On July 4, 2025, President Trump signed into law H.R. 1 – the One Big Beautiful Bill Act (OBBBA). The purpose of the law was to extend 2017 tax cuts and fund other administration priorities. In order to pay for these policies, however, significant cuts were made to programs that provide health care and other assistance.
In the public benefits world, much attention was paid – and rightfully so – to the negative impacts the bill would have on Medicaid, SNAP (the Supplemental Nutrition Assistance Program), and the Affordable Care Act (ACA) Marketplace. There is no denying that the impacts to these programs will be felt widely by the clients we serve.
However, what went largely overlooked is the impact the bill will have on the Medicare program and its recipients. While some of the cuts to Medicaid and the ACA will impact Medicare beneficiaries indirectly (especially those individuals who are dually eligible for both Medicare and Medicaid), several provisions of the OBBBA directly target Medicare beneficiaries.
History and Purpose of Medicare
Medicare is a federal health insurance program for people age 65 or older, and for people younger than age 65 with certain disabilities, permanent kidney failure, or ALS. Sixty years ago, President Lyndon B. Johnson signed Medicare into law, ensuring that older adults would have guaranteed access to medical care.
Today, it provides economic security for over 68 million older adults and people with disabilities.
Restricting Lawfully Present Immigrants
Before the OBBBA, lawfully present noncitizens could qualify for Medicare by meeting work history requirements, or if they lacked the required work credits, by meeting length of residency requirements. Qualified noncitizens who worked and contributed payroll taxes for the required number of years were eligible for Medicare coverage on the same basis as U.S. citizens.
Starting immediately, the following lawfully present immigrants are no longer eligible for Medicare, regardless of how long they have worked and paid into the system:
refugees and people granted asylum;
people with Temporary Protected Status;
survivors of human trafficking;
survivors of domestic violence; and
individuals granted humanitarian parole.
By July 2026, the Social Security Administration must identify current Medicare beneficiaries who do not meet the above immigration criteria and notify them that their coverage will end in January 2027. This marks the first time in the program’s history that Medicare coverage has been stripped from an entire category of eligible individuals.
Christine Huberty, William Mitchell 2013, is an attorney with Center for Medicare Advocacy. She engages in policy and advocacy work and represents Medicare beneficiaries from around the country at federal administrative hearings.
While undocumented immigrants have never been eligible for Medicare, lawfully present individuals who worked and paid into the system have historically been able to qualify for Medicare benefits.
Blocking Improvements to Medicare Savings Programs
The law imposes a nine-year ban on implementing improvements to Medicare Savings Programs (MSPs), which help lower-income Medicare beneficiaries pay for premiums and out-of-pocket costs. Any “savings” from this ban is expected to come from preventing eligible beneficiaries from accessing these programs, which are designed to make Medicare more affordable.
Blocking Nursing Home Staffing Standards
The legislation blocks the implementation of national minimum staffing requirements for nursing homes that were designed to improve quality of care.
Limiting Medicare’s Ability to Negotiate Drug Prices
The 2022 Inflation Reduction Act gave Medicare the power to negotiate prices for certain high-cost medications, with the first negotiated prices taking effect in 2026. The OBBBA carves out “orphan drugs” (medications for rare diseases) from this negotiation process, limiting Medicare’s ability to control costs for some of the most expensive medications.
Conclusion
Many of the impacts of the OBBBA will be felt for years to come, and disproportionately to immigrants and individuals with lower income and higher health care needs. It is important to recognize those impacts to the Medicare program, and to continue to hold elected officials accountable as the provisions of the new law are implemented.
Author’s note: Thank you to my colleagues David Lipschutz and Ali Bers for the research and policy alert upon which this article is based. The full article is available on the Center for Medicare Advocacy website.
This article was originally published on the State Bar of Wisconsin’s Public Interest Law Section Blog. Visit the State Bar sections or the Public Interest Law Section web pages to learn more about the benefits of section membership.
