomes uninsured.
Dentists care for patients at a Remote Area Medical mobile dental and medical clinic, which offers free medical care in underserved communities, in Terre Haute, Indiana, on August 02, 2025.
Higher premiums mean more people will lose coverage The Trump administration has said that enrollment has fallen because many people were unknowingly signed up by unscrupulous brokers and agents and other enrollees did not exist at all.
Signups are expected to drop again for 2027 since premiums are forecasted to soar for the second year in a row. Insurers have proposed a median increase of about 15% for next year, according to KFF, a nonpartisan health policy research group. (Insurers’ proposed rate hikes don’t include federal subsidies, so the change in enrollees’ monthly premium payments may be different.)
GOP approves the largest cuts in Medicaid history The Republicans’ “big beautiful bill” enacted the largest cuts to Medicaid since the safety net program began 66 years ago. The package is expected to slash more than $1 trillion from Medicaid and leave 7.5 million more people uninsured over a decade, according to CBO.
Among the biggest changes to the program is the first-ever federal work requirement mandate. Medicaid expansion enrollees ages 19 through 64 will be required to work, volunteer, attend school or participate in a job program at least 80 hours a month, unless they are eligible for certain exemptions. Some 5.3 million more people are expected to be uninsured in 2034 because of this provision, CBO estimates.
The Trump administration is also taking a harder-than-expected line on who qualifies for an exemption for the medically frail. Not only must enrollees have an illness or medical condition, such as cancer or a behavioral health issue, but that condition must also significantly impair their ability to comply with the work mandate, according to a rule issued by the Centers for Medicare and Medicaid Services in June.
The work mandate kicks in next year, but a few states opted to implement it early. In Nebraska, nearly 1,100 people lost coverage or were not able to enroll because of the work requirement since the mandate began there in May, according to state data through August.
And a much higher than usual share of new applicants and those seeking to renew coverage were denied for procedural reasons, often relating to paperwork. This has led some experts to worry that people are running into hurdles that could involve the new work requirement.
Millions already no longer have Medicaid coverage Overall, enrollment in Medicaid and the Children’s Health Insurance Plan (CHIP) has declined by 5.1 million, or 6% — to 73.2 million — as of June compared with the year before, according to KFF.
The number of children enrolled in Medicaid and CHIP fell by more than 2.5 million between January 2025, when Trump took office, and August, according to the Georgetown University Center for Children and Families.
It’s unclear how much of the declines can be attributed to the “big beautiful bill” changes and how many children are winding up uninsured.
Other provisions that are expected to strip people of coverage include a narrowing of eligibility for immigrants, such as asylees and refugees, which could also affect their US citizen children. A requirement that adults enrolled through Medicaid expansion recertify their eligibility every six months could lead some to fall off because of paperwork issues.
Ambulances are stationed at a hospital in Austin, Texas, on September 2, 2026.
The “big beautiful bill” also made significant changes to the financing of Medicaid, limiting how states raise money for their share of programs and enhance payments to providers.
Hospitals and other healthcare providers are concerned that these financing provisions — along with an increase in uninsured patients who have lost Medicaid and Affordable Care Act coverage — could force them to curtail services, lay off staff or even shut their doors. Some that have already had to pull back care have cited the impact of the package as one of the reasons.
Trump and congressional Republicans say all these changes are meant to improve Medicaid and make sure it remains available for the most vulnerable Americans. They also argue that Medicaid should help enrollees become financially independent through work.
A store displays a sign accepting Electronic Benefits Transfer cards for Supplemental Nutrition Assistance Program purchases, in the Brooklyn borough of New York on January 2, 2026.
A store displays a sign accepting Electronic Benefits Transfer cards for Supplemental Nutrition Assistance Program purchases, in the
It’s now harder for Americans to obtain food assistance The “big beautiful bill” contained several provisions that are expected to reduce enrollment in the Supplemental Nutrition Assistance Program, or SNAP, the formal name for food stamps, by millions of people over the next decade. The package enacted the largest cuts to food stamps in the program’s history — nearly $200 billion over a decade, according to CBO.
