Medicaid and Children’s Health Insurance Program (CHIP) cover 73 million Americans, or 1 in 5.1 As of October 1, a group of people who were legally invited to this country is no longer among them.
Here is how we got here. On July 4, 2025, President Trump signed the One Big Beautiful Bill Act (OBBBA) into law.2 OBBBA enacts a sweeping package of tax breaks for households and businesses along with increased funding for immigration enforcement and defense.3 These changes are partially being funded by cuts in several areas, which include higher education financing, clean energy incentives, and social safety net programs such as Medicaid.4
OBBBA projects reductions in Medicaid spending by $1 trillion over the next decade.5 The Congressional Budget Office estimates that the new law will increase the number of people who are uninsured in 2034 by 10 million.6
Medicaid is a ‘foundational pillar of the American healthcare system’7 and a crucial source of free or low-cost health coverage for low-income families, pregnant women, children, low-income seniors, and people with disabilities. With staggered rollout dates, one of the law’s provisions went into effect on October 1, 2026, imposing restrictions on eligibility for Medicaid, CHIP, and coverage through the Affordable Care Act for legally present non-U.S. citizens.7
Individuals losing eligibility for Medicaid include lawfully present refugees, asylees, humanitarian parolees, and survivors of human trafficking.8 Those remaining eligible include legal permanent residents such as green card holders. The Trump Administration asserts that the new law protects and strengthens Medicaid for those who rely on it most by eliminating fraud, waste, and abuse by restricting “illegal aliens.”9 The administration frames the cuts as targeting illegal immigration, yet people who are losing coverage are those who are here legally.
Historically, refugees have benefited from established pathways to healthcare in the U.S. upon arrival. However, the new law removes this safety net and leaves refugees and other vulnerable groups in limbo. Refugees arrive with untreated medical conditions, and many do not have family support to fall back on, nor employer-sponsored health coverage.8 Those costs are being shifted to families themselves, to hospitals that will bear the burden of treating people who present with late-stage conditions, and to state governments. In California, nearly 148,000 immigrants are expected to lose coverage, and the state will have to use its own money to keep families covered, at least in the short term.10 States will also have to redetermine eligibility more often and will have to ration the provision of coverage more intensely by tightening enrollment and offering fewer covered services.
The ‘One Big Beautiful Bill’ is…beautiful for whom? Its provisions for refugees and other vulnerable groups are far from beautiful. The new law will increase costs and harm public health rather than reduce waste. What can realistically be done? Resettlement agencies, clinicians, and various healthcare providers all need to play a stronger role in supporting continuity of care though alternative coverage pathways and safety-net services.11
Dr. Alemi is a Professor in the Department of Social Work & Social Ecology. He teaches courses in statistics along with qualitative and quantitative research methods. His research interests include global mental health, namely, investigating the psychosocial needs of populations affected by war and conflict.