NHC Reconciliation Letter to Congress on One Big Beautiful Bill Act (PDF)
June 24, 2025
The Honorable John Thune The Honorable Chuck Schumer
Majority Leader Minority Leader
United States Senate United States Senate
Washington, DC 20510 Washington, DC 20510
Dear Senator Thune and Senator Schumer:
The National Health Council (NHC) is deeply disappointed that the One Big Beautiful Bill Act (H.R.1) fails to address and, in fact, exacerbates concerns about Medicaid cuts, which will negatively impact people with chronic diseases and disabilities. It will also negatively affect access to coverage and care for people that obtain their health coverage through the ACA Marketplace and Medicare. The Congressional Budget Office (CBO) estimates that this bill and the failure to extend ACA tax credits would result in almost 16 million people becoming uninsured.
For more than 100 years, the NHC has engaged diverse organizations to drive patient- centered health policies and practices that increase access to affordable, high-value, and sustainable health care for all Americans. The NHC’s membership is composed of 180 national health-related organizations, the majority being the nation’s leading patient organizations. Other members include health related associations and nonprofit organizations including the provider, research, and family caregiver communities; and businesses representing biopharmaceutical, device, diagnostic, generic drug, and payer organizations.
The Essential Role of Medicaid
The NHC recognizes the critical role Medicaid plays in the lives of one in four Americans. For many people with chronic diseases and disabilities, Medicaid serves as their sole source of health coverage offering access to comprehensive and affordable care that enables individuals to manage complex health needs, maintain their quality of life, and live independently in their communities.
People with disabilities enrolled in Medicaid often have complex needs, managing both functional impairments and serious health conditions such as diabetes, obesity, mental illness, and age-related diseases like Alzheimer’s.
Consequences of Proposed Cuts
Many of the Medicaid cost-savings options included in the budget reconciliation agreement would transfer costs to patients or to the states, directly reducing the availability of care and the number of people eligible for coverage1. The consequences of these cuts could be devastating.
These cuts would place a significant burden on states attempting to maintain current coverage levels, as most lack the resources to make up for the substantial federal funding reductions under consideration. The proposed reconciliation bill heightens the risk that millions of Americans will lose access to care and coverage by shifting even more Medicaid costs to the states. As state budgets are constrained by provisions such as stricter limits on provider taxes, they will be forced to make difficult decisions that could include restricting eligibility or limiting access to critical services. People with chronic conditions rely on many of the services that are optional for states and therefore the first to be cut under budget pressures.
In addition, substantial evidence indicates that cuts to Medicaid lead to increased costs for hospitals and emergency rooms, primarily due to a rise in uncompensated care.
Medicaid provides 60% of all paid care for people with disabilities and is the largest funder of mental health, substance use disorder services, and long-term services and supports. Its role in long-term care is especially significant, covering $3 of every $4 spent on nursing facility care, compared to about 20% of hospital care and 10% of clinician services2.
Concerns with Policy Proposals
While many proposals are framed as efforts to reduce waste, fraud, and abuse, the reality is that they would result in significant loss of coverage and services for those most in need. For instance, work reporting requirements impose additional administrative burdens and have been shown to cause eligible individuals to lose coverage. Among adults under age 65 with Medicaid not receiving Supplemental Security Income (SSI) and/or Social Security Disability Insurance (SSDI), and not covered by Medicare, 92% are either working (64%), caregiving, in school, or unable to work due to illness or disability3. Projected savings from such policies would result from people losing access, not from increased efficiency.
Another example of problematic policy for patients is the proposal to delay implementation, administration, or enforcement of the final rule titled “Medicaid
Program; Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes” until January 1, 2035.The purpose of this rule is to clarify and provide support for the process of enrolling and seeking coverage that is needed by people with chronic diseases and disabilities, and its delay will result in increased barriers to access for people eligible for Medicaid. Approximately 60% of the uninsured population are eligible for Medicaid or subsidized plans in the Marketplace but are not enrolled in these programs4.
The NHC urges you to reject cuts to Medicaid. These proposals would have long- term, harmful impacts on people with chronic diseases and disabilities.
Thank you for your attention to this critical issue. Please contact Kimberly Beer, Senior Vice President, Policy & External Affairs at kbeer@nhcouncil.org or 202-557-9146 with any questions or request for additional information.