In fact, enrollment has already fallen by more than 5 million people, or nearly 13%, between the law’s enactment in July 2025 and June, according to estimates from the left-leaning Center on Budget and Policy Priorities that are based on US Department of Agriculture data. At least 1.5 million of them are children.
While the GOP package is not the sole cause, it is a major factor, experts say.
New requirement could force states to pay Among the most consequential provisions is a requirement that states start shouldering a portion of the food stamp benefit for the first time if they have a high rate of payment errors. They could be on the hook for $9 billion collectively, according to CBPP. (Historically, the federal government funded SNAP benefits, while states administered the program.)
Though this measure doesn’t kick in until next October, states are being proactive in tightening their oversight and requiring more documentation from enrollees. This is leading to many people being dropped because of paperwork issues, experts say.
The “big beautiful bill” also broadened SNAP’s existing work requirements to certain adult enrollees through age 64, to parents with dependent children ages 14 and older and to veterans, homeless adults and youth who aged out of foster care. Plus, the package requires states pay more of the administrative costs and ended the eligibility of refugees, asylees, victims of domestic violence and certain other immigrants.
Major changes for student loans Both the “big beautiful bill” and Department of Education decisions are leading to a major overhaul of the federal student loan program. Many of the provisions kicked in on July 1, but others take effect in coming years.
Federal student loans are critical to many Americans’ ability to go to college or grad school. More than 42 million borrowers have student loans, totaling more than $1.7 trillion, according to the Federal Student Aid office.
The US Department of Education says the law’s reforms implement “commonsense loan limits,” simplify repayment options and improve the health of the federal student lending system. But critics worry that the program’s revamp will make it harder and more expensive for students to finance their education and to repay their loans afterwards.
One of the major changes involves paying back one’s loans. The law created a new tiered standard repayment plan and a new Repayment Assistance Plan, known as RAP.
These options only apply to students taking out new loans at the moment. Borrowers who are currently repaying loans won’t see any immediate changes in their options as a result of the “big beautiful bill,” but most will have to switch to one of the new plans or the Income-Based Repayment plan by July 2028.
Graduates celebrate their commencement during Towson University's winter ceremony in Towson, Maryland, on December 17, 2025.
Paying for grad school could become tougher for many Graduate school students will no longer be able to borrow up to the “cost of attendance” for their programs. Instead, they will face borrowing limits that depend on what they are studying. And the Grad PLUS loan is being eliminated.
In a very controversial move, the Education Department decided that certain healthcare studies — such as nursing, physician assistants and physical therapy — were not considered professional programs. That means students pursuing these careers will be more limited in their federal student loan borrowing. The decision spurred lawsuits, which are now working their way through the courts.
Also, parents will be limited in how much they can borrow to help their undergraduate students.
SAVE plan’s demise also affects borrowers Meanwhile, the Department of Education ended the Saving on Valuable Education (SAVE) plan — a Biden administration-era income-driven repayment plan that was blocked by federal courts in July. Borrowers are being given 90 days to switch into alternate plans, many of which may leave them with higher monthly payments.
SAVE’s demise has left many borrowers worried about how they’ll afford the higher monthly payments. One speech-language pathologist in California told CNN that she and her husband are reconsidering when — or whether — they can grow their family.
Among the main selling points Republican candidates cite are popular cuts to taxes on tips and overtime, things that have a populist appeal, although many of the tax savings are more likely to benefit wealthier Americans.
But the law offsets tax cut provisions by slashing federal funding for many programs that help make up the social safety net in the US, which means fewer Americans are getting aid from the government to afford food or obtain health insurance.
The administration has also cited fraud, frequently without evidence, to cut down on government programs.
Trump signed the law in July 2025, but some of the changes to government programs are just now coming into effect, while others won’t be felt until further down the road.
Chipping away at the Affordable Care Act After failing to repeal and replace the Affordable Care Act during his first term, Trump and congressional Republicans have sought to weaken it in a variety of ways.
The biggest blow was their decision to let Obamacare’s enhanced premium subsidies lapse at the end of last year. The more generous assistance, which was approved in 2021 during the Biden administration as part of its response to the Covid-19 pandemic, broadened the number of people eligible for help and provided them larger subsidies. Enrollment nearly doubled between 2021 and 2025.
