On May 22, 2025, the House of Representatives passed the so-called One Big Beautiful Bill Act so it is now in the hands of the Senate which will make its changes and send it back to the House, possibly by early July, for reconciliation.

The proposed "One Big Beautiful Bill" includes $880 billion in cuts to Medicaid over the next decade. These cuts would result in an estimated 10.3 million people losing Medicaid coverage by 2034 and 7.6 million becoming uninsured. The bill imposes work requirements for childless adults aged 19 to 64, penalizes states that provide Medicaid to undocumented immigrants, and ends certain tax practices that states use to fund their Medicaid programs.

Although there is no language in the proposed bill that directly impacts Medicare, the nonpartisan Congressional Budget Office (CBO) found that it would add so many trillions of dollars to the national debt, “it could force nearly $500 billion in cuts to Medicare” — with some cuts taking effect as early as next year.

We will need to wait and see what changes are made by the Senate to this bill but we hope it has a lesser impact on Medicaid and Medicare than described above because Hawaii currently has about 466,000 people enrolled in Medicaid (Med-Quest) and 248,000 enrolled in Medicare.

Since Hawaii’s total population is estimated to be 1.44 million, a large proportion may be adversely affected by the One Big Beautiful Bill Act which in turn may financially impact healthcare providers statewide.