Editor’s note: This blog on how the reconciliation bill breaks the GOP’s promise not to harm Medicare is written by Natalie Kean, Director of Federal Health Advocacy at Justice in Aging, and Julie Carter, Senior Federal Policy Associate at Medicare Rights Center. Justice in Aging is a member of the Coalition on Human Needs.

Since taking control of Congress and the White House, Republican leadership and rank-and-file members have repeatedly promised not to undermine Medicare or cut Medicare benefits. With the introduction of the “One Big Beautiful Bill Act” (OBBBA), they have broken that promise.

The OBBBA takes direct aim at Medicare, gutting eligibility and restricting access to benefits, while also cutting Medicaid in ways that would harm people who are dually eligible for both programs. For low-income older adults and people with disabilities, the health and economic ramifications of these cuts would be devastating.

OBBBA Would Directly Cut Medicare Eligibility

The Act would terminate Medicare coverage for many individuals with lawful immigration status who have worked and paid taxes in the US for decades. This is a significant departure from current, longstanding policy, which recognizes eligibility for everyone who has paid sufficient Social Security and Medicare taxes on wages to be considered “fully insured.” Medicare already prohibits payment for care for anyone who is undocumented, exposing that Republican lawmakers’ claims about the effect of this provision are false. Withholding or revoking Medicare eligibility from legally present older adults and people with disabilities who have paid in, and continuing to collect Medicare taxes on their wages, is deeply unfair and a betrayal of American values.

In addition, OBBBA would cut off these individuals’ access to Affordable Care Act (ACA) tax credits that could make buying private health insurance affordable once they are ineligible for Medicare. Because current federal law already restricts Medicaid eligibility for people with lawful status who do not have a green card, many of these individuals will likely end up uninsured. 

OBBBA Would Make Medicare Unaffordable for People with Low-Incomes 

The Act traps people with Medicare in red tape by stopping the Streamlining Medicaid Eligibility & Enrollment Rules. These rules modernized outdated policies and made it easier for older adults and people with disabilities to enroll in and keep Medicaid and Medicare Savings Programs (MSPs) that help pay Medicare costs.

The Congressional Budget Office (CBO) projects that without these rules in place, fewer people would enroll in Medicaid and MSPs despite being eligible. Nearly 1.4 million low-income people with Medicare—more than 10% of the dually eligible population—would lose critical cost-sharing assistance that covers Medicare’s $185/month Part B premium and helps them afford needed care. People who would lose this financial assistance are already living on limited incomes., Their dollars would be stretched even further, forcing some to choose between paying for health care and other basic needs like food and rent and increasing risk of evictions.

Losing Medicaid Increases Risk of Death for People with Medicare 

People with Medicare whose Medicaid is terminated are also at increased risk of death. A new study examining the health consequences of losing Medicaid—and, with it, the Medicare Part D Low-Income Subsidy (LIS), which reduces prescription drug cost-sharing –found that individuals who lost Medicaid and LIS experienced 4% to 22% higher mortality than those who retained coverage. These findings build on substantial research linking prescription drug unaffordability with worse health and higher Medicare spending. Cost barriers have long been found to reduce treatment adherence, leading to poorer outcomes and the need for more costly interventions. 

OBBBA Puts Long-Term Care at Risk for People with Medicare

People with Medicare rely primarily on Medicaid, not Medicare, for long-term care. Medicaid paid for 61% of all long-term care in 2022 and more than 70% of Home- and Community-Based Services (HCBS). OBBBA would undermine access to long-term care by shifting costs to states, likely resulting in cuts to HCBS programs. It would also make it harder for people to qualify for Medicaid coverage and avoid gaps in care that helps them age in place. The bill effectively repeals the Nursing Home Minimum Staffing Rule, endangering the lives of thousands of people with Medicare due to inadequate nursing facility staffing.

OBBBA Puts Medicare’s Future at Risk 

In an additional worry, the CBO projects that the OBBBA would trigger future massive cuts to Medicare totaling nearly $500 billion due to the Statutory Pay‑As‑You‑Go Act of 2010 (S-PAYGO). This law kicks in when legislation increases the deficit and would trigger an estimated $45 billion in Medicare cuts for fiscal year 2026, plus additional cuts to other programs that help older adults and people with disabilities.

Devastating Cuts and Broken Promises 

These actions make it very clear: Republicans are breaking their promise not to undermine Medicare or cut benefits. The OBBBA would cut coverage and access to care for millions of older adults and people with disabilities, putting their lives, health and financial stability at risk.