The enhanced subsidies’ expiration, along with rising healthcare costs, sent premium payments soaring 58% for 2026. Many of those who signed up for coverage this year bought less expensive plans — though those come with higher deductibles.
But many others found they simply could not afford the heftier monthly payments. As of February, enrollment fell to 19.2 million, a drop of 2.6 million from the same period a year prior, according to the latest federal data. It was the first decline in seven years.
However, more people have dropped their coverage since then, according to states that run their own marketplace and CNN reporting.
Some states hit harder than others Enrollment in 18 states fell 8.5% as of May compared with a year prior, according to data collected by the State Marketplace Network. It had dipped only 1.4% at the start of the year.
In Mississippi, only 126,000 people were enrolled in Obamacare plans in August, a decline of 63%, the state insurance commissioner told CNN. More than 200,000 people have become uninsured.
Kara Windeler, a Florida resident who has health conditions, told CNN that she must give up her Affordable Care Act coverage in November because she cannot afford the premiums. She is trying to see doctors and receive treatment before she becomes uninsured.
Dentists care for patients at a Remote Area Medical mobile dental and medical clinic, which offers free medical care in underserved communities, in Terre Haute, Indiana, on August 02, 2025.
Higher premiums mean more people will lose coverage The Trump administration has said that enrollment has fallen because many people were unknowingly signed up by unscrupulous brokers and agents and other enrollees did not exist at all.
Signups are expected to drop again for 2027 since premiums are forecasted to soar for the second year in a row. Insurers have proposed a median increase of about 15% for next year, according to KFF, a nonpartisan health policy research group. (Insurers’ proposed rate hikes don’t include federal subsidies, so the change in enrollees’ monthly premium payments may be different.)
GOP approves the largest cuts in Medicaid history The Republicans’ “big beautiful bill” enacted the largest cuts to Medicaid since the safety net program began 66 years ago. The package is expected to slash more than $1 trillion from Medicaid and leave 7.5 million more people uninsured over a decade, according to CBO.
Among the biggest changes to the program is the first-ever federal work requirement mandate. Medicaid expansion enrollees ages 19 through 64 will be required to work, volunteer, attend school or participate in a job program at least 80 hours a month, unless they are eligible for certain exemptions. Some 5.3 million more people are expected to be uninsured in 2034 because of this provision, CBO estimates.
The Trump administration is also taking a harder-than-expected line on who qualifies for an exemption for the medically frail. Not only must enrollees have an illness or medical condition, such as cancer or a behavioral health issue, but that condition must also significantly impair their ability to comply with the work mandate, according to a rule issued by the Centers for Medicare and Medicaid Services in June.
The work mandate kicks in next year, but a few states opted to implement it early. In Nebraska, nearly 1,100 people lost coverage or were not able to enroll because of the work requirement since the mandate began there in May, according to state data through August.
And a much higher than usual share of new applicants and those seeking to renew coverage were denied for procedural reasons, often relating to paperwork. This has led some experts to worry that people are running into hurdles that could involve the new work requirement.
Millions already no longer have Medicaid coverage Overall, enrollment in Medicaid and the Children’s Health Insurance Plan (CHIP) has declined by 5.1 million, or 6% — to 73.2 million — as of June compared with the year before, according to KFF.
The number of children enrolled in Medicaid and CHIP fell by more than 2.5 million between January 2025, when Trump took office, and August, according to the Georgetown University Center for Children and Families.
It’s unclear how much of the declines can be attributed to the “big beautiful bill” changes and how many children are winding up uninsured.
Other provisions that are expected to strip people of coverage include a narrowing of eligibility for immigrants, such as asylees and refugees, which could also affect their US citizen children. A requirement that adults enrolled through Medicaid expansion recertify their eligibility every six months could lead some to fall off because of paperwork issues.
Ambulances are stationed at a hospital in Austin, Texas, on September 2, 2026.
The “big beautiful bill” also made significant changes to the financing of Medicaid, limiting how states raise money for their share of programs and enhance payments to providers.
Hospitals and other healthcare providers are concerned that these financing provisions — along with an increase in uninsured patients who have lost Medicaid and Affordable Care Act coverage — could force them to curtail services, lay off staff or even shut their doors. Some that have already had to pull back care have cited the impact of the package as one of the reasons.
