During the summer rush to introduce the One Big Beautiful Bill Act (OBBBA), President Donald Trump and other Republican lawmakers lauded the bill as transformative for middle- and working-class Americans. The reality of the GOP’s signature policy law is now setting in, including $1 trillion in Medicaid cuts that experts say could prove fatal for thousands of already vulnerable people across the U.S.

It has long been unnecessarily burdensome for disabled people to access benefits due to underfunded and understaffed state programs, among many other reasons. Earlier this year, downsizing and rule changes at the Social Security Administration (SSA) only made matters worse. Between eliminating phone identity verification and closing field offices across the country, millions of beneficiaries—many of whom are disabled and elderly—now face additional challenges accessing their benefits, along with longer wait times when issues arise. Experts say that the SSA’s already lengthy processing time indicated a need for more funding, not less. Instead, the Trump administration gutted the federal agency, exacerbating longstanding problems. 

Now, many of these same problems will be replicated across state and federal service agencies and providers, thanks to the OBBBA’s Medicare and Medicaid cuts. Adam Hazlett, the public relations director for Self-Advocates of Michigan and a professor of humanities at Henry Ford College, told Prism via email that Trump’s new law is a major concern not only due to the budget changes, but also because it rolls back civil rights. 

“It reframes disabled people as costs to be contained rather than citizens entitled to equal access to care,” said Hazlett, who is an autistic adult. 

OBBBA’s new biannual Medicaid redeterminations, additional eligibility checks, and 80-hour work requirement all make qualifying for Medicaid more inaccessible. Hazlett said these barriers, along with additional paperwork, will effectively strip eligible people of coverage. The work requirement in particular makes disability a double barrier, “first to work, and then to access the exemption,” Hazlett said. 

More broadly, the cuts to Medicaid threaten the nation’s caregiving infrastructure, with rural communities most at risk, as hospitals and clinics in these regions heavily rely on Medicaid reimbursements to survive. According to an analysis this year from KFF Health News, nearly 3 million people in the U.S. live in mostly rural counties that lack both health care facilities and reliable high-speed internet, rendering telehealth services useless.

“These people tend to live sicker and die younger than others in America,” KFF Health News reported. When already limited and overburdened rural providers are ultimately forced to shutter due to OBBBA, it doesn’t just translate to a longer drive or a mere inconvenience to disabled people; it means necessary care becomes wholly inaccessible.

Impossible to stay alive 

Nancy Baker Curtis and her 10-year-old son, Charlie, rely on services provided by Medicaid, including physical therapy, occupational therapy, speech therapy, and feeding therapy. Commonly referred to as Home and Community Based Services, these services are not federally mandated, making payment optional for individual states. 

In Iowa, where Baker Curtis and Charlie live, the state is operating with a budget shortfall of nearly $1 billion, requiring program funding to come from the federal government. The services that Charlie and other disabled people rely on will be the first to get cut. Without them, Curtis will have to spend her time with Charlie caretaking, requiring that she quit her job as a public school teacher—another area for which Medicaid funding is integral. 

“School-based therapies are funded by Medicaid,” Baker Curtis explained in an email. “Medicaid is the fourth largest funding source for public schools. Charlie has approximately 11 more years of eligibility for public school. The underfunding of schools and Medicaid will undoubtedly be detrimental to his progress, as well as the progress of other school-aged children with disabilities.” 

About 700,000 people—approximately 1 in 5—are on Medicaid in Iowa, meaning that actions at the state level affect large numbers of people, even before the OBBBA’s passage. Iowa’s former governor privatized Medicaid, leading to difficulties and incorrect denials of services. More recently, Iowa lawmakers were considering a work requirement, which ultimately came to fruition with the passage of OBBBA. Access issues in the state are also longstanding, with Iowa ranking 44th in the nation for patient-to-physician ratio, a problem Republican Gov. Kim Reynolds is trying to address with a bill aimed at improving rural health care and addressing health care provider shortages. However, with Medicaid also on Trump’s chopping block, it’s unclear how successful the bill will be if passed.

Medicaid cuts are catastrophic for people such as Alex Watters, who received day-to-day care and was able to pursue his degrees due to Medicaid. Watters is a councilmember in Sioux City, Iowa, and the director of alumni engagement at Morningside University. 

“As a quadriplegic, I need assistance bathing, getting dressed, positioned in my wheelchair in the morning, assisted occasionally throughout the day, and helped back into bed in the evening,” Watters said in an email. Considering the cost of Watters’ medication, without Medicaid paying an agency to provide these necessary services, the councilman said he could not have afforded them on his own. 

However, Medicaid underfunding has been an issue for far longer than Trump has been president, with disabled people most acutely feeling the effects.

Watters said that in Iowa, longstanding Medicaid underfunding has meant that people with disabilities often lack adequate caregivers, making it almost impossible for them to stay housed, maintain employment, or simply stay alive.

There are only two agencies in Sioux City that offer daily caregiver support, and neither has the staff necessary to meet the needs of disabled people in the area. Burdensome paperwork is often cited as a hurdle.

When speaking to caregiver agencies about their reasons for only accepting private pay, Watters said he’s been told that it would require hiring an additional staff member to become Medicaid certified. 

“They feel that they would need an additional staff member just to keep up on the amount of paperwork necessary, that they would not be fully reimbursed for the services, and the delay in those reimbursements would not be financially sustainable,” Watters explained. 

As the forthcoming effects of the OBBBA become clear, nearly two-thirds of the public see the bill unfavorably, prompting a GOP rebrand ahead of the midterms. Trump officials urged other Republicans to refer to the bill as “a boost for ordinary Americans.” Conceding that the polls were not in their favor, Republican lawmakers appear unconcerned that the bill cuts necessary resources; their focus is on its marketing. 

No matter the rebranding, when coupled with statewide challenges already faced by disabled people, the Trump administration’s efforts to gut federal agencies, benefits, and services may lead to despair. But Baker Curtis and others who spoke to Prism said now more than ever, people must fight back. 

“I encourage people with disabilities and their caregivers to speak with the media, their neighbors, and show up at town halls,” said Baker Curtis, noting that the majority of the Trump cuts will happen in 2027. This was echoed by Watters, who said that elected officials—Democrat and Republican—must be made to feel the impact of the Trump administration’s actions “or nothing will change.”

Watters said this means that rather than being allowed to simply throw their hands up in defeat, residents are demanding that state lawmakers implement solutions to stop the federal bleeding. 

“We’re calling for creative funding strategies, but that’s only part of the work,” Hazlett echoed. “The deeper task is reframing how we see disability itself. For too long, disability has been cast as deficit—something to fix, hide, or merely ‘manage.’ … Our response has to be courage, solidarity, and unapologetic organizing.” 

Editorial Team:
Tina Vasquez, Lead Editor
Carolyn Copeland, Top Editor
Stephanie Harris, Copy Editor