From Medicaid to ICE: How Trump’s Landmark Bill Reshapes America

Described by Mike Johnson as “a key cornerstone of America’s new golden age” and by the White House as “a once-in-a-generation piece of legislation,” the so-called “One Big Beautiful Bill” (OBBB) passed by Congress this July is notable for the ways in which it both fulfills and contradicts the promises President Trump made on the campaign trail. The bill was signed into law on July 4, after narrowly passing through both the House of Representatives and the Senate along party lines. 

With its nearly 1000 pages, this bill represents the core of President Trump’s domestic policy agenda. Its many provisions include extending the 2017 Tax Cuts and Job Act, limiting the availability of federal student loans, reducing incentives for clean energy investment, funding a new missile defense system and implementing a no tax on tips policy until 2028. This article will hone in on three provisions in the bill that are particularly detrimental to the lives of vulnerable Americans: reducing eligibility for Medicaid, cutting funding for food assistance programs and expanding the budget for Immigration and Customs Enforcement (ICE). 

“We’re Not Cutting Medicaid”:

Although Trump claimed repeatedly on the campaign trail that “we’re not cutting Medicaid,” the One Big Beautiful Bill Act (OBBBA) does just that. Medicaid, occasionally confused with Medicare, is a federal entitlement program aimed at providing health coverage to those who can’t afford it. As of January 2025, Medicaid provided health coverage to more than 70 million people, including children in low or moderate income families, parents with very low incomes, pregnant people with low or moderate incomes and people with disabilities. In addition to the aforementioned groups that are automatically entitled to Medicaid coverage, the Affordable Care Act (ACA) of 2010 provided incentives — in the form of temporary funding increases — for states to voluntarily expand Medicaid coverage to include all low-income adults.

The ACA expansion to Medicaid was a key target of the cuts within the OBBBA, which requires people eligible through the expansion to meet new work requirements, mandates state-level eligibility checks every six months (as opposed to only once a year) and eliminates the incentives for new states to adopt the expansion. The White House claims that these new restrictions — particularly the work requirement — are aimed at “[s]trengthening Medicaid by eliminating waste, fraud, and abuse.” However, this stated goal is disingenuous, as nearly two thirds of adults with Medicaid coverage already work, and those that don’t are largely disabled, caring for family members or going to school. 

And yet, many of those qualified individuals will lose coverage under the OBBBA, not because they aren’t working, but because of the added bureaucratic burden of proving their eligibility twice a year. One study found that, because of the work requirement alone, an estimated 10 to 15 million people will be at risk of losing their coverage by 2034, many of whom are qualified to receive benefits even under the OBBBA. What this estimate fails to account for, however, is one of the crucial second order effects of the OBBBA: making healthcare less accessible even to individuals who are not on Medicaid. 

The combination of several different provisions in the OBBBA is estimated to cause a more than $135 billion decrease in federal Medicaid spending on rural hospitals throughout the next decade. Considering that almost half of rural hospitals are already operating at a financial loss, many experts assert that the OBBBA’s Medicaid cuts will place over 300 rural hospitals at immediate risk of closure. Illinois is among the states most dramatically affected, as our hospitals are projected to lose more than 19% of their federal funding, putting nine rural hospitals at risk of closure and “jeopardizing care for 54,000 rural Illinoisans,” according to Governor Pritzker. 

Although the bill does include a short-term relief fund to help keep these hospitals afloat, the fund is woefully inadequate in supplementing the cuts, as it will only offset about a third of hospitals’ estimated losses and will expire after six years, while many of the cuts are intended to be permanent. Considering that more than 60 million people in the U.S. rely on rural hospitals — only about a fourth of whom are on Medicaid — and nearly a third of those hospitals could soon face closures, it is likely that the OBBBA will cause countless Americans to lose access to healthcare, regardless of their insurance. 

The (Potential) Death of SNAP:

While cuts to Medicaid have been front and center in debates about the “One Big Beautiful Bill” for months, one of the less-discussed — but equally destructive — portions of the bill is its massive cuts to the Supplemental Nutrition Assistance Program (SNAP). SNAP, once known as the Food Stamp Program, is a nutritional support program for low-income households, which provides money on a scaled basis that can be used to purchase most types of food. Based on the assumption that eligible families should spend 30% of their net income on food, SNAP pays the difference between a family’s expected contribution and the cost of the Thrifty Food Plan (TFP), a USDA diet plan designed to be both healthy and affordable.

