Instant Insight

30-Second Take

• Medicaid marks 60 years as Trump’s OBBBA slashes $1 trillion in funding
• Dual eligibles (seniors/disabled) face greatest risk from cuts
• States may reduce long-term care services first

Quick Brief

2-Minute Digest

Essential Context

Medicaid, created in 1965 to provide healthcare for low-income Americans, now faces its greatest threat in decades. President Trump’s One Big Beautiful Bill Act (OBBBA) reduces Medicaid spending by $1 trillion over 10 years, risking care for 71.4 million enrollees and 68.6 million Medicare beneficiaries.

Core Players

• Donald Trump – President who signed OBBBA into law
• AFSCME – Union fighting Medicaid/Medicare protections
• Dual eligibles – 12.8 million seniors/disabled relying on both programs
• CMS – Federal agency overseeing Medicare/Medicaid

Key Numbers

• 71.4M – Medicaid enrollees (Jan 2025)
• 68.6M – Medicare enrollees
• $1T – Medicaid spending reduction over 10 years
• 12.8M – Dual eligibles (Medicare + Medicaid)
• 38% – U.S. population relying on these programs

Full Depth

Complete Coverage

The Catalyst

“This law is as ugly as it gets,” said AFSCME, warning of higher costs and reduced services. The OBBBA passed earlier this month, coinciding with Medicaid’s 60th anniversary celebrations.

President Trump signed the bill despite opposition from healthcare advocates, framing it as fiscal responsibility.

Inside Forces

Medicaid’s structure leaves states vulnerable to funding cuts. The OBBBA targets technical provisions like provider taxes and state-directed payments, forcing tough budget decisions.

Long-term care – nursing homes and home health services – may be first to face reductions, as these services account for one-third of Medicaid spending.

Power Dynamics

AFSCME and Governor Healey (MA) lead opposition efforts, pledging to protect healthcare access. CMS Director Chris Klomp claims the law strengthens support for dual eligibles, though critics dispute this.

States with large dual eligible populations face particular challenges in maintaining care quality.

Outside Impact

Medicaid cuts could disproportionately affect rural areas and communities of color. Advocacy groups warn of increased emergency room visits and delayed care.

Long-term care providers fear workforce shortages and facility closures if funding dries up.

Future Forces

States will likely implement tiered service reductions:

• Phase 1: Limiting long-term care options
• Phase 2: Reducing home health services
• Phase 3: Restricting eligibility criteria

Data Points

• 1965: Medicaid established under LBJ
• 2025: OBBBA signed into law
• 2024: 12.8M dual eligibles
• 38%: U.S. population on Medicaid/Medicare
• 1/3: Medicaid spending on long-term care