The “One Big Beautiful Bill” Act —a trillion-dollar, Trump-era tax-and-spending package that both extends tax cuts, creates new worker deductions, and makes sweeping cuts to health care and social safety net programs—passed both chambers of Congress in July 2025 and was promptly signed into law by the President. Just weeks later, the Congressional Budget Office (CBO) scored the legislation to measure its impact on the federal budget and society.
In its final report released in mid‑July, CBO found that the new law will add $3.4 trillion to the federal deficit from 2025 to 2034, and result in about 10 million Americans losing health insurance coverage by 2034.
1. What Is the “One Big Beautiful Bill” Act?
Known as the “One Big Beautiful Bill” (or OBBBA for short), the measure was a hodgepodge of tax, spending, and policy changes. The bill permanently extended major parts of the 2017 Tax Cuts and Jobs Act, created new overtime and tip deductions, and advanced phase‑outs of clean energy credits. It also implemented large cuts to Medicaid, nutrition assistance, and other social safety net programs to partially offset lost revenue from the tax cuts.
Over the course of several weeks before final passage, the CBO’s estimated impacts changed. The early scores showed $2.4 trillion of added deficit and nearly 11 million fewer Americans insured. After Senate revisions and negotiations, the final tallies came in at around $3.4 trillion in added debt and nearly 10 million Americans losing coverage .
II. CBO’s Key Findings
a. Costs: $3.4 trillion over 10 years
The CBO and Joint Committee on Taxation estimate that the law would add $3.4 trillion to federal deficits from 2025 to 2034 – using both static and dynamic scoring methods and taking into account changes to the bill late in the legislative process.
Primary contributors to this cost are:
- Extending tax cuts for individuals and corporations.
- Accelerating the phaseout of tax incentives for green energy, which lessens expected revenue from that sector.
- Increased funding for defense and immigration enforcement.
b. Coverage Losses: 10 Million More Uninsured
The bill has substantial Medicaid cuts and new eligibility restrictions. Specifically:
- Work or volunteer requirements for Medicaid recipients – an estimated 326 billion over 10 years to reduce enrollment.
- Freeze on provider taxes used to pay for Medicaid operations (~191 billion in savings).
- Cut state-directed Medicaid payments to slow the growth of the program (~149 billion).
Under the new law, over 10 million Americans will become uninsured by 2034, a slight improvement over previous estimates of 10.9 or 11.8 million, due to the removal of provisions that would have reduced coverage for undocumented immigrants .
c.Net Changes: Medicaid Savings, Public Health Risk
Even though the bill decreases federal health care spending by more than $1.05 trillion over the 2025‑2034 period, the deficit balloons due to tax cuts and increased spending in other sectors.
Aside from the numbers, the reductions in coverage and spending cuts will probably disproportionately hurt low-income people, rural hospitals, and marginalized communities.
III. Political and Public Reactions
🎯 Public Sentiment & Political Divisions
Polls indicate that the overall public response is more negative than positive: according to a Wall Street Journal‑NORC poll, Americans say by a 70% to 26% margin that the bill helps the rich more than the middle and lower classes, and 42% approve while 52% disapprove of the law overall
At the same time, deficit hawks are highlighting the law’s lack of attention to fiscal sustainability, while proponents tout the growth and relief it will bring in future years.
Democrats are using the CBO’s score to point to the law’s regressive tax system and impact on health care. Former Senate Minority Leader Chuck Schumer said the bill was a “big, ugly betrayal” that will bring “net harm to working families”
Republicans are touting the new tax deductions for tips, overtime pay, and auto financing and focusing on the provisions that they say will benefit seniors and working class taxpayers, even as they continue to argue among themselves over the bill’s Medicaid and immigration provisions
Impacts on Hospitals and Communities
The Guardian has described major impacts on hospitals, particularly in rural areas: “Pemiscot Memorial Hospital in Fulton, Mo., is on the verge of closing, according to officials, who say the hospital takes in about 80% of its revenue through federal programs that are being slashed by the bill. “There will be destabilization across the country in medically underserved communities,” said leaders in community health.”
IV. Why It Matters: Fiscal Trends & Public Health
The legislation’s impacts on the fiscal path of the U.S. and on the landscape of the country’s health care safety net could be particularly significant if implemented on a national scale.
National fiscal path: Deficits increasing by $3.4 trillion from this legislation would further accelerate growth in the federal debt and may result in increased borrowing costs for the government and credit markets.
Coverage gap: Even relatively small reductions in Medicaid and ACA Marketplace enrollment could lead to cost shifting to providers, increases in uncompensated care, and other broader impacts.
Midterm election talking point: The bill is likely to become a major talking point in the 2026 midterm elections, as candidates and voters balance the cost of lost healthcare benefits against lower taxes
V.Looking Forward
Opposition to healthcare credits: Congress is already negotiating on Affordable Care Act tax credits that would otherwise expire, and lead to an additional 4‑5 million without coverage.
Pushback from states: Some states may counter by expanding their own coverage or supporting providers, but the funds are far from unlimited.
Eyeing the bottom line: With bond yields and other economic indicators reacting to ballooning national debt, the legislation could change the federal budget decades down the line.
The Congressional Budget Office’s (CBO) July 2025 report forecasts 10 million additional uninsured Americans and $3.4 trillion in increased debt from the “One Big Beautiful Bill” Act. The bill’s implications for healthcare access, fiscal stability, and political momentum will probably continue to dominate headlines in the coming months.
At SG INC CPA, we don’t just keep up with tax law changes—we help you get ahead. Whether you’re a doctor, investor, or business owner, we tailor smart tax strategies to your needs. With major laws like the One Big Beautiful Bill Act, the right CPA can help you avoid overpaying and stay fully compliant.
Book a consultation today—we’ll show you what the new rules mean and how to save the right way.
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