The Senate’s “Big Beautiful Bill” Is a Disaster for Public Health
Here’s what’s in it and what you can still do to stop it
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Late Friday night, while most Americans were asleep, Senate Republicans quietly released their updated version of the “Big Beautiful Bill,” a sweeping tax and spending package that advances President Trump’s second-term agenda.
Within 24 hours, they passed a procedural vote to begin full Senate debate on the 940-page reconciliation bill, clearing the path for a final vote in the Senate before the bill returns to the House.
That vote will likely happen today or early tomorrow morning after the Vote-a-rama.
The middle of the night timing was strategic, as Republicans know this bill is deeply unpopular, so they’re rushing it through before the public can react.
And when you look at what’s inside, it’s easy to see why.
Here’s what’s actually in the bill (as of now), and why it represents the most dangerous attack on healthcare, nutrition assistance, and economic fairness in modern U.S. history, all of which are pillars of public health.
Who Is Benefitting Most?
The Senate’s updated bill could cost $4.5 trillion over the next decade and will add $3.3 trillion to the national debt over a decade (a nearly $1 trillion increase over the House-passed bill), according to the nonpartisan Congressional Budget Office.
And the bulk of that spending is going to those who need it the least.
The bottom 10% of earners are expected to lose money, while the top earners will gain the most.
If you make less than $55,628/year, you can expect to lose money. For example, those making less than $22,868/year can expect a 4% drop in household income each year.
While those making more than $692,000/year can expect to see a 2.3% increase in annual income.
The top 20% of households (>$217,000 per year) would receive nearly 60% of the tax benefits, while the top 5% (>$460,000) would get more than 1/3 of all benefits.
According to the Joint Committee on taxation, corporations will receive over $900 billion over 10 years, even if they offshore jobs or automate away their workforce.
Many are calling this the largest redistribution of wealth from the poorest to the wealthiest Americans in U.S. history. It’s being paid for by both massively increasing the deficit, which will drive up interest payments for years to come, and by gutting the very programs that help people survive, including healthcare and nutrition assistance.
Enormous Cuts to the Social Safety Net
To fund this upward wealth transfer, the bill makes devastating cuts to healthcare, food assistance, education, and clean energy. Here’s what that looks like:
Healthcare
According to the nonpartisan Congressional Budget Office, $1.1 trillion would be cut from Medicaid, Medicare, and the ACA, forcing 16 million people off their health insurance.
Imposes new $35 co-pays for Medicaid patients, even for those earning just $16,000/year.
These cuts would also devastate the care infrastructure:
Over 300 rural hospitals are at immediate risk of closure or severe service cuts.
Nearly 600 nursing homes face shutdowns, particularly those serving Medicaid-dependent patients.
Community clinics in underserved areas may be forced to scale back or shut down altogether, leaving millions with nowhere to turn for maternity care, emergency services, or chronic disease management.
Some of the most devastating impacts of this bill will come from its assault on healthcare. Stripping over 16 million people of insurance and adding new out-of-pocket costs for the poorest Americans will have direct, deadly consequences. Public health researchers estimate more than 50,000 unnecessary deaths each year. At the same time, slashing Medicaid funding threatens to collapse the care infrastructure in much of rural America, with hundreds of hospitals, nursing homes, and community clinics at risk of closing their doors.
Nutrition Assistance
$197 billion in cuts to SNAP (food stamps) over the next decade, primarily through stricter eligibility rules and administrative changes.
More than 5 million people live in households that would be at risk of losing at least some of their food assistance, including 800,000 children.
The cumulative impact of these changes means millions of families, including children in poverty, seniors, and disabled individuals, stand to lose access to food assistance, further deepening food insecurity across the country. While framed as a push to encourage work, research consistently shows that work requirements do not increase employment. Instead, they function as a barrier to access where people lose benefits because they fail to navigate burdensome paperwork or miss deadlines. That’s why these provisions are counted as cost savings. Not because people’s circumstances improve, but because fewer eligible people are able to stay enrolled.
