Since early 2025, the administration and its allies have made it harder for Americans to get health care. Their “One Big Beautiful Bill” piles on paperwork, adds new costs, shrinks who qualifies for ACA coverage, and could leave about 10 million more people uninsured. New Republican rules add fees and extra steps to re-enroll or use special enrollment in the marketplace; the agency says 750,000 to 2,000,000 people could lose coverage. They also cut by 90% the funding for helpers who guide families through sign-ups. On top of that, the government moved to stop enforcing a new mental-health rule that helped people get care.
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- On July 4, 2025, the One Big Beautiful Bill Act became Public Law 119-21, legislating major changes to Medicaid and the ACA marketplaces. (congress.gov)
- The law requires Medicaid expansion adults to file massive new paperwork burdens involving “community engagement” (work/education/service) of at least 80 hours, verified by states and not waivable, beginning no later than the first quarter after December 31, 2026. (congress.gov)
- The law mandates new costs on families for expansion enrollees over 100% of the federal poverty line beginning in FY2029. (congress.gov)
- The law restricts states’ ability to fund health care, barring federal matching for Medicaid provider taxes and by directing CMS to limit certain Medicaid state-directed payments to Medicare rates. (congress.gov)
- CBO projects the law will increase the number of people without insurance by about 10 million in 2034 and reduce federal spending on Medicaid and the marketplaces by roughly $1.06 trillion over 10 years. (aha.org)
- The law tightens ACA premium tax credit eligibility for immigrants, eliminating access for lawfully present immigrants under 100% FPL who are ineligible for Medicaid due to immigration status (effective Jan 1, 2026). (congress.gov)
- Beginning Jan 1, 2027, premium tax credits are limited to U.S. citizens, lawful permanent residents, Cuban/Haitian entrants, and COFA migrants; KFF estimates 1.4 million lawfully present immigrants will lose coverage due to these and related changes. (congress.gov)
¶ Trump and Republicans Added New Barriers, Paperwork, And Annoyance Try To Kick Families – Up To 2 Million People – Off Of Health Care
- Trump’s CMS finalized the 2025 “Marketplace Integrity and Affordability” rule adding a $5 monthly bill for auto-reenrolled $0-premium enrollees unless they confirm eligibility, eliminating the monthly SEP for ≤150% FPL, requiring pre-enrollment SEP verification, changing income verification to require documentation when IRS data are unavailable, and shortening the federal open enrollment period to Nov 1–Dec 15 starting in plan year 2027. (cms.gov)
- The rule removes DACA recipients from “lawfully present” eligibility for exchanges (cms.gov)
- CMS and AHA note the agency estimated 750,000–2,000,000 people could lose coverage due to the rule’s combined changes. (aha.org)
¶ The administration and republicans slashed funding, making it harder for families to sign up for health insurance coverage
- On Feb 14, 2025, Trump’s CMS reduced federal Navigator funding for FFE states from $100 million to $10 million per year, reversing recent investments in outreach and enrollment assistance. (cms.gov)
- KFF highlights that similar cuts in the prior Trump term produced staff layoffs and reduced outreach; it warns the new 90% cut will likely diminish enrollment and post-enrollment help. (kff.org)
- News coverage underscores Navigators’ role in Medicaid/CHIP and marketplace enrollments and the likely impact of the 90% cut on low-income communities. (axios.com)
¶ Trump And Republicans Engaged In A War To Make It More Difficult For Families To Access Reproductive Health Care
- Defunding Planned Parenthood Clinics: A 2025 provision blocks federal Medicaid payments for one year to nonprofit family planning providers that both perform abortions and received >$800,000 in Medicaid reimbursements in 2023; on Sept 11, 2025, an appeals court allowed the administration to block Medicaid funds to Planned Parenthood while litigation proceeds. (pbs.org)
- Maine Family Planning announced it would halt primary care services due to the Medicaid reimbursement ban’s financial impact, illustrating effects beyond abortion services. (apnews.com)
- On April 1, 2025, the administration began withholding about $66 million in Title X grants from Planned Parenthood and other providers, leaving several states without Title X funding and jeopardizing low-cost family planning services. (washingtonpost.com)
- In May 2025, the administration told a federal court it would stop enforcing—and may rescind—the new federal mental health parity rule for employer plans, weakening requirements intended to ensure equitable access to mental health and substance use care. (reuters.com)
¶ Republican Executive actions weakened public health institutions and capacity that support domestic health security
- Executive Order 14155 (Jan 20, 2025) directed U.S. withdrawal from the World Health Organization, revoked prior pandemic-response directives, paused future WHO funding, and recalled U.S. personnel. (federalregister.gov)
