The one big beautiful bill act (OBBBA) in 2025 will resume certain elements of the tax cuts and jobs act (TCJA) on both corporate and individual level. The drop in federal revenue notwithstanding, despite its main objective to increase economy, there are some serious fiscal and healthcare impacts of OBBBA. On the direct side, OBBBA changes Medicaid rules by introducing federal work requirements and stricter eligibility checks, which may cause coverage losses and add administrative burdens for states. On the indirect side, the reduction in revenue can compel the government to run deficits in the budget, creating additional strain on social programs like Medicaid. The paper explains how both the direct and indirect provisions of OBBBA could affect the funding, sustainability and accessibility to Medicaid due to budgetary constraints and how fiscal policies can influence entitlement programs and entire healthcare system using health economics theories and history factors. Results show that these effects emphasize the importance of maintaining health insurance as an instrument to safeguard vulnerable populations and that Medicaid remains a key factor in ensuring the affordability of healthcare and financial security to millions of Americans.

Cheng Chen. An Analysis of OBBBA Effect on Medicaid and the Importance of Health Insurance. International Journal of Social Sciences and Economic Management (2025), Vol. 6, Issue 2: 74-81. https://doi.org/10.38007/IJSSEM.2025.060208.

[1] Tolbert, J., Cervantes, S., Rudowitz, R., & Burns, A. (2025, May 30). Understanding the intersection of Medicaid and work: An update.  https://www.kff.org/ edicaid/understanding-the-intersection-of-medicaid-and-work-an-update/

[2] Lukens, G., & Zhang, E. (2025). Medicaid Per Capita Cap Would Harm Millions of People by Forcing Deep Cuts and Shifting Costs to States | Centre on Budget and Policy Priorities. Centre on Budget and Policy Priorities. https://www.cbpp.org/research/health/medicaid-per-capita-cap-would-harm-millions-of-people-by-forcing-deep-cuts-and 

[3] Jang, J., & Lee, K.-H. (2023). Dynamics of Macroeconomy, Medicaid, and State Fiscal Conditions: A Role of Medicaid Expansion. Risk Management and Healthcare Policy, Volume 16, 2323–2337. https://doi.org/10.2147/rmhp.s425539 

[4] Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C. (2020). Improving the prognosis of health care in the USA. The Lancet, 395(10223), 524–533. National Library of Medicine. https://doi.org/10.1016/s0140-6736(19)33019-3 

[5] Haught R., Coleman A., Dobson A., Richards C., & McGuire C. (2025). Federal cuts to Medicaid could end medicaid expansion and affect hospitals in nearly every state. Commonwealthfund.org. https://doi.org/10.26099/f7jj-t666

[6] MARKUS, A. R., GIANATTASIO, K., LUO, E. (QIAN), & STRASSER, J. (2019). Predicting the Impact of Transforming the Medicaid Program on Health Centres’ Revenues and Capacity to Serve Medically Underserved Communities. The Milbank Quarterly, 97(4), 1015–1061. https://doi.org/10.1111/1468-0009.12426 

[7] Allen, H., Eliason, E., & Zewde, N. (2024). The long-term effects of Medicaid expansions on mortality. American Journal of Public Health, 114(S4), S435–S442. https://doi.org/10.2105/AJPH.2024.307621 

[8] National Academy for State Health Policy. (2025, July 8). What health care provisions of the One Big Beautiful Bill Act mean for states https://nashp.org/what-health-care-provisions-of-the-one-big-beautiful-bill-act-mean-for-states

[9] Rudowitz R, Musumeci M, & Hall C (2019). February State Data for Medicaid Work Requirements in Arkansas https://www.kff.org/medicaid/state-data-for-medicaid-work-requirements-in-arkansas/

[10] Lin, Y., Monnette, A., & Shi, L. (2021). Effects of Medicaid expansion on poverty disparities in health insurance coverage. International Journal for Equity in Health, 20(1). https://doi.org/10.1186/s12939-021-01486-3 

[11] Donohue, J. M., Cole, E. S., James, C. V., Jarlenski, M., Michener, J. D., & Roberts, E. T. (2022). The US Medicaid program: Coverage, financing, reforms, and implications for health equity. Journal of the American Medical Association, 328(11), 1085–1099. https://doi.org/10.1001/jama.2022.14791 

[12] Mellor, J. M., McInerney, M., Garrow, R. C., & Sabik, L. M. (2023). The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries. Health Services Research, 58(5). https://doi.org/10.1111/1475-6773.14155 

[13] Banthin J, Buettgens M, J, C., & Mermin G. (2025). Tax Cut Extension with Medicaid and SNAP Spending Reductions. RWJF. https://www.rwjf.org/en/insights/our-research/2025/05/tax-cut-extension-with-medicaid-and-snap-spending-reductions.html 

[14] Noh, S., Janousek, C. L., & Park, J. H. (2020). State strategies to address medicaid prescription spending: negotiated pricing vs price transparency. Health Economics, Policy and Law, 1–15. https://doi.org/10.1017/s1744133120000080 

[15] Buchmueller, T., Whitman, A., Peters, C., & Lew, N. D. (2024). Improving Access to Affordable and Equitable Health Coverage: A Review from 2010 to 2024. Nih.gov; Office of the Assistant Secretary for Planning and Evaluation (ASPE). https://www.ncbi.nlm.nih.gov/books/NBK611354/ 

[16] Blavin, F., & Ramos, C. (2021). Medicaid Expansion: Effects On Hospital Finances And Implications For Hospitals Facing COVID-19 Challenges. Health Affairs, 40(1), 82–90. https://doi.org/10.1377/hlthaff.2020.00502