The “One Big Beautiful Bill” (OBBB), supported by all five members of Nebraska’s delegation and signed by President Trump, guts our health care to give tax breaks to billionaires and fund sweeping, unproductive deportations of everyday working people that will separate families and devastate communities. These cuts will take billions from Nebraska’s health system and health care coverage away from tens of thousands of Nebraskans.
Almost 1 in 4 Nebraskans rely on either Medicaid or the Affordable Care Act’s Marketplace coverage, the programs targeted by OBBB, to receive health care. The OBBB’s Medicaid cuts are the largest in the program’s history. The OBBB’s Medicaid cuts could cause up to 55,000 Nebraskans to lose coverage and the state to lose up to $4 billion in federal Medicaid funding over the next 10 years. Dozens of provisions in the OBBB slash Medicaid and undermine our health system. Key cuts include:
- Attacks Nebraska’s voter approved Medicaid expansion program, which provides coverage to over 65,000 Nebraskans. These cuts include imposing harsh and unnecessary work requirements, copays, and more frequent redeterminations.
- Work Requirements: While much of the work requirement details will be further defined by our state and the federal government, generally, individuals will have to complete 80 hours of qualifying activities like work in the month prior to application and again when enrolled for at least one month within every 6 month period. There will be some exemptions, such as for those who are parents/caregivers with children under 14 or children with disabilities, medically frail, pregnant/postpartum, among others. While a vast majority of people with Medicaid would meet work requirements or exemptions, these additional paperwork requirements are expected to cause massive coverage losses. These changes must be implemented by December 31, 2026.
- Copays: States must impose cost sharing of up to $35 on certain services for expansion adults with incomes 100-138% FPL, which will become effective October 1, 2028.
- Redeterminations: States will be required to redetermine those eligible every 6 months instead of every 12 months, which is expected to cause churn and disruptions in continuity of care. This new requirement begins for renewals scheduled on or after December 31, 2026.
- Limits the Medicaid retroactive coverage available. Currently Medicaid provides 3 months of retroactive coverage, and this bill drops this down to 1 month for Medicaid expansion enrollees and 2 months for other enrollees. This means that families will be faced with more medical debt, and hospitals and providers will be faced with more uncompensated care. This becomes effective January 1, 2027.
- Ends Children’s Health Insurance Program (CHIP) and Medicaid coverage for asylees, refugees, and immigrant categories that cover victims of domestic violence – all categories had been eligible for Medicaid prior to this change. This becomes effective October 1, 2026.
- Reduces federal funding for Medicaid by limiting provider taxes that Nebraska relies on to balance our budget and support our health system.
- Makes it more difficult to afford and enroll in the Affordable Care Act’s Marketplace that over 135,000 Nebraskans rely on to access care.
Due to the significance of these cuts, everyone is expected to feel the impact, regardless of what health care coverage they have.
The fight continues. In the next year, our state will decide how to implement these changes. Nebraska needs you to tell our state leaders that they must do as much as is permitted to protect Nebraskan’s health care under this new law. Stay tuned for more on how you can help save our health care.