The One Big Beautiful Bill Act: Understanding Its Impact on Everyday Americans

Introduction to the One Big Beautiful Bill Act

The Social Determinants of Health (SDOH) shape nearly every aspect of life and health in America. According to the CDC, SDOH include the conditions where people are born, grow, live, work, and age—like jobs, education, housing, healthcare, and safe environments. Policies that change access to healthcare, food, housing, or education impact much more than a family’s budget—they affect life expectancy, well-being, and community stability.

The new One Big Beautiful Bill Act (OBBBA) is poised to bring major changes to all of these areas and impact everyday Americans. Supporters say the bill helps the middle class and those in poverty. However, a close look at the evidence shows the most direct effects—both positive and negative—will be felt by individuals and families making less than $125,000 to $150,000 a year (about 400% of the federal poverty level for a family of four). For those earning less than $75,000, the risk of losing critical supports like Medicaid, SNAP, or affordable insurance is even higher.

While households with higher incomes may experience indirect impacts (like higher hospital or local taxes, or community clinic closures), the bill’s most significant consequences—lost coverage, increased food and housing insecurity, and limited access to preventive care—are concentrated among those with low to moderate incomes. Understanding how OBBBA interacts with the SDOH is crucial for everyone. Not just policy enthusiasts, but for parents, educators, employers, and communities across the country.

The following lays out 25 ways OBBBA impacts average Americans, what’s changing, who’s affected, and what we can all do to navigate the road ahead.

25 Ways the One Big Beautiful Bill Act Could Impact Everyday Americans

1. Healthcare Access Shrinks

OBBA could result in over 10 million people losing Medicaid by 2034. This change will directly impact access to affordable healthcare.

2. Work Requirements May Exclude Many

Medicaid’s new 80-hour monthly work rule risks cutting off coverage for people with disabilities, caregivers, and those in unstable jobs.

3. More Uninsured Families

The bill could increase the number of uninsured Americans by 16 million, including many children.

4. Mental Health Support Gaps Widen

Cuts to Medicaid and ACA plans could force rural and BIPOC communities to travel farther—or wait longer—for mental health care.

5. Gender-Affirming Care Blocked

OBBA prohibits federal funds for gender-affirming care. This affects thousands who rely on Medicaid and CHIP.

6. SNAP Food Aid Reductions

Stricter SNAP eligibility rules may cut food support for over 2 million people. This will increase food insecurity in low-income communities.

7. Rising Medical Debt

As more lose coverage, families face higher out-of-pocket costs. They are at greater risk for medical debt.

8. Impact on Working Parents

New work rules don’t account for unpaid caregivers (like parents or adult children). This risks coverage loss for millions.

9. Reduced Support for People with Disabilities

Work requirements and eligibility changes will likely reduce access for people with disabilities, despite the ADA’s protections.

10. Potential Job Losses in Healthcare

Cuts to federal funding may force clinics and hospitals—especially in rural areas—to reduce staff or close.

11. Threats to School-Based Health Services

Schools in low-income districts often use Medicaid to fund nurses and counselors. Budget cuts may mean fewer support staff for students.

12. Affordable Housing Becomes Harder

Families facing higher health costs or lost benefits may struggle to keep up with rent or mortgage payments. This risks housing instability.

13. Greater Hunger Among Children

Cuts to SNAP and Medicaid hit children hardest. Hunger and illness often go hand-in-hand.

14. Less Support for Mental Health Parity

Mental health coverage is often the first to go with insurance losses. This worsens crises for those with anxiety, depression, or substance use disorders.

15. Strain on Community Clinics

As insurance rates drop, more people turn to safety-net clinics. This strains already limited resources.

16. Fewer Job Training Programs

Eligibility changes in SNAP and Medicaid may eliminate employment and training programs that help people move out of poverty.

17. Increased Costs for Prescription Drugs

Without insurance, Americans pay full price for medications. This leads many to skip doses or abandon treatment.

18. Racial Disparities May Widen

Black, Latino, and Native American communities are overrepresented in Medicaid and SNAP. OBBA’s cuts could deepen inequities.

19. Safe Environments Threatened

Reduced access to preventive care and food support can increase homelessness, food insecurity, and unsafe living conditions.

20. Telehealth Expansion Uncertain

OBBA doesn’t guarantee funding for telehealth. This service has become vital for rural and disabled Americans.

21. Housing Stability on the Line

Losing health or food benefits can force families into choosing between rent and groceries. This is a key driver of homelessness.

