Potential health impacts of the ‘big beautiful bill’

JessicaRodriguezRivas, CC BY-SA 4.0, via Wikimedia Commons

U-M experts weigh in on the health-and financial-implications of cutting, changing Medicaid, Medicare, SNAP, Affordable Care Act

As the U.S. Senate debates the One Big Beautiful Bill Act of 2025, University of Michigan experts are available to discuss elements of the proposed spending plan that stand to leave a mark on health, health care and public health.

The bill calls for substantial funding cuts or new requirements for Medicaid, Medicare, the Supplemental Nutrition Assistance Program, or SNAP, the Affordable Care Act and other health-related and safety net programs used by millions of people across the country.

Kate Bauer, associate professor of nutritional sciences at the School of Public Health, has researched and worked extensively with urban and rural populations to understand hunger and programs meant to alleviate it.

Kate Bauer

"The dramatic federal cuts to SNAP will hurt our children, our neighbors and the economy," she said. "Every dollar that a SNAP user spends to buy food supports local businesses and food producers. The budget proposal takes billions of dollars from our communities only to make the most rich in our country even richer.

"SNAP is one of the most effective strategies we have in the U.S. to bring families out of poverty and ensure that children have food. Study after study has shown that this program is not wasteful and there is extremely little waste or fraud. Families on SNAP work so hard to make ends meet, especially with our current high food prices. There is no doubt that children will suffer when SNAP is cut."

Bauer's Feeding Michigan Families project and video

Contact: [email protected]

Renuka Tipirneni is an associate professor of internal medicine at the Medical School and of health management and policy at the School of Public Health.

Renuka Tipirneni

"Medicaid cuts of this scale will cause millions of people to lose coverage, including those who are eligible but have difficulty keeping up with frequent and onerous paperwork requirements," she said. "Our research has found that Medicaid is associated with improved health and fewer deaths, as well as improvements in people's personal financial situation and the larger state economy. Medicaid loss will likely lead to reversal of these positive health and economic benefits."

As for work requirements, "our research shows that most people with Medicaid are already working or in school, and those who aren't working have significant health limitations and family caregiving responsibilities. Prior state work requirements did not increase the number of people working, but did increase the number of people who are uninsured," Tipirneni said.

Additionally, claims of Medicaid waste can't be substantiated, she said.

"The Medicaid program has the lowest administrative costs of any health insurance program in the nation, at under 5%. Policies aimed at eliminating waste will find an already efficiently operated program with nothing to cut but eligibility and benefits to vulnerable Americans. I worry about how Medicaid funding cuts will affect older adults and people with disabilities, who rely on Medicaid coverage for important services such as mobility equipment and home health care services that help keep people healthy and living in their homes."

Contact: Kara Gavin, [email protected]

Minal Patel, professor of health behavior and health equity at the School of Public Health, studies how the financial burden of chronic illness affects people's ability to manage diabetes. In a recent study, she found a striking pattern.

Minal Patel

"Nearly 1 in 4 people spent more than $300 a month just to manage their diabetes. That's what many households pay for heat and electricity, or to keep a car running," she said. "These aren't luxuries; they're basic needs competing with life-sustaining care."

Medications, special foods, doctor's visits and blood glucose supplies are the biggest expenses for the 30 million Americans with diabetes, a number expected to double in coming decades, Patel said. About 10% of Medicaid enrollees have diabetes and millions rely on SNAP to survive, she said. Moreover, managing diabetes costs the U.S. as a whole more than $400 billion a year.

The proposed Medicaid and SNAP cuts could dismantle the supports that keep people out of crisis, Patel said.

"Medicaid helps people afford insulin. SNAP helps them buy the right foods. Take those away, and people won't just get sicker, they'll end up in emergency rooms, or worse," she said. "Medicaid is one of the few things holding costs to taxpayers in check, covering preventive care, stabilizing conditions, and reducing emergency room visits. Cutting it equates to sending every household in America a $3,000 medical bill year after year. It's like a levee holding back a flood of medical debt and hospital strain. If we break that barrier, the surge will hit hospitals, taxpayers and families alike."

"Cutting Medicaid doesn't eliminate costs-it just shifts them. And it pushes patients closer to the edge," Patel said. "Our research found that fewer than half of participants knew where to go for help. If we pull the rug out now, we're creating a health crisis that will be far more expensive-and far more devastating-down the line."

Contact: [email protected]

Michelle Meade is co-director of the Center for Disability Health and Wellness, professor of physical medicine and rehabilitation at the Medical School, and a longtime researcher on the care of people with disabilities and the policies that relate to their care and coverage.

