May 30th, 2025: This Week's Digest
- Eleanor Valentin
- May 30, 2025
- 12 min read
Updated: Jun 6, 2025
Welcome to the first weekly digest from Policies Humanized. We’re so excited to begin this journey and even more thrilled that you’re here with us.
Each week, Policies Humanized breaks down the biggest legislative and policy stories, making them clear, personal, and actionable. We believe policy shouldn’t just be reported; it should be understood.
In this week’s edition, we narrow our scope to take a closer look at "The One Big Beautiful Bill (OBBB)."
Next week, we will cover:
Key points and controversies from RFK Jr.’s MAHA Report
A bipartisan push to make childbirth free
Debate over water fluoridation
COVID-19 vaccine policies
President Trump's new executive order targeting prescription drug prices
Each of these carries real consequences for our lives, health, and access to care. At the end of every section, we’ll offer a clear, actionable takeaway: What’s happening, what your rights are, and what you can do.
Let’s humanize policy together.
The One Big Beautiful Bill (OBBB)
Breaking down the “One Big Beautiful Bill,” you can find the full proposal here: https://www.congress.gov/bill/119th-congress/house-bill/1/text
On Thursday, May 22nd, the OBBB Act was passed in the House of Representatives by a margin of one defining vote: 215 to 214. The bill was sponsored by Representative Jodey C. Arrington, who represents the 19th congressional district of Texas and is also the chairman of the House Budget Committee.
The fine prints of the package include a combination of changes that would impact taxes, healthcare, education, climate initiatives, and national defense. The Committee for a Responsible Federal Budget estimates that the bill would add $3.1 trillion to the national debt. We are going to break down parts of the proposed Act that would significantly impact resources impacting public health and well-being.
This week, the bill's status has rapidly evolved, with stakeholders engaged in intense negotiations. The urgency is tangible as the voting deadline approaches. Key elements of the OBBB include:
(1) Proposed changes to Medicaid and the Affordable Care Act:
a. Work Requirements: Starting on December 31, 2026, states would be required to establish a provision where able-bodied adults between the ages of 18 and 65 in the Medicaid expansion must complete 80 hours per month of work or volunteering unless they meet exemption requirements.
b. Beneficiary Costs: Medicaid recipients with incomes above the federal poverty line may be required to pay increased fees or premiums for their coverage. Copayments up to $35 for services will be enforced for certain enrollees with incomes above the federal poverty level.
c. Eligibility and Enrollment Restructuring: Stricter eligibility verification requirements will be implemented to check who qualifies for Medicaid and the Children's Health Insurance Program (CHIP). Redeterminations would become biannual for Adults on Medicaid. States would have to verify addresses and ensure deceased individuals are not enrolled. Retroactive coverage of Medicaid and CHIP would be reduced from 90 to 30 days. Additionally, the bill puts a pause on certain federal rules that have made it easier to enroll in programs including Medicare Savings Programs, Medicaid, CHIP, and the Basic Health Program.
d. Changes to State Medicaid Payments: States currently help pay for Medicaid by using provider taxes, or taxes health care providers pay to the state, and state directed payments (SDPs), or extra payments states give to Medicaid providers that are usually above the normal Medicaid rate to incentivize care. The bill would cap SDPs for states that have not expanded Medicaid under the Affordable Care Act so that states cannot pay more than 110% of what Medicare would pay for the same services unless those payments were already in place before the bill passes. This affects states primarily states that have not yet expanded Medicaid.
e. Funding Restrictions: Starting in 2027, there would be prohibitions into what can be funded by Medicaid. Medicaid would no longer pay for gender-affirming care for both adults and children (the "Crenshaw Amendment”). Non-profit clinics that provide abortion care would no longer receive Medicaid funding. Additionally, ACA plans that covers abortions, except in cases of rape, incest, or danger to the mother's life would also no longer receive Medicaid funding. Medicare and ACA premium tax credit eligibility for undocumented immigrants and individuals with temporary immigration status would be eliminated and it would become more difficult for undocumented immigrants to access Medicaid.
f. Other Provisions:
Pharmacy benefit managers (PBMs) would no longer be allowed to use spread pricing in Medicaid, this means that PBMs will no longer be allowed to charge Medicaid more than they pay pharmacies and pocket the difference.
