One Big Beautiful Fiscal Crisis
July 2, 2025 |
The healthcare provisions in the Senate’s reconciliation bill will put a massive strain on New York’s budget and healthcare system – starting this fiscal year
Introduction
Yesterday, in a 51-49 vote, Senate Republicans passed the “One Big Beautiful Bill Act” (OBBBA), which, if passed by the House this week, will increase the national debt by approximately $4 trillion while leaving 11 million more Americans uninsured by 2035. The bill is significantly more draconian in its Medicaid cuts than the version passed by the House in May, cutting the program by $1 trillion over 10 years, rather than the $800 billion proposed in the House bill. The impact on New York will be dramatic; the state has estimated that the bill will have a $13.5 billion annual impact on the state budget and leave 1.5 million additional New Yorkers uninsured, returning the state’s uninsurance rate to levels not seen since before the passage of the Affordable Care Act.
Some of these impacts will phase in over time as various provisions go into effect over the next three years. But others – including the changes to the Essential Plan which represent the single largest threat to New York’s health system and budget – will begin almost immediately, effective January 1, 2026. This brief describes the timeline of the most immediate impacts.
One Big Beautiful Fiscal Crisis
July 2, 2025 |
The healthcare provisions in the Senate’s reconciliation bill will put a massive strain on New York’s budget and healthcare system – starting this fiscal year
Introduction
Yesterday, in a 51-49 vote, Senate Republicans passed the “One Big Beautiful Bill Act” (OBBBA), which, if passed by the House this week, will increase the national debt by approximately $4 trillion while leaving 11 million more Americans uninsured by 2035. The bill is significantly more draconian in its Medicaid cuts than the version passed by the House in May, cutting the program by $1 trillion over 10 years, rather than the $800 billion proposed in the House bill. The impact on New York will be dramatic; the state has estimated that the bill will have a $13.5 billion annual impact on the state budget and leave 1.5 million additional New Yorkers uninsured, returning the state’s uninsurance rate to levels not seen since before the passage of the Affordable Care Act.
Some of these impacts will phase in over time as various provisions go into effect over the next three years. But others – including the changes to the Essential Plan which represent the single largest threat to New York’s health system and budget – will begin almost immediately, effective January 1, 2026. This brief describes the timeline of the most immediate impacts.