How Trump’s megabill may be affecting you right now

Alex Wroblewski/AFP/Getty Images

When Republicans ask voters to keep them in the majority, they frequently point to the most significant policy achievement of Trump 2.0 — the tax and spending cuts bill known as the One Big Beautiful Bill Act.

Among the main selling points Republican candidates cite are popular cuts to taxes on tips and overtime , things that have a populist appeal, although many of the tax savings are more likely to benefit wealthier Americans .

But the law offsets tax cut provisions by slashing federal funding for many programs that help make up the social safety net in the US, which means fewer Americans are getting aid from the government to afford food or obtain health insurance.

The administration has also cited fraud , frequently without evidence, to cut down on government programs.

Trump signed the law in July 2025, but some of the changes to government programs are just now coming into effect, while others won’t be felt until further down the road.

After failing to repeal and replace the Affordable Care Act during his first term , Trump and congressional Republicans have sought to weaken it in a variety of ways.

The biggest blow was their decision to let Obamacare’s enhanced premium subsidies lapse at the end of last year. The more generous assistance, which was approved in 2021 during the Biden administration as part of its response to the Covid-19 pandemic, broadened the number of people eligible for help and provided them larger subsidies. Enrollment nearly doubled between 2021 and 2025.

The enhanced subsidies’ expiration , along with rising healthcare costs, sent premium payments soaring 58% for 2026. Many of those who signed up for coverage this year bought less expensive plans — though those come with higher deductibles.

But many others found they simply could not afford the heftier monthly payments. As of February, enrollment fell to 19.2 million, a drop of 2.6 million from the same period a year prior, according to the latest federal data. It was the first decline in seven years.

However, more people have dropped their coverage since then, according to states that run their own marketplace and CNN reporting.

Enrollment in 18 states fell 8.5% as of May compared with a year prior, according to data collected by the State Marketplace Network. It had dipped only 1.4% at the start of the year.

In Mississippi, only 126,000 people were enrolled in Obamacare plans in August, a decline of 63%, the state insurance commissioner told CNN. More than 200,000 people have become uninsured.

Kara Windeler, a Florida resident who has health conditions, told CNN that she must give up her Affordable Care Act coverage in November because she cannot afford the premiums. She is trying to see doctors and receive treatment before she becomes uninsured.

Spencer Platt/Getty Images/File

The Trump administration has said that enrollment has fallen because many people were unknowingly signed up by unscrupulous brokers and agents and other enrollees did not exist at all.

Signups are expected to drop again for 2027 since premiums are forecasted to soar for the second year in a row. Insurers have proposed a median increase of about 15% for next year, according to KFF, a nonpartisan health policy research group. (Insurers’ proposed rate hikes don’t include federal subsidies, so the change in enrollees’ monthly premium payments may be different.)

The Republicans’ “big beautiful bill” enacted the largest cuts to Medicaid since the safety net program began 66 years ago. The package is expected to slash more than $1 trillion from Medicaid and leave 7.5 million more people uninsured over a decade, according to CBO.

Among the biggest changes to the program is the first-ever federal work requirement mandate. Medicaid expansion enrollees ages 19 through 64 will be required to work, volunteer, attend school or participate in a job program at least 80 hours a month, unless they are eligible for certain exemptions. Some 5.3 million more people are expected to be uninsured in 2034 because of this provision, CBO estimates.

The Trump administration is also taking a harder-than-expected line on who qualifies for an exemption for the medically frail . Not only must enrollees have an illness or medical condition, such as cancer or a behavioral health issue, but that condition must also significantly impair their ability to comply with the work mandate, according to a rule issued by the Centers for Medicare and Medicaid Services in June.

The work mandate kicks in next year, but a few states opted to implement it early. In Nebraska, nearly 1,100 people lost coverage or were not able to enroll because of the work requirement since the mandate began there in May, according to state data through August.

And a much higher than usual share of new applicants and those seeking to renew coverage were denied for procedural reasons, often relating to paperwork. This has led some experts to worry that people are running into hurdles that could involve the new work requirement.

Overall, enrollment in Medicaid and the Children’s Health Insurance Plan (CHIP) has declined by 5.1 million, or 6% — to 73.2 million — as of June compared with the year before, according to KFF.

The number of children enrolled in Medicaid and CHIP fell by more than 2.5 million between January 2025, when Trump took office, and August, according to the Georgetown University Center for Children and Families.

It’s unclear how much of the declines can be attributed to the “big beautiful bill” changes and how many children are winding up uninsured.