Trump and congressional Republicans say all these changes are meant to improve Medicaid and make sure it remains available for the most vulnerable Americans. They also argue that Medicaid should help enrollees become financially independent through work.
A store displays a sign accepting Electronic Benefits Transfer cards for Supplemental Nutrition Assistance Program purchases, in the Brooklyn borough of New York on January 2, 2026.
A store displays a sign accepting Electronic Benefits Transfer cards for Supplemental Nutrition Assistance Program purchases, in the
It’s now harder for Americans to obtain food assistance The “big beautiful bill” contained several provisions that are expected to reduce enrollment in the Supplemental Nutrition Assistance Program, or SNAP, the formal name for food stamps, by millions of people over the next decade. The package enacted the largest cuts to food stamps in the program’s history — nearly $200 billion over a decade, according to CBO.
In fact, enrollment has already fallen by more than 5 million people, or nearly 13%, between the law’s enactment in July 2025 and June, according to estimates from the left-leaning Center on Budget and Policy Priorities that are based on US Department of Agriculture data. At least 1.5 million of them are children.
While the GOP package is not the sole cause, it is a major factor, experts say.
New requirement could force states to pay Among the most consequential provisions is a requirement that states start shouldering a portion of the food stamp benefit for the first time if they have a high rate of payment errors. They could be on the hook for $9 billion collectively, according to CBPP. (Historically, the federal government funded SNAP benefits, while states administered the program.)
Though this measure doesn’t kick in until next October, states are being proactive in tightening their oversight and requiring more documentation from enrollees. This is leading to many people being dropped because of paperwork issues, experts say.
The “big beautiful bill” also broadened SNAP’s existing work requirements to certain adult enrollees through age 64, to parents with dependent children ages 14 and older and to veterans, homeless adults and youth who aged out of foster care. Plus, the package requires states pay more of the administrative costs and ended the eligibility of refugees, asylees, victims of domestic violence and certain other immigrants.
Major changes for student loans Both the “big beautiful bill” and Department of Education decisions are leading to a major overhaul of the federal student loan program. Many of the provisions kicked in on July 1, but others take effect in coming years.
Federal student loans are critical to many Americans’ ability to go to college or grad school. More than 42 million borrowers have student loans, totaling more than $1.7 trillion, according to the Federal Student Aid office.
The US Department of Education says the law’s reforms implement “commonsense loan limits,” simplify repayment options and improve the health of the federal student lending system. But critics worry that the program’s revamp will make it harder and more expensive for students to finance their education and to repay their loans afterwards.
One of the major changes involves paying back one’s loans. The law created a new tiered standard repayment plan and a new Repayment Assistance Plan, known as RAP.
These options only apply to students taking out new loans at the moment. Borrowers who are currently repaying loans won’t see any immediate changes in their options as a result of the “big beautiful bill,” but most will have to switch to one of the new plans or the Income-Based Repayment plan by July 2028.
Graduates celebrate their commencement during Towson University's winter ceremony in Towson, Maryland, on December 17, 2025.
Paying for grad school could become tougher for many Graduate school students will no longer be able to borrow up to the “cost of attendance” for their programs. Instead, they will face borrowing limits that depend on what they are studying. And the Grad PLUS loan is being eliminated.
In a very controversial move, the Education Department decided that certain healthcare studies — such as nursing, physician assistants and physical therapy — were not considered professional programs. That means students pursuing these careers will be more limited in their federal student loan borrowing. The decision spurred lawsuits, which are now working their way through the courts.
Also, parents will be limited in how much they can borrow to help their undergraduate students.
SAVE plan’s demise also affects borrowers Meanwhile, the Department of Education ended the Saving on Valuable Education (SAVE) plan — a Biden administration-era income-driven repayment plan that was blocked by federal courts in July. Borrowers are being given 90 days to switch into alternate plans, many of which may leave them with higher monthly payments.
SAVE’s demise has left many borrowers worried about how they’ll afford the higher monthly payments. One speech-language pathologist in California told CNN that she and her husband are reconsidering when — or whether — they can grow their family.