Sep 3, 2026 · 53 min · 12 segments
Medicaid provides health insurance for 1 in 5 Americans and plays a crucial role in US health care infrastructure. The One Big Beautiful Bill Act (OBBBA) is estimated to cut Medicaid spending by…
Julie DonohueGuest
Derek AngusHost
We may be one car accident away from no longer being able to work and needing Medicaid.
And I think we'll start to see a realization of the role that Medicaid plays when our clinics and our hospitals are losing revenue from this important program.
It has changed quite a bit over the decades, but it is now on track for an unprecedented overhaul that could see millions of people lose coverage.
On Independence Day 2025, President Trump signed the One Big Beautiful Bill Act into law.
Prominent health economist David Cutler published a piece in JAMA Health Forum shortly thereafter, talking about the OBBPA, titled, The Worst Piece of Healthcare Legislation Ever.
This law seeks to cut trillions of dollars in taxes, paying for them in part with huge cuts to social services none larger than the cuts proposed for Medicaid.
In fact, $1 trillion is expected to be removed from Medicaid spending in the next decade.
So I thought it would be a good time to discuss the cuts, what they could mean for patients, clinicians, hospital systems, and the country at large.
My wife, Julie Donoghue, is professor and chair of the Department of Health Policy and Management, the School of Public Health, University of Pittsburgh.
She's also deputy editor here at JAMA Health Forum, and she is a longtime scholar of Medicaid.
And so I asked Julie if she could teach me and maybe the rest of us a little bit about Medicaid and about what might be coming with the OBBBA.
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We may be one car accident away from no longer being able to work and needing Medicaid.
And I think we'll start to see a realization of the role that Medicaid plays when our clinics and our hospitals are losing revenue from this important program.
It has changed quite a bit over the decades, but it is now on track for an unprecedented overhaul that could see millions of people lose coverage.
On Independence Day 2025, President Trump signed the One Big Beautiful Bill Act into law.
Prominent health economist David Cutler published a piece in JAMA Health Forum shortly thereafter, talking about the OBBPA, titled, The Worst Piece of Healthcare Legislation Ever.
This law seeks to cut trillions of dollars in taxes, paying for them in part with huge cuts to social services none larger than the cuts proposed for Medicaid.
In fact, $1 trillion is expected to be removed from Medicaid spending in the next decade.
So I thought it would be a good time to discuss the cuts, what they could mean for patients, clinicians, hospital systems, and the country at large.
My wife, Julie Donoghue, is professor and chair of the Department of Health Policy and Management, the School of Public Health, University of Pittsburgh.
She's also deputy editor here at JAMA Health Forum, and she is a longtime scholar of Medicaid.
And so I asked Julie if she could teach me and maybe the rest of us a little bit about Medicaid and about what might be coming with the OBBBA.