Other provisions that are expected to strip people of coverage include a narrowing of eligibility for immigrants, such as asylees and refugees, which could also affect their US citizen children. A requirement that adults enrolled through Medicaid expansion recertify their eligibility every six months could lead some to fall off because of paperwork issues.

Brandon Bell/Getty Images

The “big beautiful bill” also made significant changes to the financing of Medicaid, limiting how states raise money for their share of programs and enhance payments to providers.

Hospitals and other healthcare providers are concerned that these financing provisions — along with an increase in uninsured patients who have lost Medicaid and Affordable Care Act coverage — could force them to curtail services, lay off staff or even shut their doors. Some that have already had to pull back care have cited the impact of the package as one of the reasons.

Trump and congressional Republicans say all these changes are meant to improve Medicaid and make sure it remains available for the most vulnerable Americans. They also argue that Medicaid should help enrollees become financially independent through work.

Anthony Behar/Sipa USA/AP/File

The “big beautiful bill” contained several provisions that are expected to reduce enrollment in the Supplemental Nutrition Assistance Program, or SNAP, the formal name for food stamps, by millions of people over the next decade. The package enacted the largest cuts to food stamps in the program’s history — nearly $200 billion over a decade, according to CBO.

In fact, enrollment has already fallen by more than 5 million people, or nearly 13%, between the law’s enactment in July 2025 and June, according to estimates from the left-leaning Center on Budget and Policy Priorities that are based on US Department of Agriculture data. At least 1.5 million of them are children.

While the GOP package is not the sole cause, it is a major factor, experts say.

Among the most consequential provisions is a requirement that states start shouldering a portion of the food stamp benefit for the first time if they have a high rate of payment errors. They could be on the hook for $9 billion collectively, according to CBPP. (Historically, the federal government funded SNAP benefits, while states administered the program.)

Though this measure doesn’t kick in until next October, states are being proactive in tightening their oversight and requiring more documentation from enrollees. This is leading to many people being dropped because of paperwork issues, experts say.

The “big beautiful bill” also broadened SNAP’s existing work requirements to certain adult enrollees through age 64, to parents with dependent children ages 14 and older and to veterans, homeless adults and youth who aged out of foster care. Plus, the package requires states pay more of the administrative costs and ended the eligibility of refugees, asylees, victims of domestic violence and certain other immigrants.

Both the “big beautiful bill” and Department of Education decisions are leading to a major overhaul of the federal student loan program . Many of the provisions kicked in on July 1, but others take effect in coming years.

Federal student loans are critical to many Americans’ ability to go to college or grad school. More than 42 million borrowers have student loans, totaling more than $1.7 trillion, according to the Federal Student Aid office .

The US Department of Education says the law’s reforms implement “commonsense loan limits,” simplify repayment options and improve the health of the federal student lending system. But critics worry that the program’s revamp will make it harder and more expensive for students to finance their education and to repay their loans afterwards.

One of the major changes involves paying back one’s loans. The law created a new tiered standard repayment plan and a new Repayment Assistance Plan, known as RAP.

These options only apply to students taking out new loans at the moment. Borrowers who are currently repaying loans won’t see any immediate changes in their options as a result of the “big beautiful bill,” but most will have to switch to one of the new plans or the Income-Based Repayment plan by July 2028.

Robyn Stevens Brody/Sipa USA/AP/File

Graduate school students will no longer be able to borrow up to the “cost of attendance” for their programs. Instead, they will face borrowing limits that depend on what they are studying. And the Grad PLUS loan is being eliminated.

In a very controversial move, the Education Department decided that certain healthcare studies — such as nursing, physician assistants and physical therapy — were not considered professional programs. That means students pursuing these careers will be more limited in their federal student loan borrowing. The decision spurred lawsuits, which are now working their way through the courts.

Also, parents will be limited in how much they can borrow to help their undergraduate students.

Meanwhile, the Department of Education ended the Saving on Valuable Education (SAVE) plan — a Biden administration-era income-driven repayment plan that was blocked by federal courts in July. Borrowers are being given 90 days to switch into alternate plans, many of which may leave them with higher monthly payments.

SAVE’s demise has left many borrowers worried about how they’ll afford the higher monthly payments. One speech-language pathologist in California told CNN that she and her husband are reconsidering when — or whether — they can grow their family.