Education
$300 billion in cuts to higher education over the next decade.
Reforms income-driven repayment (IDR) plans, limiting loan forgiveness and increasing monthly costs for borrowers.
Imposes new accountability standards on colleges, which could restrict access to federal aid for students at institutions that don’t meet federal performance benchmarks.
Drops proposed “risk-sharing” fees, but maintains provisions that shift more financial burden onto students.
Some of the most far-reaching consequences of this bill will fall on students already facing steep barriers to higher education. By shrinking access to grants and making repayment more difficult, the bill would make it harder for millions of working-class and first-generation students to attend college, finish their degrees, or avoid long-term debt.
Climate and Energy
Repeals or phases out clean energy tax credits for wind, solar, EVs, and residential energy efficiency
Includes a new excise tax on solar and wind projects using components from “adversary” nations
Maintains existing fossil fuel subsidies, with no offsetting reductions
Analysts warn that revoking these credits could drive up electricity bills by up to $400+ per household annually, depending on the region and energy mix
The Senate bill removes hundreds of billions in clean energy tax support, while keeping fossil fuel giveaways intact. Energy economists are calling it one of the most anti-environmental bills in U.S. history. And it’s a public health risk, accelerating emissions and increasing health-harming pollution.
And Where the Priorities Are
While programs that keep people healthy, housed, fed, and educated are being gutted, the bill sends hundreds of billions toward policing, militarization, and unaccountable agencies:
Military Spending
Increases the Pentagon budget by $150 billion (a 15% jump) despite the Department of Defense failing every audit in its history.
Immigration Enforcement
Provides $150 billion for immigration enforcement over four years — more than the combined Medicaid cuts in some states.
Together, these choices reveal a fundamental shift in national priorities away from care, equity, and public health, and toward policing, surveillance, and privilege protection.
This Is a Public Health Emergency
This bill is antithetical to anything we’d expect from an administration claiming to care about making Americans healthier. Income inequality, healthcare access, food security, and environmental stability are among the strongest drivers of public health, and this bill attacks all of them.
If passed, it will:
Strip more than 16 million people of their health insurance.
Shut down rural hospitals, nursing homes, and community clinics across the country.
Raise out-of-pocket costs for low-income patients, even those making as little as $16,000/year.
Slash nutrition support for families, seniors, and people with disabilities.
Drive up electricity bills by eliminating clean energy investments.
Funnel over $1 trillion to corporations and the ultra-wealthy.
At its core, this bill takes resources away from the people who need them most in order to pay for tax cuts that overwhelmingly benefit corporations and the wealthiest Americans. It includes cuts to Medicaid, nutrition assistance, and education to fund giveaways for those who need no help at all. And it will directly harm the health of people across this country.
What You Can Do
This isn’t over, but we’re running out of time.
Call your senators today, especially if you live in Maine, Alaska, Missouri, Wisconsin, Utah, and Florida.
Download the 5 Calls app or call the Capitol switchboard at 202-224-3121 and ask to be connected to your senator’s office.
Urge them to vote NO on the “Big Beautiful Bill.”
Call Script:
Hi, my name is [Your name], and I’m a constituent from [City, State]. I’m calling because I care deeply about public health and the well-being of our communities — and I’m urging Senator [Last name] to vote NO on the One Big Beautiful Bill.
This bill would take health care away from millions, gut Medicaid, and shut down rural hospitals and nursing homes that families depend on. That’s not how we build a healthier America.
Please do the right thing. Stand up for public health, and vote no on this bill.
Thank you.
This is an extremely helpful breakdown. Thank you!
So much is happening but please make people aware of the upcoming FDA meeting (and associated docket) related to fluoride on July 23. Must request to provide public comment by 7/9:
"Use of Orally Ingestible Unapproved Prescription Drug Products Containing Fluoride in the Pediatric Population"