The bill makes it easier for closed rural hospitals to reopen under a special “Rural Emergency Hospital (REH)” designation.
$25 million will be allocated to the Department of Health and Human Services (DHHS) to be used on artificial intelligence with the purpose of finding and recovering improper or fraudulent Medicare payments.
Stricter rules for ACA tax credits will be implemented including annual income verification, elimination of special enrollment period access based on projected income (the requirement of documentation of income), and the removal of caps on how much someone would have to repay if they got more ACA subsidy than they were eligible for.
The bill inserts a provision to appropriate cost-sharing reduction (CSR) payments for low-income beneficiaries in the individual health insurance market which lowers out of pocket costs.
The bill repeals or freezes implementation of rules that require minimum staffing levels in nursing homes, possibly allowing nursing homes to operate with fewer nurses.
What are the impacts?
Millions of low-income children and adults could lose access to healthcare. With expanded work requirements, the most vulnerable groups who are unable to meet the 80 hours per month threshold due to illness, caregiving, distance from work or volunteer opportunities due to being in rural areas or locations with lower job options, and other responsibilities would lose Medicaid coverage.
States might face budget constraints. By taking on a higher administrative and financial burden, states would be forced to reduce coverage or divert funds from other programs.
State directed payment caps will de-incentivize health care organizations and professionals to take Medicaid patients. Healthcare professionals already face high health professional school debts and this would reduce access to care for the most vulnerable.
If Medicaid no longer covers gender-affirming care, abortion care, and services for undocumented immigrants, critical support and life-saving care would be cut off. Children and victims of violence would be impacted the most.
Higher out of pocket costs and co pays would discourage seeking care. Preventive care would decrease and emergency visits for medical conditions that could have been prevented would create a higher financial burden and exacerbate the already existing crisis in health care worker shortages.
(2) Proposed Changes to the Supplemental Nutrition Assistance Program (SNAP) and Thrifty Food Plan (TFP):
a. Spending Cuts: SNAP spending would be reduced by nearly $300 billion through 2034, approximately a 30% cut from current projections, making it the largest reduction in the program’s history.
b. Cost Shifting to States: States would be required to pay 5% of SNAP benefit costs (previously fully federally funded) and 75% of administrative costs (up from 50%). If their error rates in processing benefits exceed 6%, they would face additional financial penalties. This cost shift accounts for over $128 billion in federal savings and may force states to either raise taxes, cut other services, or reduce SNAP benefit levels.
c. Work Requirements: The bill increases the upper age limit for Able-Bodied Adults Without Dependents (ABAWDs) from 54 to 64 and edits the definition of a dependent child from under 18 to under 7. Currently, ABAWDs can only get SNAP benefits for 3 months out of every 3 years unless they meet certain work requirements, however, states can request waivers from this limit. The new proposal would make it harder for states to obtain waivers from time limits, requiring county-level unemployment over 10% and removing other waiver bases. The number of exemptions states can give is reduced from 8% to 1%.
d. General SNAP Work Requirements: The general age range for work requirements would expand to individuals aged 18 to 64. The age of a child that exempts a parent from work requirements is raised from under 6 to under 7.
e. Thrifty Food Plan Freeze: The Thrifty Food Plan (TFP) is an estimate of how much it costs to buy a budget friendly nutritious diet for a family managed by the United States Department of Agriculture (USDA) and estimates how much money people would receive through SNAP. The new proposal would freeze this estimate and only adjust for inflation. The USDA would only be allowed to update the TFP every five years and only after public comment.
f. Deductions and Eligibility:
i. Automatic eligibility for Standard Utility Allowances (SUAs) is limited to households with an elderly or disabled member.
ii. Internet costs can no longer be used in SNAP shelter expense calculations.
iii. States must use a National Accuracy Clearinghouse to prevent duplicate benefits.
iv. The error tolerance level in benefit calculations is reduced from $37 to $0.
v. SNAP eligibility would be limited to U.S. citizens and Lawful Permanent Residents (LPRs), cutting benefits for people with lawful status, including refugees, trafficking victims, and children.
vi. The National Education and Obesity Prevention Grant Program would be repealed.
vii. Federal support for school meal programs would be cut by $700 million between 2028 and 2034.