Sincerely,
Randall L. Rutta
Chief Executive Officer
1 cbo–emails–re–e&c–reconcilation–scores–may–11,–2025.pdf
2 The Potential Impacts of Cuts to Medicaid | Johns Hopkins | Bloomberg School of Public Health
3 Understanding the Intersection of Medicaid and Work: An Update | KFF
NHC Reconciliation Letter to Congress on One Big Beautiful Bill Act (PDF)
June 24, 2025
The Honorable John Thune The Honorable Chuck Schumer
Majority Leader Minority Leader
United States Senate United States Senate
Washington, DC 20510 Washington, DC 20510
Dear Senator Thune and Senator Schumer:
The National Health Council (NHC) is deeply disappointed that the One Big Beautiful Bill Act (H.R.1) fails to address and, in fact, exacerbates concerns about Medicaid cuts, which will negatively impact people with chronic diseases and disabilities. It will also negatively affect access to coverage and care for people that obtain their health coverage through the ACA Marketplace and Medicare. The Congressional Budget Office (CBO) estimates that this bill and the failure to extend ACA tax credits would result in almost 16 million people becoming uninsured.
For more than 100 years, the NHC has engaged diverse organizations to drive patient- centered health policies and practices that increase access to affordable, high-value, and sustainable health care for all Americans. The NHC’s membership is composed of 180 national health-related organizations, the majority being the nation’s leading patient organizations. Other members include health related associations and nonprofit organizations including the provider, research, and family caregiver communities; and businesses representing biopharmaceutical, device, diagnostic, generic drug, and payer organizations.
The Essential Role of Medicaid
The NHC recognizes the critical role Medicaid plays in the lives of one in four Americans. For many people with chronic diseases and disabilities, Medicaid serves as their sole source of health coverage offering access to comprehensive and affordable care that enables individuals to manage complex health needs, maintain their quality of life, and live independently in their communities.
People with disabilities enrolled in Medicaid often have complex needs, managing both functional impairments and serious health conditions such as diabetes, obesity, mental illness, and age-related diseases like Alzheimer’s.
Consequences of Proposed Cuts
Many of the Medicaid cost-savings options included in the budget reconciliation agreement would transfer costs to patients or to the states, directly reducing the availability of care and the number of people eligible for coverage1. The consequences of these cuts could be devastating.
These cuts would place a significant burden on states attempting to maintain current coverage levels, as most lack the resources to make up for the substantial federal funding reductions under consideration. The proposed reconciliation bill heightens the risk that millions of Americans will lose access to care and coverage by shifting even more Medicaid costs to the states. As state budgets are constrained by provisions such as stricter limits on provider taxes, they will be forced to make difficult decisions that could include restricting eligibility or limiting access to critical services. People with chronic conditions rely on many of the services that are optional for states and therefore the first to be cut under budget pressures.
In addition, substantial evidence indicates that cuts to Medicaid lead to increased costs for hospitals and emergency rooms, primarily due to a rise in uncompensated care.
Medicaid provides 60% of all paid care for people with disabilities and is the largest funder of mental health, substance use disorder services, and long-term services and supports. Its role in long-term care is especially significant, covering $3 of every $4 spent on nursing facility care, compared to about 20% of hospital care and 10% of clinician services2.
Concerns with Policy Proposals
While many proposals are framed as efforts to reduce waste, fraud, and abuse, the reality is that they would result in significant loss of coverage and services for those most in need. For instance, work reporting requirements impose additional administrative burdens and have been shown to cause eligible individuals to lose coverage. Among adults under age 65 with Medicaid not receiving Supplemental Security Income (SSI) and/or Social Security Disability Insurance (SSDI), and not covered by Medicare, 92% are either working (64%), caregiving, in school, or unable to work due to illness or disability3. Projected savings from such policies would result from people losing access, not from increased efficiency.
Another example of problematic policy for patients is the proposal to delay implementation, administration, or enforcement of the final rule titled “Medicaid
Program; Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes” until January 1, 2035.The purpose of this rule is to clarify and provide support for the process of enrolling and seeking coverage that is needed by people with chronic diseases and disabilities, and its delay will result in increased barriers to access for people eligible for Medicaid. Approximately 60% of the uninsured population are eligible for Medicaid or subsidized plans in the Marketplace but are not enrolled in these programs4.
The NHC urges you to reject cuts to Medicaid. These proposals would have long- term, harmful impacts on people with chronic diseases and disabilities.
Thank you for your attention to this critical issue. Please contact Kimberly Beer, Senior Vice President, Policy & External Affairs at kbeer@nhcouncil.org or 202-557-9146 with any questions or request for additional information.
Sincerely,
Randall L. Rutta
Chief Executive Officer
1 cbo–emails–re–e&c–reconcilation–scores–may–11,–2025.pdf
2 The Potential Impacts of Cuts to Medicaid | Johns Hopkins | Bloomberg School of Public Health
3 Understanding the Intersection of Medicaid and Work: An Update | KFF