An OPINION By Clayton Hulin, RN
On July 4, while most Americans were watching fireworks, President Donald Trump signed something else explosive: the One Big Beautiful Bill Act—or as some folks are already calling it, OBBBA. The name sounds hopeful. The reality is a lot rougher—especially if you’re a nurse, a Medicaid patient, or someone trying to provide care in rural America.
Let me break it down in plain English.
Medicaid is Taking a Hit
This law cuts about $1 trillion from Medicaid. That’s not a typo. And it’s not just numbers on a spreadsheet. That’s fewer people covered. Fewer services provided. More closed clinics. More patients turning up in emergency rooms because they lost coverage and waited too long to get care. And guess who picks up the slack? Nurses. Always nurses.
The bill also adds work requirements for Medicaid. Sounds good on paper…until you realize this means millions of people will lose coverage just because they couldn’t file the right paperwork in time or missed one report. If you’ve ever tried to help an elderly or disabled patient navigate a government form, you know how bad this could get. And when they lose coverage? They don’t disappear. They just show up at our hospitals, untreated and desperate.
States Will Cut Corners… And Nurses Will Pay
The bill puts a chokehold on how states can fund Medicaid using provider taxes. That might sound like an internal finance detail, but here’s the real-world effect: states will have fewer dollars to work with, and they’ll be forced to make brutal choices. Some will cut optional services. Others will lower reimbursement rates. Some will close entire programs or even hospitals…especially in rural areas.
That means layoffs, reduced hours, and heavier workloads for those of us left behind. If you’re a nurse already stretched thin, you’ll be asked to do more for less, again.
The Staffing Rule That Could Have Helped? Delayed Until 2034
CMS had a rule ready to go that would have required 24/7 RN coverage in nursing homes. It would’ve put real teeth behind safe staffing. But OBBBA put it on ice. Not a pause. A decade-long delay. So we go back to the same broken system… nurses outnumbered, patients neglected, and administrators shrugging because no one’s forcing their hand.
One Bright Spot? Overtime Pay Tax Relief
There is one silver lining: federal tax relief for overtime pay. Nurses earning up to $150,000 (or $300,000 for joint filers) can deduct up to $12,500 (or $25,000) in overtime pay from their taxable income. If you’re working long shifts or doubles to keep the place running, you’ll finally see more of that money in your paycheck.
It’s not a fix, but it’s something.
Rural Health Gets a Band-Aid, Not a Lifeline
The bill creates a $50 billion Rural Health Transformation Program. Sounds good. But here’s the thing: Medicaid cuts in rural areas are projected to be three times that size over the next decade. The math doesn’t add up. And even worse, some of that rural funding may be redirected to non-rural areas. In the end, it’s lipstick on a fracture.
Bottom Line for Nurses
This bill puts a target on Medicaid patients…and when they suffer, we carry the load. It threatens rural hospitals. It kneecaps safe staffing standards. It turns coverage into a bureaucratic obstacle course.
The people making these decisions? They won’t be in the ER at 2 a.m. when we’re trying to calm a confused patient who lost his meds because his coverage got yanked. They won’t be around when a nurse collapses after a double shift because no one else could cover. But we will.
We always are.
Clay Hulin is a Registered Nurse and writes from Franklinville NY on a variety of subjects from music to healthcare. You can reach him anytime, claymation_88@yahoo.com
Citations
Investor’s Business Daily. (2025, July 18). The Big, Beautiful Health Care Squeeze Is Here. What That Means For Your Coverage. Retrieved from
https://www.investors.com/news/big-beautiful-bill-trump-budget-health-care-coverage/ Big Rapids Pioneer+11Investors+11MarketWatch+11
Big Rapids News. (2025). Rural hospitals face uncertainty ahead of impending Medicaid cuts. Retrieved from https://www.bigrapidsnews.com/news/article/rural-michigan-hospitals-face-uncertainty-ahead-20786057.php
Associated Press. (2025). Work requirements could transform Medicaid and food aid under US budget bill. Retrieved from https://apnews.com/article/1556d8a594dc5668b298641081b759c9
Kaiser Family Foundation. (2025, July 30). A closer look at the work requirement provisions in the 2025 Federal Budget Reconciliation Law. Retrieved from https://www.kff.org/medicaid/issue-brief/a-closer-look-at-the-work-requirement-provisions-in-the-2025-federal-budget-reconciliation-law/
American Hospital Association. (2025, June 13). Rural hospitals at risk: Cuts to Medicaid would further threaten access.