Alex Wroblewski/AFP/Getty Images

当共和党人请求选民让他们继续保持多数席位时，他们经常会提到特朗普 2.0 最重要的政策成就——被称为“一项伟大的法案”的减税和削减开支法案。

共和党候选人列举的主要卖点之一是削减小费和加班费的税收，这些措施具有民粹主义吸引力，尽管许多税收节省更有可能使富裕的美国人受益。

但该法案通过大幅削减美国社会保障体系中许多项目的联邦资金来抵消减税条款，这意味着越来越少的美国人能够从政府获得援助来购买食物或获得医疗保险。

政府还经常在没有证据的情况下，以欺诈为由削减政府项目。

特朗普于 2025 年 7 月签署了该法律，但政府项目的一些变化现在才开始生效，而另一些变化则要过一段时间才会显现出来。

特朗普在第一任期内未能废除和取代《平价医疗法案》后，国会共和党人试图通过各种方式削弱该法案。

最大的打击是他们决定让奥巴马医改的额外保费补贴在去年年底到期。这项更为慷慨的援助计划于2021年在拜登政府时期获得批准，作为应对新冠疫情的措施之一，扩大了受益人群的范围，并为他们提供了更高的补贴。2021年至2025年间，参保人数几乎翻了一番。

由于政府加大补贴力度，加上医疗成本不断上涨，2026 年的保费飙升了 58%。今年许多参保人购买了价格较低的保险计划——尽管这些计划的自付额较高。

但许多其他人发现他们根本负担不起更高的月费。根据最新的联邦数据，截至2月份，入学人数下降至1920万，比去年同期减少了260万。这是七年来首次出现下降。

然而，根据一些自行运营医疗保险市场的州和 CNN 的报道，自那以后，更多的人取消了他们的医疗保险。

根据州医疗保险市场网络收集的数据，截至5月份，18个州的医疗保险注册人数比上年同期下降了8.5%。而年初时，这一数字仅下降了1.4%。

密西西比州保险专员告诉CNN，8月份该州只有12.6万人参加了奥巴马医改计划，下降了63%。超过20万人失去了医疗保险。

佛罗里达州居民卡拉·温德勒患有多种疾病，她告诉CNN，由于无力承担保费，她必须在11月放弃《平价医疗法案》的医保。她正努力在失去医保之前就医并接受治疗。

Spencer Platt/Getty Images/文件

特朗普政府表示，参保人数下降是因为许多人在不知情的情况下被不择手段的经纪人和代理人登记参保，还有一些参保人根本不存在。

由于保费预计将连续第二年飙升，预计2027年的参保人数将再次下降。据无党派健康政策研究机构凯撒家庭基金会（KFF）称，保险公司已提议明年保费中位数上涨约15%。（保险公司提议的涨价幅度不包括联邦补贴，因此参保人每月实际支付的保费可能会有所不同。）

共和党人提出的“宏大法案”对医疗补助计划（Medicaid）进行了自66年前该社会保障项目启动以来最大规模的削减。据国会预算办公室（CBO）估计，该方案预计将从医疗补助计划中削减超过1万亿美元的资金，并在未来十年内导致750万人失去医疗保险。

该计划最大的变化之一是首次引入联邦工作要求。19至64岁的医疗补助计划扩容参保者将被要求每月至少工作、做义工、上学或参加就业培训项目80小时，除非他们符合某些豁免条件。国会预算办公室估计，由于这项规定，预计到2034年将新增约530万无医保人口。

特朗普政府在医疗体弱者豁免资格方面也采取了比预期更为强硬的立场。根据医疗保险和医疗补助服务中心6月份发布的一项规定，参保人不仅必须患有疾病或健康问题，例如癌症或心理健康问题，而且这些疾病或健康问题还必须严重影响他们履行工作义务的能力。

强制就业令将于明年生效，但一些州选择提前实施。内布拉斯加州的数据显示，截至8月份，自该州5月份强制就业令生效以来，已有近1100人因该规定而失去医保或无法参保。

因程序性原因（通常与文件不全有关）而被拒的新申请人和续保申请人比例远高于往常。这让一些专家担心，人们遇到的障碍可能与新的工作要求有关。

根据凯撒家庭基金会 (KFF) 的数据，截至 6 月，与上年同期相比，参加医疗补助计划 (Medicaid) 和儿童健康保险计划 (CHIP) 的人数总体减少了 510 万，降幅为 6%，至 7320 万。

根据乔治城大学儿童与家庭中心的数据，从特朗普就任总统的 2025 年 1 月到 8 月，参加 Medicaid 和 CHIP 的儿童人数减少了 250 多万。

目前尚不清楚有多少下降是由于“巨额账单”的变化造成的，也不清楚有多少儿童最终失去了医疗保险。

其他可能导致部分民众失去医保的条款包括缩小移民（例如寻求庇护者和难民）的参保资格范围，这可能会影响到他们的美国公民子女。此外，要求通过医疗补助计划扩容加入的成年人每六个月重新认证其资格，也可能导致部分人因文书问题而失去参保资格。