22. Young Adults Most At Risk

Young people aging out of parents’ plans or public aid will face new gaps in coverage and support.

23. Fewer Preventive Screenings

Loss of insurance coverage means fewer cancer screenings, vaccines, and preventive services, especially for marginalized groups.

24. Community Health Will Suffer

OBBA’s broad cuts mean less community investment in parks, healthy food, clean air, and safe spaces—critical to well-being.

25. Economic Ripple Effects Will Be Felt Locally

As families lose benefits and clinics face cuts, local economies may suffer. Research shows every $1 cut from SNAP or Medicaid can result in up to $1.70 lost in local economic activity.

Navigating Change—What You Can Do

Stay informed about what’s changing and how it might impact you or your community. If you work in HR, care management, or support roles, be ready to help others understand the bill and connect them to resources. Everyone can advocate for smarter, more compassionate policy—one conversation at a time.

• Learn about SDOH and OBBBA from trusted sources (CDC, Kaiser Family Foundation, local public health).

• Share this information with your network—awareness is a powerful first step.

• Support those around you—especially if you’re in a position to answer questions or guide people through these changes.

• Advocate for policies that protect and expand SDOH—not just for yourself, but for your whole community.

  
  

References and Sources for Each Fact

1. Medicaid Coverage Losses

• Kaiser Family Foundation (KFF). How Will the 2025 Budget Reconciliation Affect the ACA, Medicaid, and the Uninsured Rate?

2. Work Requirements May Exclude Many

• Center on Budget and Policy Priorities (CBPP). Medicaid Work Requirements Will Reduce Coverage Without Increasing Employment

3. More Uninsured Families

• Kaiser Family Foundation. How Will the 2025 Budget Reconciliation Affect the ACA, Medicaid, and the Uninsured Rate?

4. Mental Health Support Gaps Widen

• Substance Abuse and Mental Health Services Administration (SAMHSA). 2023 National Survey on Drug Use and Health

• National Rural Health Association. Mental Health in Rural America

5. Gender-Affirming Care Blocked

• Politifact. Fact-check on gender-affirming care and Medicaid

• KFF. Medicaid’s Role in Covering Transgender People

6. SNAP Food Aid Reductions

• Center on Budget and Policy Priorities. SNAP Works for America's Children

7. Rising Medical Debt

• American Journal of Public Health. Medical Bankruptcy in the United States, 2019

• Kaiser Family Foundation. Medical Debt in the U.S.

8. Impact on Working Parents

• Kaiser Family Foundation. Medicaid Work Requirements Including Parents Would Lead to Large Coverage Losses

9. Reduced Support for People with Disabilities

• National Disability Rights Network. Medicaid Work Requirements Threaten Health and Independence

10. Potential Job Losses in Healthcare

- Health Affairs. Potential Effects of Medicaid Cuts on Rural Hospitals

- National Association of Community Health Centers (NACHC). America’s Health Centers

11. Threats to School-Based Health Services

- Healthy Schools Campaign. The Role of Medicaid in School-Based Health

12. Affordable Housing Becomes Harder

- Urban Institute. The Link Between Housing and Health

13. Greater Hunger Among Children

- Feeding America. Child Hunger Facts

14. Less Support for Mental Health Parity

- Mental Health America. Mental Health Parity

15. Strain on Community Clinics

- National Association of Community Health Centers. America’s Health Centers

16. Fewer Job Training Programs

- Center for Law and Social Policy (CLASP). Job Training and Public Assistance

17. Increased Costs for Prescription Drugs

- Commonwealth Fund. When Out-of-Pocket Drug Costs Lead to Nonadherence

18. Racial Disparities May Widen

- Kaiser Family Foundation. Key Facts on Health and Health Care by Race and Ethnicity

19. Safe Environments Threatened

- CDC. Social Determinants of Health

20. Telehealth Expansion Uncertain

- National Conference of State Legislatures. Telehealth Policy Trends and Considerations

21. Housing Stability on the Line

- National Low Income Housing Coalition. NLIHC Research

22. Young Adults Most At Risk

- Georgetown University Center for Children and Families. Medicaid Unwinding Data

23. Fewer Preventive Screenings

- Centers for Disease Control and Prevention (CDC). Prevention

24. Community Health Will Suffer

- Robert Wood Johnson Foundation. Social Determinants of Health: The Solid Facts

25. Local Economic Ripple Effects

- USDA Economic Research Service. The Supplemental Nutrition Assistance Program (SNAP) and the Economy