What are the impacts?
Millions of individuals could lose access to food assistance they rely on due to stricter requirements. Individuals with chronic conditions, particularly, older adults would be forced to work to keep their benefits. Parents who are unable to afford or find childcare would be forced to choose between putting food on the table or being there to take care of their young children.
States would take on more costs which would create stricter budgets and eligibility rules, decreasing access to families in need. This could again, take away money from other just as important initiatives such as education and housing.
Restricting SNAP benefits to only U.S. citizens and lawful permanent residents takes away essential nutrients from immigrant families, children, refugees, and others.
Federal cuts to school meal programs would impact children from low-income households the most. Many families and children across the U.S. depend on free or reduced price meals for daily nutrition. In their prime years of growth and learning, children would be harmed in both their health and educational learning.
The freeze on Thrifty Food Plan could mean families receive lower benefits than necessary to purchase nutritious groceries. Their quality and quantities of meals could decline, in turning affecting their health, everyday performance, and nutrition.
(3) Proposed Changes to Student Loans and Education:
a. Pell Grant Eligibility: Requirements to qualify for Pell Grants would become stricter.
b. Workforce Pell Grants: Pell Grant would be extended for students attending trade or career training programs.
c. Elimination of Subsidized Loans: Federal Direct subsidized loans for undergraduates would be discontinued starting July 1st, 2026.
d. Oversight Rollback: The Secretary of Education would no longer have authority to regulate colleges based on whether their graduates find gainful employment. The Gainful Employment Rule was implemented to make sure career education programs prepare students to gain positive employment outcomes.
e. Loan Limit Restructuring: The bill would end Grad PLUS loans which currently allows graduate and professional students to borrow up to their cost of attendance. It would limit undergraduate loan caps at $50,000 and limit graduate and professional loan caps at either $100,000 or $150,000 based on the program. Additionally, it would impose a new cap of $50,000 on Parent PLUS loans regardless of how many dependents they have.
f. Limits on Debt Cancellation: Language is included to prevent any future president from unilaterally canceling broad categories of student debt.
g. Repeal of Discharge Protections: Students defrauded by for-profit schools or attending schools with poor outcomes would lose access to debt forgiveness and loan discharge options.
What are the impacts?
College could become more expensive for lower and middle income families if subsidized loans are eliminated. Students would be forced to find alternative funding which could come with higher interest rates, risking their chance in pursuing higher education. The same could be the outcome with caps in Parent PLUS loans and the cancellation of Grad PLUS loans.
By removing protection for students who might be defrauded by for-profit schools, it is possible that more for-profit institutions rise and thousands of students could be left with massive debts and poor job outcomes.
The $200,000 cap on education loans across undergraduate and graduate/ professional programs would prevent students from pursuing higher education. In terms of students who wish to pursue graduate and professional school in a healthcare field, this would create another barrier in recruiting health professionals into underserved and rural areas. Less future healthcare professionals would take on Medicaid patients as well due to the cumulative debt they have incurred to become a health professional.
(4) Proposed Changes that Rollback Renewable Energy Incentives and Environmental Protections:
a. Repeal and Restriction of Clean Energy Tax Credits: Many clean energy credits from the Inflation Reduction Act (IRA) would be scaled back or repealed, including those for solar, wind, hydrogen, clean fuels, and electric vehicles. For certain technology neutral clean energy credits projects to qualify, it must begin within 60 days of the bill being enacted and operational by the end of 2028. Additionally, the Clean Hydrogen Production Credit will be ended for projects starting after the end of this year. The Clean Fuel Production Credit is extended to 2031 but will have stricter requirements. Tax credits for electric vehicles and home energy efficiency improvements will be repealed.
c. Environment Protection Agency (EPA) and National Highway Traffic Safety Administration (NHTSA) Rules: The bill would repeal federal rules that aims to reduce greenhouse gas and emissions pollutants from vehicles and power plants.
d. Permitting Energy Development Projects: The bill would speed up the approval process for building energy infrastructure projects and includes rules about how the federal government manages the country’s oil reserves and backs energy loans.
e. Natural Resources and Federal Land Use: The bill contains provisions barring the sale of public lands in Utah and Nevada and instructs the House Natural Resources Committee to reduce the deficit by at least $1 billion.
