Jamie and Melissa Anne take on the Medicare changes in The One Big Beautiful Bill (OBBBA), signed into law by President Trump on July 4, 2025. OBBBA makes significant (although less extensive than Medicaid) changes to Medicare that could still have major impacts on seniors and people with disabilities. While core benefits remain intact for those who still qualify, the law tightens eligibility for legal immigrants, excluding many who have paid into the system but lack green cards. It halts planned reforms that would have streamlined enrollment for low-income assistance programs, potentially leaving 1.4 million seniors without help paying premiums or co-pays. OBBBA also triggers up to 4% annual Medicare provider payment cuts starting in FY2026 under PAYGO rules, which may lead some clinicians and hospitals, especially in rural areas, to limit Medicare patients or close services. Indirectly, massive Medicaid cuts will harm dual-eligible citizens who rely on Medicaid to cover out-of-pocket Medicare costs and long-term care. The bill also expands exemptions in Medicare’s prescription drug price negotiation program, reducing the number of drugs subject to negotiation and likely keeping premiums and co-pays higher. While supporters say the law strengthens Medicare’s finances and targets waste, critics argue it erodes access, affordability, and fairness, disproportionately harming vulnerable populations like low-income seniors, rural residents, and legal immigrants who have worked and paid taxes for decades.

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