- Health policy experts warn that leaving WHO undermines global disease surveillance, vaccine coordination, and preparedness for threats such as avian influenza—reducing protective benefits for people in the U.S. as well. (healthaffairs.org)
- Reporting links concurrent U.S. foreign aid freezes/cuts to setbacks in global malaria control efforts, illustrating broader erosion of health capacity that can reverberate back to U.S. health security. (reuters.com)
- On September 30, 2025, the administration announced 100% tariffs on imported branded drugs and a “TrumpRx” deal highlighted by voluntary price cuts largely affecting Medicaid and a narrow set of products. (ft.com)
- Health policy experts noted that Medicaid already receives deep discounts, questioning real‑world savings for most consumers as tariffs threaten higher prices in commercial markets. (washingtonpost.com)
¶ The administration’s FY2026 budget aggressively sought to cuts and restructure NIH and NCI, slashing cancer research capacity
- HHS testimony requested only $27.5B for NIH (about a 40% cut from FY2025) while asserting NIH has “broken the trust of the American people,” signaling both reduced resources and hostile posture toward mainstream medical research. (hhs.gov)
- The White House budget preview outlined eliminating the National Institute on Minority Health and Health Disparities and other NIH components and consolidating programs. Universities warn these changes would upend U.S. research. (ofr.harvard.edu)
- The President’s budget would cut the National Cancer Institute to $4.531B—about 37% below its current funding.. (fightcancer.org)
- The National Cancer Institute confirms its FY2025 appropriation is $7.22B, underscoring the magnitude of the proposed reduction. (cancer.gov)
- CRS finds the budget would cut new NIH competing grants by 29% and reduce ARPA‑H from an estimated $1.5B to $945M, directly shrinking high‑risk cancer R&D. (congress.gov)
Brookings estimates NIH direct research funding would fall ~40%, with National Cancer Institute research grants down 38.6% and intramural research down 36% from 2025 levels. (brookings.edu)
- OMB’s January funding freeze created immediate uncertainty; courts intervened, while HHS also “indefinitely” blocked NIH Federal Register postings needed for peer‑review meetings—delaying grant awards—before partial reversals. (alston.com)
- The administration briefly halted NIH research funding via an OMB footnote restricting spending to salaries and facilities, pausing grants and contracts until public and congressional pressure forced a reversal. (washingtonpost.com)
- Reuters warned of “backdoor” cuts by delaying obligation of billions in health and education funds at fiscal year‑end—an executive tactic that can cancel congressionally approved spending. (reuters.com)
¶ A mandated 15% cap on NIH “indirect costs” would cripple the research infrastructure that enables cancer studies nationwide
- Trump’s NIH issued a policy capping indirect cost reimbursement at 15% for new and existing grants; a federal court imposed a nationwide preliminary injunction, but litigation continues. (congress.gov)
- 22 states and major institutions sued, with judges blocking the cuts amid warnings of layoffs, lab closures, and stalled clinical trials. (reuters.com)
- Universities and medical groups say the cap would gut support for labs, staff, patient operations, and compliance essential to cancer trials. (news.stanford.edu)
- Independent analyses estimate the cap would strip roughly $4B/year from institutional research infrastructure, triggering widespread layoffs and facility shutdowns. (embopress.org)
- Trump’s budget preview proposed eliminating NIMHD, directly shrinking research into cancer disparities and community‑based participation. (ofr.harvard.edu)
- CMS quietly dropped key health‑equity data requirements from the Enhancing Oncology Model, rolling back tools to integrate social determinants into oncology care. (ajmc.com)
NIH documents show health disparities impose enormous national costs, underscoring the stakes of cutting minority health research capacity. (nih.gov)
¶ Trump’s Politicization and downsizing of federal science weakened research into cancer causes
- Trump’s EPA eliminated its Office of Research and Development and began mass layoffs, reducing independent environmental health science that informs carcinogen regulation and cancer prevention. (apnews.com)
- Executive actions to reclassify civil servants (reviving Schedule F‑style authority) make it easier to purge career scientists and reviewers across agencies central to health research. (reuters.com)
- AP’s analysis shows EPA’s deregulatory push minimizes health benefits in rulemaking, risking increased pollution‑related morbidity and mortality that cancer research must confront. (ap.org)
¶ The Pediatric Brain Tumor Consortium (PBTC) was the only NCI-funded network dedicated solely to early-phase pediatric brain tumor trials and had a long track record of lifesaving research.
