One year after President Donald Trump signed the ‘One Big Beautiful Bill’ Act into law on July 4, researchers, advocacy organizations and government officials continue to assess its impact on healthcare coverage and food assistance programs nationwide.

The legislation, which reduced federal spending for Medicaid and the Supplemental Nutrition Assistance Program (SNAP), passed the Senate on a 50-50 vote, with Vice President J.D. Vance casting the tie-breaking vote.

Since the law took effect, enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) has declined by 4.6 million people nationwide between April 2025 and March 2026, according to enrollment data compiled by KFF, a nonprofit health policy research organization.

KFF also reports that enrollment in Affordable Care Act (ACA) Marketplace plans has declined from approximately 22.3 million people in 2025 to between 16.5 million and 17.5 million in 2026. During the same period, average deductibles for Marketplace plans increased 37% to a record $3,786.

The expiration of enhanced ACA tax credits at the end of 2025 also contributed to higher insurance premiums for many people purchasing coverage through the Marketplace.

Researchers note that Black Americans are disproportionately represented among participants in Medicaid, ACA Marketplace plans and SNAP. According to federal data, approximately 26% of SNAP participants (about 10.2 million people) are Black.

Healthcare organizations also report that more than 1,000 hospitals, clinics, maternity wards, nursing homes and other healthcare providers have either closed or reduced services since the law was enacted. Planned Parenthood says nearly 30 of its health centers have closed during that period, with about two-thirds located in rural or medically underserved communities.

Supporters of the legislation have argued that the changes strengthen program integrity and reduce unnecessary government spending. U.S. Department of Agriculture Secretary Brooke Rollins has attributed declining SNAP participation to efforts to reduce fraud and to what the administration describes as improvements in the nation’s economy.

Critics, however, contend the changes have made it more difficult for low-income families to access healthcare and food assistance. Protect Our Care, a nonprofit advocacy organization, said the law represents a significant reduction in the nation’s healthcare safety net.

“This report makes clear that the dysfunction borrowers experience isn’t a series of isolated mistakes,” said Bonnie Latreille, visiting senior fellow with the Debt Collection Lab at Princeton University and former student loan ombudsman for the U.S. Department of Education of a report examining the transition. “It’s the predictable result of a fragmented system that shifts risk onto the people least equipped to absorb it, with no one held accountable.”

The legislation also reduced federal funding for SNAP by approximately $187 billion. According to available enrollment data, more than four million people had left the program by March 2026, including an estimated 700,000 children. Participation declined in every state, with 21 states reporting reductions of at least 10%.

Researchers have also pointed to Georgia’s Medicaid Pathways to Coverage program as an example of how work requirements may affect enrollment. State officials reported fewer than 7,500 participants enrolled during the program’s first year, despite estimates that approximately 300,000 adults were eligible. Administrative costs exceeded $40 million during that period.

Planned Parenthood officials say the reduction in federal funding has affected access to reproductive healthcare services, including contraception, cancer screenings and sexually transmitted infection testing. According to the organization, distributions of birth control, breast exams and STI testing have all declined since the law took effect.

To offset reductions in federal funding, 14 states approved more than $400 million in emergency funding to help maintain healthcare services. According to Planned Parenthood, states that fully replaced lost federal funding experienced fewer clinic closures than states that provided only partial or no replacement funding.

Many analysts say the law’s full impact has yet to be realized because several of its major provisions will not take effect until 2027 and 2028.

Last year, the nonpartisan Congressional Budget Office estimated that the combined healthcare and food assistance changes would reduce annual income for the nation’s lowest-income households by an average of about $1,200, while higher-income households would benefit from the legislation’s tax provisions. The Commonwealth Fund, a nonprofit health research organization, estimates the lowest-income households could experience average annual losses of approximately $1,600, while the highest-income households could see gains averaging about $12,000.

Researchers say the long-term effects of the legislation on healthcare access, food assistance participation and economic disparities will become clearer as additional provisions are implemented over the next several years.