Michelle Meade

"As a clinician and researcher who works with people with spinal cord injury and other severe physical disabilities, I know that Medicaid provides access to critical health care and community-based services," she said. "It is the difference between being hospitalized and being able to get out of bed and participate in the community; between life and death.

"Research has identified significant innovations and led to programs to prevent secondary conditions, limit hospitalization, and support community engagement and employment for both people with disabilities and their families. Now is the time to identify these best practices and invest in-not cut-these cost-effective and lifesaving services and programs."

Contact: [email protected]

Donald Moynihan and Pamela Herd are professors at the Ford School of Public Policy and can offer their insights on work requirements for Medicaid. They say the bill uses administrative burdens to accomplish an unpopular policy goal.

Donald Moynihan

"The lawmakers and Trump administration officials argue work requirements work for Medicaid. They are flat-out wrong. To be sure, they work-but only if your goal is to reduce access to services, while largely failing to increase labor market participation. They are especially damaging to vulnerable populations, such as those who are already in poor health," they said.

Pamela Herd

"If you account for Medicaid beneficiaries who are already working-and those excluded from work requirements due to disability or caregiving responsibilities-almost no one should lose coverage. But when Arkansas adopted work requirements in 2018, nearly all of the people who lost coverage had met the requirements. They simply couldn't manage the paperwork to prove it. Beyond work requirements, there are other administrative burdens, such as co-pays and more frequent renewals, that we know will kick eligible beneficiaries off the program. Bottom line: The result of this vision would be dysfunctional government to pay for tax cuts."

Contact: [email protected]
Contact: [email protected]

Michael Shepherd is an assistant professor of health management and policy at the School of Public Health. His research focuses on the politics and policies associated with rural health disparities, including rural hospital closures and Medicaid policy. He can discuss how proposed Medicaid cuts would disproportionately impact rural communities, where residents rely on program coverage at higher rates than the national average.

Michael Shepherd

"When you're thinking about what Medicaid cuts mean for rural communities, it's not just that people on Medicaid may lose their benefits-it's that everybody may lose access to health care, and a lot of people may lose their jobs," he said. "Rural hospitals operate on shoestring budgets and most of them are staying open because of reimbursements they get from Medicaid. Hospitals in rural communities are often the largest employers, so when a hospital closes, you're talking about increasing unemployment, lowering incomes and an exodus of people from the community."

Contact: [email protected]

Scott Greer, professor of health management and policy, studies the ways health and health care shape political beliefs.

Scott Greer

"What we've found is a growing trend over about the last 30 years or so is for ill health or a decline in self-reported health to increasingly predict either dropping out of the political process or in voting for the radical right," he said. "What happens is that when you're diagnosed with a chronic disease or otherwise see a significant lasting decrease in your self-reported health, you get a lot of exposure to the health care system.

"You get a lot of exposure to your employer's HR. Maybe you get exposure to the government's benefits system. Maybe you get exposure to the home health care system. And a little bit of exposure goes a long way because many of these systems are not designed to make you feel like an empowered patient, to feel like a respected adult human being.

"They're disempowering. They aren't necessarily trustworthy and some are explicitly designed to create administrative burden and make your life harder. So what do you do when you spend a lot of time dealing with people who quite aren't legitimately taking your interests seriously? You become less trusting. And when you become less trusting there's a political party on offer in most countries that's willing to accept your vote and feed all your worst instincts."

Contact: [email protected]

John Z. Ayanian

John Ayanian, director of the Institute for Healthcare Policy and Innovation and leader of the evaluation that IHPI is performing of Michigan's Medicaid expansion, has led numerous studies assessing access to care, quality of care and health care disparities. He also is a professor of internal medicine at the Medical School, professor of health management and policy at the School of Public Health and professor of public policy at the Ford School of Public Policy.

Contact: Kara Gavin, [email protected]

A. Mark Fendrick

A. Mark Fendrick, is director of the Center for Value Based Insurance Design and professor of internal medicine at the Medical School and professor of health management and policy at the School of Public Health. His research focuses on how clinician payment and consumer engagement initiatives impact access to care, quality of care and health care costs.

Contact: Kara Gavin, [email protected]

Nora Becker

Nora Becker is a health economist and assistant professor of internal medicine at the Medical School. Her clinical and research interests are in the impacts of changes in health policy and health insurance design on health and financial outcomes for women and economically disadvantaged populations.

Contact: Kara Gavin, [email protected]