Still Unraveling the Big Beautiful Bill: Healthcare Edition

Back in July, we were told this bill would fix everything. This administration repeatedly said it is focused on reducing the cost of health care for Americans. Yet, it has delivered the largest cut to essential health programs, including Medicare, in US history. Critics warned us, but most people didn’t have 1,000+ pages of free time to comb through what was actually in it. I have been revisiting it because, as we moved into 2026, provisions are starting to kick in and parts of the so-called “Big Beautiful Bill” are no longer theoretical.

“The One Big Beautiful Bill Act delivers on President Trump’s promise of empowering Americans,” said Tom Cole upon the passage of the bill he voted for. “This is a transformational step toward restoring American greatness.” Those are some pretty bold statements for a bill that takes away essential health care from the people who need it the most to give a tax cut to millionaires and billionaires. Many claim they didn’t know this was what they were voting for, yet they didn’t think twice before voting to pass this bill. And when legislation is crafted by combining dozens of major policy changes into a single bill, the fine print becomes harder to read. So here is the truth.

The bill cuts over $1 trillion from health care while also adding $3.4 trillion to the national debt and helping Medicare become insolvent sooner, triggering an automatic $500 billion cut to it over the next decade. Nationally, Marketplace health insurance premiums are estimated to go up by 75%; 10,000,000 Americans will lose their health insurance, and 4 million people a month will lose SNAP food assistance. There’s nothing beautiful about this, especially at a time when Oklahomans face high prices and economic uncertainty due to rampant inflation and large-scale tariffs. And that’s not all. Here’s more about what  Tom Cole voted “yes” to and what it means for Oklahoma's health.

Medicare Cuts

H.R. 1 blocks the implementation of rules that would have helped low-income Medicare enrollees to cover premiums and cost-sharing for their Medicare benefits. According to the Center for American Progress, this will “disproportionately affect disabled people, as they are more likely to have lower incomes than nondisabled people.” Lastly, the bill eliminates Medicare eligibility for people with lawful immigration status, even if they have paid into the program. I will follow up more on this later. The Congressional Budget Office estimates that, without future action by Congress, the bill will trigger the Statutory Pay-As-You-Go Act of 2010, which automatically enacts $490 billion in Medicare cuts from 2027 through 2034.

For a bill that was supposed to streamline and reduce waste in government, H.R. 1 adds more paperwork and bureaucracy to Medicaid and makes it more insolvent, rather than helping it. Prior to H.R. 1, the federal government paid for 68.5% of Oklahoma’s Medicaid program, SoonerCare. However, the law now restricts states’ ability to raise revenue to fund Medicaid, a program jointly run by states and the federal government that helps people with limited income gain access to health care coverage. In Oklahoma, 1 million people participate in Soonercare; that number is higher because in 2020, Oklahomans voted to expand Medicaid. H.R. 1 requires SoonerCare recipients to verify eligibility twice a year, rather than once as before. It also adds a strict 80 hours-a-month work eligibility requirement, which poses a challenge for families with young children and people who cannot work due to disabilities. The cuts are also estimated to cost Oklahoma hospitals $8.7 billion.

More expensive Marketplace healthcare

The bill increases healthcare premiums by 75% for the 300,000 Oklahomans who rely on the Affordable Care Act to obtain Marketplace health insurance. It also deprives many lawful immigrant categories of access to Marketplace healthcare.

Closed rural hospitals and lost health benefits for many rural Oklahomans

51,100 rural Oklahomans can expect to lose their healthcare coverage, and rural hospitals stand to lose $2.4 billion. Tom Cole actually voted “yes” on the House version of this bill to cut health care for rural Oklahomans in the 4th district. While the Senate version of the One Big, Beautiful Bill, which is now law, restored some of the rural health funding in the form of a one-time $50 billion addition to the bill, these cuts will lead to the closure of rural hospitals, which are already struggling, according to the Oklahoma Hospital Association. This translates into cuts to important services and tens of thousands of job losses in rural Oklahoma.

No more food assistance for people who need it the most

H.R. 1 forces states to foot the bill for the Supplemental Nutrition Assistance Program, a federal and state-run food assistance program. In 2024, Oklahoma ranked 5th highest among the 50 states and Washington, DC, in SNAP benefit recipients, with 16.8% of Oklahomans participating. Under the bill, an estimated 131,000 Oklahomans – one-sixth of current SNAP recipients – will lose their SNAP benefits. That includes 25,000 people in our district, according to Oklahoma Watch.

No Medicare, Medicaid, SNAP, or other assistance for lawful immigrants

According to The National Immigration Law Center, H.R.1 made lawfully present immigrants ineligible for Affordable Care Act (ACA) subsidies, SNAP, Medicare, Medicaid, and the Children’s Health Insurance Program. Refugees, asylum recipients, survivors of human trafficking, survivors of domestic violence, and others are no longer eligible for these programs under H.R. 1. This includes lawful immigrants eligible for Medicare who have already paid into the system. The Congressional Budget Office has noted that 1.2 million people nationwide will lose health insurance, and between 120,000 and 250,000 lawful immigrants will lose SNAP benefits.

Conclusion

As these healthcare provisions take effect, the reality is simple: this is what Tom Cole voted for. Cole voted for all of these changes, every eligibility shift, every funding adjustment, every structural overhaul. We deserve better than that. Healthcare policy shapes whether families can access care, afford prescriptions, or keep insurance coverage. We can all agree that our healthcare is too important to be buried in sweeping, opaque legislation. We deserve transparency. We deserve leaders who know exactly what they are voting for. You deserve a leader who refuses to fall in line, but someone willing to pause, question, and, when necessary, vote no.