- The PBTC was formed by the National Cancer Institute (NCI) in 1999 to improve treatment of primary brain tumors in children through multi-center early-phase trials across leading hospitals in the U.S. and Canada. (pbtc.org)
- Leaders in the field note the PBTC was the only NCI-funded initiative focused exclusively on early-phase trials for children and young adults with brain tumors and has been pivotal since 1999. (braintumor.org)
- The Society for Neuro-Oncology warned that discontinuing PBTC funding endangers a cornerstone of pediatric brain tumor trial development. (soc-neuro-onc.org)
¶ In 2025, under the Trump administration, NCI announced it would end PBTC funding after March 2026 and began transitioning trials away from the network.
- NCI stated that, following its assessment, “the PBTC will not be able to apply for another 5-year funding award to continue its funding beyond March 2026,” with activities to be shifted into the Pediatric Early Phase Clinical Trials Network (PEP-CTN). (dctzd.cancer.gov)
- NCI’s transition page reiterates the PBTC will not be renewed beyond March 2026 and describes moving PBTC studies to PEP-CTN “wherever feasible and appropriate.” (dctd.cancer.gov)
- National media and trade coverage reported NCI was ending support for the 26-year-old PBTC, noting the network would be ineligible to seek renewed funding past March 2026. (fiercebiotech.com)
- PBS NewsWeekend reported that, in August 2025, the Trump administration announced it would stop supporting the federally funded PBTC beginning March 2026. (pbs.org)
- The PBTC told member institutions to stop enrolling new patients across six active trials after the federal funding decision; these included a CAR‑T cell trial for ependymoma. (beckershospitalreview.com)
- PBS reported that PBTC “paused enrollment in its ongoing clinical trials,” meaning “all new entries are on hold or suspended.” (pbs.org)
- The PBTC national vice chair confirmed the group lost NCI funding, would dissolve, and had “closed all trials to new enrollments.” (spectrumlocalnews.com)
- KQED reported that “enrollment in active studies was suspended” and “families who had waited months for a spot in those trials were told to go home,” with the PBTC chair adding, “Currently, there are no options for new patients.” (kqed.org)
- Elected officials documented that “terminal patients on waiting lists for these trials will no longer be able to enroll, and those currently enrolled may lose access… as studies are put on hold due to lack of funding.” (gillibrand.senate.gov)
- Clinicians at Children’s Hospital Colorado said trials at their PBTC site were affected and that this unpredictability is “stressful for families,” especially those whose children were already enrolled or awaiting opportunities. (kunc.org)
- Reporting based on the PBTC decision shows children were turned away from specific PBTC trials, including a HER2 CAR‑T study for recurrent ependymoma run across multiple PBTC centers, after new enrollment was halted. (beckershospitalreview.com)
- The New York Times–based reports emphasized that the paused PBTC trials included options for cancers with few or no effective standard treatments for children, underscoring the immediate, individualized impact on those waiting. (beckershospitalreview.com)
- KQED described identified families who had “waited months” for PBTC trial slots but were told to go home when enrollment was suspended, reflecting discrete, real-world harms to those children. (kqed.org)
- Pediatric cancer remains the leading cause of disease-related death for U.S. children, heightening the stakes of lost trial access. (reuters.com)
- Diffuse intrinsic pontine glioma (DIPG) remains almost uniformly fatal, with fewer than 10% of children surviving two years, so access to innovative early-phase trials is often the only path beyond palliative care. (news.weill.cornell.edu)
¶ Federal freezes and funding-withholding actions in 2025 disrupted rural safety‑net care
- In late January 2025, a White House-directed grant pause caused community health centers in at least 10 states to lose or delay access to federal funds—forcing some to shut down temporarily; CHCs serve more than 32 million people and about one in five rural Americans. (pbs.org)
- HHS withheld roughly $65.8 million in Title X grants beginning April 1, 2025, leaving seven states with no Title X–funded services and cutting off contraception, STI testing, and cancer screenings for hundreds of thousands of patients. (washingtonpost.com)
- State attorneys general warned HHS that the Title X freeze would reduce services and lead to clinic closures “fall[ing] particularly hard on poor and rural communities.” (portal.ct.gov)
- Title X grantees reported canceled appointments and halted services as funding was withheld, underscoring immediate access losses in rural states like Missouri and Montana. (mfhc.org)
¶ Administration moves in 2025 curtailed reproductive, family‑planning, and violence‑prevention services, which rural communities have fewer alternatives to replace
- A federal judge vacated the administration’s July 2025 policy that tied Teen Pregnancy Prevention grants to anti‑DEI and anti‑transgender directives, finding it vague and unlawful—after months of uncertainty for grantees serving low‑resource areas. (reuters.com)
- Another judge blocked the administration’s attempt to impose ideological conditions on domestic‑violence grants (including limits on DEI and abortion resource referrals), citing threats to essential services. (apnews.com)
