By a single vote, the U.S. House of Representatives on Thursday passed what President Donald Trump has dubbed the “Big Beautiful Bill” that contains deep cuts to Medicaid and SNAP, the food assistance program for low-income citizens.
Its fate is now in the hands of the 100-member U.S. Senate, which could make significant changes to the legislation. The bill cuts Medicaid and food assistance benefits, in part, to help pay for Trump’s tax breaks enacted during his first term.
Until there is a final bill, the House has crafted a blueprint that would significantly upend the social safety net for hundreds of thousands of lower-income people in New Jersey.
It would eliminate around $3.6 billion from the $14 billion the federal government now spends on New Jersey’s Medicaid program.
There are 1.85 million people who rely on Medicaid for health care, housing and other basic needs in the Garden State, according to state estimates. One in five, at least, are projected to lose coverage, according to state estimates.
U.S. Rep. Tom Kean Jr., R-7th Dist., a member of the House Energy and Commerce Committee that approved the bill last week, said the changes will protect the integrity of the program.
“On healthcare, we protected Medicaid for every intended beneficiary in New Jersey and across the country and stopped illegal immigrants from stealing taxpayer-funded benefits,” Kean said after the House vote.
U.S. Rep. Nellie Pou, D-9th Dist., voted against the bill, calling it “Republicans big ugly budget ... skewed toward giving tax relief to the wealthy and not the middle class.”
“It will gut Medicaid and take health care from millions,” Pou wrote in a post Thursday morning on X.
Here’s how the bill could affect New Jersey.
1) Overall Medicaid enrollment will plummet
One in five people are expected to lose health coverage from NJ FamilyCare, which is what the Medicaid program is called in New Jersey. That amounts to about 371,000 people, according to the state Department of Human Services.
Policy officials say losses largely would be driven by new rules requiring recipients to work or attend school a minimum of 80 hours a month. The work requirements would begin no later than Dec. 31, 2026.
The vast majority of Medicaid recipients already work, while most of the remaining people are taking care of a disabled child or are themselves disabled.
“The recently proposed Medicaid work requirement would not only cause millions of adults to lose their Medicaid coverage but would also create new barriers to enrollment by requiring applicants to prove they’re already working or qualify for an exemption,” said Michael Karpman, principal research associate at the Urban Institute.
2) People insured through the Affordable Care Act will face premium hikes
There are more than 454,000 people who would face steep hikes in their insurance premiums because they are covered through Get Covered New Jersey, the state’s Affordable Care Act marketplace.
They receive help paying for their premiums through federally funded tax credits that would diminish or disappear.
Many more people with middle-class incomes qualified for assistance through enhanced tax credits that began during the pandemic under the American Rescue Plan Act of 2021 and continued through the Inflation Reduction Act.
This enhanced tax credit assistance for these higher-income people (a single person earning about $60,000) expires at the end of the year. Some assistance would still remain in place for those on the lower end of the spectrum, but 88% will see price hikes, the state said.
Kaiser Family Foundation, a national research nonprofit, estimates the average premium increase will be 75%. In New Jersey, the average person would see their costs rise by 110%, with costs increasing by $1,260 per person, per year, according to the Department of Banking and Insurance.
New Jersey provides some assistance through state subsidies but nowhere near what the federal government pays
3) State and county costs will rise to run the Supplemental Nutrition Assistance Program, (formerly known as food stamps)
The SNAP program serves 800,000 lower-income people in New Jersey, nearly half of whom are children, one in three are disabled and 20% are more than 60 years old, according to the Department of Human Services.
New Jersey would lose $200 million in federal assistance, including $100 million more to administer the program, beginning in 2028. Of this, $78 million would have to come from county boards of social services.
John Donnadio, executive director of the New Jersey Association of Counties, said the burden on county governments, which administer SNAP, will be immense.
“There’s no way county governments can make up the difference without increasing property taxes,” he said.
There are expanded work requirements for SNAP benefits too. Under current law, work requirements ended for people when they turned 54. The new bill raises the work requirement to everyone under 65. Parents of children between the ages of 7 and 18 also must show they are working to get SNAP benefits.
4) Planned Parenthood is at risk
Planned Parenthood, which provides abortion and family planning services, as well as health screenings and check-ups for lower-income people, would receive no Medicaid funding under the House bill.
Planned Parenthood predicted that 200 health centers would close and the 1.1 million people it serves hard-pressed to find affordable care.
About one-third of Planned Parenthood‘s patients rely on Medicaid, according to Princeton University Professor Health Howard.
“Congressional Republicans want to ‘defund’ Planned Parenthood because some Planned Parenthood health centers, where legal, provide abortion care. The consequences will be catastrophic,” Planned Parenthood President and CEO Alexis McGill Johnson said in a statement.
“Cancers will go undetected, birth control will be harder to get, and the public health infrastructure — already pushed to the brink — will break down," McGill Johnson said
5) Changes for immigrant children
Under Gov. Phil Murphy, 46,890 children of undocumented parents in New Jersey get health insurance through Medicaid. The benefit is slated to cost $164 million in the coming fiscal year, paid solely with state money.
The new rules the House supports would not allow any state to cover undocumented immigrants without facing a huge financial penalty. The Trump Administration would deduct an additional $700 million in federal aid if New Jersey chose to insure people who are in the country illegally.
6) Hospitals would lose funding
Hospitals in New Jersey would collectively lose $300 million under the bill, according to the Department of Human Services.
New Jersey is one of 49 states that acquire more federal Medicaid funding by taxing hospitals. This tax revenue is used to qualify for a bigger share of federal Medicaid funding, which is then passed on as grants for hospitals and nursing homes.
“Cutting federal support undermines our entire healthcare system. Hospitals, clinics, and primary care providers depend on Medicaid,” Human Services Commissioner Sarah Adelman said. “These changes threaten their ability to serve everyone and maintain their workforces, driving up costs and delaying care.”
The Associated Press contributed to this report.
Susan K. Livio may be reached at slivio@njadvancemedia.com. Follow her on X@SusanKLivio.