Introduction
In 2025, former President Donald Trump introduced what he referred to as the “Big Beautiful Bill,” a proposed overhaul of the nation’s healthcare system. Positioned as a solution to the rising costs of healthcare, Trump’s bill promises to lower premiums, reduce taxes, and offer increased access to healthcare options. For many, these claims echo the promises made during his 2016 campaign, in which he vowed to dismantle the Affordable Care Act (ACA) and replace it with something “much better.” However, a closer examination of the proposed legislation reveals that, far from alleviating the burdens on the American people, it could end up driving health costs higher for many, especially the most vulnerable populations.
Here I aim to critically analyze the implications of Trump’s “Big Beautiful Bill” on American healthcare costs, exploring its potential consequences for premiums, the accessibility of care, and the financial stability of middle- and low-income families. By examining the details of the bill and comparing them to the current state of American healthcare, it becomes clear that the reforms proposed could exacerbate existing inequalities and lead to significant cost increases for many citizens.
The Underlying Premise: Deregulation and the Free Market
At the core of Trump’s healthcare vision is a return to the idea of a free market system—one in which competition is supposed to drive down costs. The bill seeks to eliminate regulations that, according to Trump, create inefficiencies within the healthcare system. In particular, it aims to scale back the consumer protections put in place by the ACA, including the requirement for insurers to cover people with preexisting conditions, the expansion of Medicaid, and the essential health benefits mandated for insurance plans.
Trump’s “Big Beautiful Bill” is built on the assumption that, by allowing insurers to offer a wider range of plans with fewer government restrictions, individuals will be able to choose health coverage that better fits their needs, at a lower cost. However, this approach risks creating a fragmented and uneven healthcare landscape, where only those who can afford premium coverage will have access to high-quality care. Meanwhile, those who cannot afford the more expensive plans may find themselves with inadequate coverage, leading to higher out-of-pocket costs for essential services.
The Impact on Premiums: Lowering Costs for Some, Raising Costs for Others
One of the bill’s central promises is that it will lower premiums for individuals. This is achieved, in part, by reducing the requirements for insurance companies to cover a broader range of services. While premiums may decrease for young, healthy individuals who are able to purchase minimalist plans with few coverage requirements, these lower premiums come at the cost of higher deductibles and out-of-pocket expenses.
For older adults, individuals with preexisting conditions, and those with chronic health conditions, the situation is much more dire. The “Big Beautiful Bill” allows insurers to charge older adults significantly higher premiums—potentially up to five times as much as younger individuals. While the bill may offer tax breaks and subsidies to offset some of these costs, these measures are likely to fall short of compensating for the higher premiums that many will face.
Moreover, the proposed bill allows states to apply for waivers that permit them to roll back protections against discrimination based on preexisting conditions. For the millions of Americans living with conditions such as diabetes, heart disease, or cancer, this could mean being priced out of health insurance altogether or being forced to pay exorbitant premiums for minimal coverage.
Medicaid and the Expansion of Coverage: A Step Backward
One of the most significant impacts of Trump’s healthcare reform is the potential rollback of Medicaid expansion. Under the ACA, Medicaid was expanded to cover millions of low-income Americans who were previously ineligible for assistance. The “Big Beautiful Bill” proposes to reverse this expansion, placing greater restrictions on who qualifies for Medicaid and cutting funding to the program. In states that have expanded Medicaid under the ACA, the removal of this provision would mean that millions of people would lose access to essential health services.
In states where Medicaid expansion was not implemented, the consequences could be even more dire, as those who are uninsured would face even greater barriers to accessing care. The bill also proposes to shift Medicaid to a block grant system, which would allow states more control over how the funds are allocated. While this might seem like a boon for state governments, it is likely to lead to cuts in coverage and benefits, further exacerbating the financial strain on low-income families who rely on the program.
A Deterioration of Health Services for Vulnerable Populations
The proposed changes to Medicaid and insurance regulations would not only affect premiums but could also lead to a deterioration in the quality of healthcare services for vulnerable populations. Low-income individuals and those with chronic health conditions would be especially at risk, as the “Big Beautiful Bill” would likely reduce the number of essential services covered by insurance plans. Mental health services, addiction treatment, and reproductive health services, which are currently protected under the ACA, could become less accessible under the new proposal.
The bill also proposes giving more power to private insurers, allowing them to design plans that may exclude certain types of coverage that are considered non-essential, such as mental health care or maternity services. This could leave individuals with fewer options for comprehensive care, forcing them to pay out-of-pocket for services that were once covered by their insurance plans. This would place an additional financial burden on already vulnerable populations, who may not have the means to afford these out-of-pocket costs.
The Tax Cuts: Who Really Benefits?
Trump’s “Big Beautiful Bill” includes provisions for tax cuts, particularly for the wealthiest Americans and corporations. While these cuts may provide short-term financial relief for high earners, they come at the expense of funding for critical healthcare programs. The bill proposes repealing taxes that were used to fund the ACA’s insurance subsidies, as well as taxes on medical devices and high-end health insurance plans. By eliminating these revenue streams, the bill would shift the financial burden onto the general public, forcing many Americans to bear higher costs for fewer healthcare benefits.
Moreover, the tax cuts are unlikely to trickle down to middle- and low-income families, who will still face higher premiums and out-of-pocket costs under the proposed system. For those struggling to make ends meet, the tax breaks for the wealthy will do little to offset the rising costs of healthcare, which could leave them with fewer resources to cover medical expenses.
The Real Cost: A Health System That Prioritizes Profits Over People
While the “Big Beautiful Bill” promises lower costs and greater access to care, its true implications may result in a healthcare system that prioritizes profits over people. The bill’s focus on deregulation, privatization, and tax cuts for the wealthy risks creating a system where access to healthcare is determined by one’s ability to pay, rather than by need. For many Americans, especially those in lower income brackets or with chronic health conditions, this could mean higher premiums, reduced access to essential services, and greater financial strain.
As the cost of healthcare continues to rise in the United States, the “Big Beautiful Bill” may represent a step backward, not forward, for the American people. Instead of fostering a more equitable and affordable healthcare system, it could exacerbate the very issues it aims to address, leaving many Americans with fewer options and higher costs.
Conclusion
Trump’s “Big Beautiful Bill” is a deeply flawed proposal that threatens to increase healthcare costs for many Americans, particularly those who are already struggling to afford care. While it promises lower premiums for some, it does so by reducing protections for the most vulnerable populations and shifting the financial burden onto the public. By undermining the gains made under the ACA, the bill risks exacerbating health disparities and leaving millions of Americans without access to affordable, comprehensive healthcare.
In order to create a truly effective healthcare system, it is imperative that we focus on expanding access to care, lowering costs for everyone, and ensuring that health services are available to those who need them most. Trump’s proposal, though well-intentioned in its goals, falls short of achieving these objectives and, if passed, could have devastating consequences for millions of Americans. Ultimately, the fight for affordable healthcare will continue, and it is up to lawmakers, healthcare professionals, and the American public to ensure that the future of healthcare policy prioritizes the well-being of all citizens, rather than corporate profits.
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