Brandon Bell/Getty Images

这项“宏伟法案”还对医疗补助计划的融资方式进行了重大改革，限制了各州为其项目份额筹集资金的方式，并提高了对医疗服务提供者的支付。

医院和其他医疗机构担心，这些融资条款，加上失去医疗补助和《平价医疗法案》保障的无保险患者人数增加，可能会迫使他们缩减服务、裁员甚至关门。一些已经不得不缩减服务的机构表示，该方案的影响是原因之一。

特朗普和国会共和党人表示，所有这些改革都是为了改善医疗补助计划（Medicaid），确保最弱势的美国人能够继续获得这项服务。他们还认为，医疗补助计划应该帮助参保者通过工作实现经济独立。

安东尼·贝哈尔/西帕美国/美联社/文件

这项“庞大而美好的法案”包含多项条款，预计将在未来十年内减少数百万人参与补充营养援助计划（SNAP，即食品券的正式名称）。据国会预算办公室（CBO）估计，该方案对食品券计划的削减幅度达到了该计划历史上的最高水平——十年内削减近2000亿美元。

事实上，根据左倾智库“预算与政策优先中心”基于美国农业部数据的估算，从该法案于2025年7月生效到今年6月，入学人数已经减少了500多万人，降幅近13%。其中至少有150万是儿童。

专家表示，虽然共和党的方案并非唯一原因，但却是一个主要因素。

其中一项影响最为深远的条款是，如果各州支付错误率较高，则必须首次承担一部分食品券福利金。据CBPP估计，各州可能总共要为此支付90亿美元。（历史上，SNAP福利金由联邦政府出资，而各州负责管理该项目。）

尽管这项措施要到明年10月才会生效，但各州已积极加强监管，要求参保者提供更多文件。专家表示，这导致许多人因文件问题而被取消参保资格。

这项“宏伟法案”还扩大了SNAP（补充营养援助计划）现有的工作要求范围，将部分64岁以下的成年参保者、有14岁及以上受抚养子女的父母、退伍军人、无家可归的成年人以及已脱离寄养体系的青少年纳入其中。此外，该方案要求各州承担更多行政费用，并取消了难民、寻求庇护者、家庭暴力受害者和其他一些移民的资格。

无论是“宏伟法案”还是教育部的相关决定，都将对联邦学生贷款项目进行重大改革。许多条款已于7月1日生效，但其他条款将在未来几年内陆续生效。

联邦学生贷款对于许多美国人上大学或研究生院至关重要。据联邦学生援助办公室统计，超过4200万借款人背负着学生贷款，总额超过1.7万亿美元。

美国教育部表示，该法案的改革实施了“合情合理的贷款限额”，简化了还款方式，并改善了联邦学生贷款系统的健康状况。但批评人士担心，该计划的改革将使学生更难、更昂贵地筹集教育资金，并在毕业后偿还贷款。

其中一项重大变化涉及贷款偿还方式。该法律设立了新的分级标准还款计划和新的还款援助计划（简称RAP）。

这些选项目前仅适用于正在申请新贷款的学生。目前正在偿还贷款的借款人不会因为这项“巨额法案”而立即看到任何选项变化，但大多数人必须在2028年7月之前转而选择新的还款计划或基于收入的还款计划。

罗宾·史蒂文斯·布罗迪/西帕美国/美联社/文件

研究生将不再能够借贷至其课程的“全部费用”。取而代之的是，他们将面临取决于所学专业的借贷限额。此外，研究生PLUS贷款也将被取消。

教育部做出了一项极具争议的决定，将某些医疗保健专业——例如护理、医师助理和物理治疗——排除在专业课程之外。这意味着攻读这些专业的学生在申请联邦助学贷款时将受到更多限制。该决定引发了多起诉讼，目前这些诉讼正在法院审理中。

此外，家长可以借款资助本科生的金额也将受到限制。

与此同时，美国教育部终止了“节约宝贵教育”（SAVE）计划——这项拜登政府时期推出的收入驱动型还款计划已于7月被联邦法院叫停。借款人有90天时间转而选择其他还款计划，但许多新计划可能会导致更高的月供。

SAVE计划的终止让许多借款人担心如何负担更高的月供。加州一位语言治疗师告诉CNN，她和丈夫正在重新考虑何时——甚至是否——要孩子。