- Rural communities face greater barriers to family‑planning care and IPV services than urban areas, so disruptions to these programs disproportionately harm rural health access. (jahonline.org)
¶ 2025 federal law and rules set in motion large Medicaid coverage losses that will hit rural residents and providers hardest
- The 2025 reconciliation law (H.R. 1) mandates 80‑hours‑per‑month Medicaid work requirements for expansion adults starting January 1, 2027 (or earlier at a state’s option), with limited exemptions, and bars those losing Medicaid for non‑compliance from Marketplace subsidies—driving substantial coverage losses. (congress.gov)
- Nearly one in four rural residents are covered by Medicaid, and expansion adults represent a large share of rural Medicaid enrollees—so work‑requirement‑driven losses will fall heavily on rural areas. (kff.org)
- Research shows Medicaid expansion improved rural hospital finances and reduced closures; conversely, large Medicaid cuts/work requirements threaten rural hospital viability and essential services like obstetrics. (kff.org)
- Hospital groups project that H.R. 1’s Medicaid provisions would cause 1.8 million rural residents to lose coverage and reduce federal Medicaid spending on rural hospitals by over $50 billion in 10 years, worsening an already fragile rural hospital landscape. (aha.org)
- On March 4, 2025, CMS rescinded federal guidance that enabled states to cover housing, nutrition, and related health‑related social needs (HRSN) under Medicaid, signaling a more restrictive, case‑by‑case approach going forward. (medicaid.gov)
- Analysts and provider groups warned the HRSN rescission will limit or complicate future state efforts to address rural drivers of poor health, like housing instability and food insecurity. (aamc.org)
- In July 2025, CMS announced it does not anticipate approving or extending new Section 1115 Medicaid workforce initiatives, curtailing state strategies to recruit and retain providers (including behavioral health and dental) in shortage areas common in rural America. (kff.org)
¶ Immigration and visa actions in 2025 disrupted the rural physician pipeline
- In May–June 2025, State Department actions paused J‑1 visa interview scheduling (later partially eased), prompting the NRMP to warn residencies about delayed starts or deferrals—affecting international physicians who often staff rural shortage areas. (nrmp.org)
- The American Academy of Family Physicians objected to proposed visa changes (limits on J‑1 duration and a new $100,000 H‑1B fee), warning they would “jeopardize patient care and the primary care workforce,” which rural communities rely on. (aafp.org)
- Empirical studies show international medical graduates placed via the Conrad 30 program serve rural and underserved areas in significant numbers, making visa slowdowns and new barriers acutely harmful to rural access. (jamanetwork.com)
¶ 2025 ACA marketplace policy shifts reduce enrollment help and raise barriers that rural consumers are least equipped to overcome
- CMS cut federal Navigator funding to $10 million for 2025 (about a 90% reduction from the prior year), shrinking enrollment assistance that rural consumers often need due to connectivity, literacy, and travel barriers. (cms.gov)
- The 2025 Marketplace Integrity and Affordability rule shortens open enrollment for federal‑platform states beginning in 2027 and tightens verification and other requirements through 2026—changes experts and state AGs warn will reduce coverage. (cms.gov)
- Prior evidence shows that cutting navigator/outreach resources increases confusion and reduces enrollment, with rural residents particularly affected by diminished in‑person help. (ccf.georgetown.edu)
¶ Public‑health capacity was weakened by 2025 freezes and layoffs, undermining support on which rural communities depend
- HHS ordered a broad pause on agency communications and publications in January 2025 (including CDC’s MMWR), and congressional letters documented canceled meetings and blocked data releases—impeding public‑health guidance and support. (usnews.com)
- During the October 2025 shutdown, mass layoffs at CDC and HHS further eroded federal public‑health capacity that states and rural localities depend on for disease surveillance, vaccination policy, and emergency response. (politico.com)
¶ Administration moves in 2025 curtailed reproductive, family‑planning, and violence‑prevention services, which rural communities have fewer alternatives to replace
- A federal judge vacated the administration’s July 2025 policy that tied Teen Pregnancy Prevention grants to anti‑DEI and anti‑transgender directives, finding it vague and unlawful—after months of uncertainty for grantees serving low‑resource areas. (reuters.com)
- Another judge blocked the administration’s attempt to impose ideological conditions on domestic‑violence grants (including limits on DEI and abortion resource referrals), citing threats to essential services. (apnews.com)
- Rural communities face greater barriers to family‑planning care and IPV services than urban areas, so disruptions to these programs disproportionately harm rural health access. (jahonline.org)
- As of early 2025, 46% of rural hospitals were operating at a loss and 432 were vulnerable to closure, with many communities already facing “care deserts.” Policies that cut coverage or funding exacerbate this fragility. (chartis.com)