The OBBBA will cut SNAP spending by approximately $186 billion throughout the next decade. In part, these cuts will operate similarly to those of Medicaid, by expanding 80-hour-a-month work requirements to adults as old as 64, including parents with minor children older than fourteen. Under previous law, adults over 54 and adults with dependent children were exempt from this requirement. As with the Medicaid work requirements, this change means that more than 10 million people will be at risk of losing at least a portion of their benefits, with no evidence that the new rules will actually increase employment. 

However, heightened eligibility requirements are far from the only way in which the OBBBA threatens SNAP. The OBBBA also made a key change to the Thrifty Food Plan, which is required under the 2018 Farm Bill to be reviewed and updated every five years, in order to ensure that the TFP does not fall out of step with modern lifestyles. Counter to this aim, the OBBBA requires that all future updates to the TFP be cost neutral. This effectively prevents the USDA from making meaningful changes to the TFP, even when needed — and they desperately are. County-level food prices reveal that, as of 2024, the maximum SNAP benefit failed to cover the cost of a modestly priced meal in 99% of counties, falling short of monthly meal costs by more than $50. The OBBBA’s budget neutrality requirement makes it effectively impossible to fix this problem, or any others that may arise as our lived realities continue to change. 

Perhaps an even bigger threat to SNAP, however, is the fact that the OBBBA — for the first time ever — requires states to cover a portion of the cost for SNAP payments. Most state budgets will simply be incapable of supporting these costs. Forty states were already projecting short- and long-term fiscal losses even prior to the passage of this bill. Thus, this new provision in the OBBBA all but guarantees that states will have to cut spending for other programs in order to continue providing SNAP benefits at current levels. Or, alternatively, the OBBBA allows states to opt out of SNAP entirely, depriving the most vulnerable American families of the resources they rely on to survive.

Considering all of these provisions in tandem, studies have estimated that more than 22 million families are going to lose some or all of their SNAP benefits due to this bill. Among these families, more than 3 million people under 65 will lose access to SNAP entirely, which will cause the deaths of more than 90,000 people between now and 2039. 

The Unprecedented Expansion of ICE:

Despite these devastating cuts to the social safety net, the Congressional Budget Office estimates that the “One Big Beautiful Bill” will actually increase the budget deficit by $3.4 trillion over the next ten years — directly contradicting Trump’s repeated promises to lower the deficit. Though this is largely a result of the extensive tax cuts contained within the bill, $170 billion of this deficit spending is reportedly directed towards immigration enforcement and border security. 

$170 billion may seem like a drop in the bucket in reference to a $3.4 trillion deficit, but experts claim that this funding will make ICE the biggest federal law enforcement agency in existence, with an annual budget larger than that of the FBI, Drug Enforcement Administration and U.S. Marshals Service combined. Though precise numbers are difficult to find, some have even estimated that the ICE budget will now rival that of several world militaries, including the Israeli Defense Force. 

The budget increase for ICE includes $45 billion for constructing new immigrant detention centers, to use at their discretion across the next 51 months. This makes ICE’s annual detention budget roughly 300% higher than in 2024 and more than $5 billion larger than the entire Federal Bureau of Prison’s budget. This comes at a time when ICE has faced increasing scrutiny — and lawsuits — over the inhumane conditions of these detention facilities, with a report by Senator Jon Ossoff’s office identifying 510 credible reports of human rights abuses in immigration detention. Moreover, the bill explicitly approves the use of so-called “family residential centers” for the long-term or indefinite detention of children, a practice proven to have severe consequences for childhood development and mental health.  

Also included in the OBBBA is a lump-sum payment of approximately $30 billion for ICE’s enforcement and deportation operations, including funding to hire 10,000 new ICE officers across the next five years. According to experts at the National Immigration Law Center, the bill is written “to provide maximal flexibility…to use enforcement funds with little to no oversight.” Prior examples have shown that when agencies are pushed to massively increase hiring in a short period of time, effective vetting of applicants becomes virtually impossible. For example, when President Bush tried to double the number of Border Patrol agents following 9/11, he allowed the agency to be infiltrated by drug cartels and even hired a future serial killer. 

In trying to lessen the budget deficit caused by these investments, at least partially, the OBBBA further increases the burden on immigrants trying to come here legally, through drastically increasing application fees, including a fee to apply for asylum. By increasingly transforming our immigration process into a pay-to-play system, the Trump administration reveals a broader pattern within their “Big Beautiful Bill.” Behind all of the previsions described in this article is an indifference — or even hostility — towards the needs of our most vulnerable populations, whether it be young adults covered by Medicaid, low-income families reliant on SNAP, or asylum seekers desperate for safety. So yes, the OBBBA is “a key cornerstone” of the age we now live in, but perhaps not in the way Mike Johnson meant.