What are the impacts?
The rollback of clean energy investments could deter new developments of clean energy initiatives. Environmental justice programs to reduce pollution, improve air quality, and create better climate outcomes would be gutted. This would disproportionally impact low-income communities and communities of color who are most likely to live in, go to school in, and work in areas of pollution and poor air quality. They already face higher rates of asthma, cancer, and other illnesses. Children who go to school with heavy pollution would fall behind compared to their peers who learn in cleaner environments.
Increased fossil fuel projects would grow putting many communities at risk. Climate goals would stall and business initiatives with long-term projects on sustainability could be reversed.
(5) Proposed Changes on Impacting Research and Development:
a. College Endowment Tax: Taxes on the net investment income of certain private university endowments would increase up to 21%. The bill expands the definition of taxable income to include student loan interest and some royalty income.
What are the impacts?
The increase in endowment taxes could reduce available funds for scholarships, research initiatives, faculty hiring, and other services. Institutions may respond by raising tuition, limiting financial aid, or having to cut academic programs to fit their fiscal year budgets and continue planning for the future.
Diverse students and faculty are essential for the exchange of ideas and for innovation. Research is crucial for scientific and medical breakthroughs. A college endowment tax would take money away from students who otherwise could not afford to attend university or do research. It would curb investment in critical fields like public health, medicine, technology, and more.
What are your rights?:
You have the right to be informed about how federal legislation affects your health care, education, food access, and the environment.
You also have the right to contact your representatives, participate in public hearings by sending in your testimony or testifying.
You can advocate for yourself and your community.
What can you do?:
As a constituent, your voice matters. Reach out to your elected officials. Your House representative and both U.S. senators represent your interests, and their staffs often track constituent feedback on specific bills. To find your elected official, visit https://www.house.gov/representatives/find-your-representative for your representative and https://www.senate.gov/senators/senators-contact.htm to find your senator. You can call their office or write to their office (especially your senator) to share how this legislation could affect you and those around you.
Submit comments or letters to the Senate committees reviewing the bill.
Join an advocacy group that aligns with your beliefs. Power comes in numbers. Just a simple google search with the issue and the state or town you live in will yield results.
Share this newsletter with others who are curious about what the OBBB says about health adjacent policies. Do more research into the issues you want to learn more about.
Fact check and question everything you read and hear (even this!), there are so many publications out there but not everything is accurate. We have done a lot of fact checking here, but it is still important to be aware. If you find anything in this article that is inaccurate, please kindly let us know.
Talk about this with people around you. It is key to stay in the loop and know what is happening and what could impact you before it happens.
The outcome of the OBBB sets a powerful precedent for future legislations. By speaking up now, you can urge lawmakers to approach public health, education, and safety with more transparency and humanity.
Thank you for joining us for the first newsletter edition of Policies Humanized. You have probably seen or heard news of the “One Big Beautiful Bill” almost everywhere this week, whether that is social media, the news, or heard from someone you know. Fun fact, or not so fun, the word count of the proposal is even longer than the book The Hobbit. Ingrained in all the complicated jargons are proposals that carries with it complex implications for healthcare, access to nutritious food, education, environmental protections, and more. By unpacking the fine print, we hope to empower you with tools for action.
Next week, we will be back with a breakdown of RFK Jr.’s MAHA Report, the push to make childbirth free, and more public health proposals.
Until then,
The Policies Humanized Team
*Correction on May 31st at 9:24PM for the line "Students would be forced to find alternative funding which could come with higher interest rates, risking their change in pursuing higher education" to change the word change to chance, new sentence being "Students would be forced to find alternative funding which could come with higher interest rates, risking their chance in pursuing higher education."
*Correction on June 6th at 1:00PM amending new topic coverage timeline
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