'One Big Beautiful Bill': How cuts will affect healthcare in 5 areas

'One Big Beautiful Bill': How cuts will affect healthcare in 5 areas

Trump's "One Big Beautiful Bill" Could Significantly Impact Prostate Cancer Patients and Older Adults

For IPCSG Newsletter

Prostate cancer patients and older adults face potential disruptions to their healthcare coverage and treatment access under the recently enacted "One Big Beautiful Bill Act," signed by President Donald Trump on July 4, 2025.

The sweeping legislation, officially known as House Resolution 1, will reduce federal healthcare spending by approximately $1 trillion over the next eight years, with cuts targeting programs that serve millions of older Americans—the demographic most affected by prostate cancer.

Medicare Changes Could Limit Access to Specialists

While the bill contains no direct Medicare cuts, it could trigger up to $500 billion in provider reimbursement reductions between 2026 and 2034 through an existing budget mechanism called PAYGO. These cuts would affect payments to doctors, hospitals, and other healthcare providers.

Healthcare policy experts warn that reduced reimbursements may cause urologists, oncologists, and other specialists critical to prostate cancer care to stop accepting new Medicare patients or discontinue Medicare participation altogether. Rural healthcare facilities, already struggling with limited resources, face particular vulnerability.

The bill also restricts Medicare eligibility for certain lawfully present non-citizens who previously qualified through work history, with changes taking effect January 1, 2027.

Prescription Drug Costs: A Mixed Picture

The legislation's impact on medication costs presents a complex scenario for prostate cancer patients. While the bill maintains some drug price negotiation powers granted under the 2022 Inflation Reduction Act, it delays negotiations for critical cancer treatments.

Notably, Keytruda, a cancer-fighting medication used in some advanced prostate cancer cases, will face delayed price negotiations. The bill also completely excludes certain treatments from Medicare negotiation processes and carves out "orphan drugs" for rare diseases.

Dr. Gerard Anderson of Johns Hopkins University's Bloomberg School of Public Health notes that approximately 40 percent of Medicare beneficiaries receive low-income subsidies through Medicare Part D. The new law reduces premium support for these beneficiaries, meaning many will pay more for prescription medications.

Medicaid Cuts Affect Millions of Older Adults

The legislation slashes $790 billion from Medicaid over the next decade, potentially affecting 22 million people aged 50 and older who rely on the program. For prostate cancer patients who depend on Medicaid for treatment coverage, these cuts could restrict access to care and force difficult decisions about continuing employment to maintain coverage.

Dr. Kanwar Kelley, a specialist in multiple medical fields and CEO of Side Health, warns that the cuts will "restrict their access to care and cause changes in planning for retirement, due to budget constraints or the need to continue working to continue coverage into later life."

ACA Coverage Becomes More Difficult to Obtain

More than 5 million Americans between ages 55 and 64 currently receive health insurance through the Affordable Care Act (ACA). The bill makes enrollment more challenging by shortening enrollment periods, imposing new documentation requirements, and eliminating automatic re-enrollment.

Perhaps most significantly, the bill does not extend enhanced ACA premium tax credits expiring at the end of 2025. This means enrollees with incomes above four times the poverty level will lose subsidy eligibility entirely, while those with lower incomes will receive smaller tax credits. Since premiums are typically higher for older adults who require more medical care, this age group faces disproportionate financial burden.

Long-Term and Home Care Services at Risk

The legislation reduces federal funding for nursing facilities and prohibits implementation of new staffing requirements designed to improve care quality. It also limits Medicaid payments to nursing facilities in 46 states and could lead to reduced spending for home care services.

For prostate cancer patients requiring post-surgical care, radiation therapy support, or assistance managing treatment side effects, these service reductions could prove particularly challenging as the aging population grows.

Timeline and Next Steps

Many provisions will take years to fully materialize, but some changes could affect patients within the next one to two years. The Congressional Budget Office estimates that at least 10 million people will lose health insurance coverage over the next nine years due to the bill's provisions.

Prostate cancer patients are encouraged to:

• Review their current Medicare and prescription drug coverage
• Consult with healthcare providers about potential changes to care access
• Explore supplemental insurance options before anticipated changes take effect
• Contact congressional representatives to voice concerns about healthcare access

As implementation details emerge, IPCSG will continue monitoring how these changes specifically affect prostate cancer treatment access and patient outcomes.

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Sources

1. Mills, D. (2025). How will older adults be affected by Trump's 'One Big Beautiful Bill'? Medical News Today. Retrieved from https://www.medicalnewstoday.com

2. The Health Foundation for Western & Central New York. (2025). Analysis of Medicare provider reimbursement impacts under HR1.

3. Center for Medicare Advocacy. (2025). Policy brief on HR1 Medicare eligibility changes.

4. Kaiser Family Foundation. (2025). Analysis of Medicaid and ACA impacts under the One Big Beautiful Bill Act. Retrieved from https://www.kff.org

5. Anderson, G. (2025). Impact of HR1 on Medicare beneficiaries with low-income subsidies. Johns Hopkins Bloomberg School of Public Health News Release.

6. Congressional Budget Office. (2025). Budget estimate for House Resolution 1 Medicare cuts under PAYGO provisions.

7. The Wall Street Journal. (2025). Medicare drug price negotiation delays under new legislation.

8. U.S. Congress. (2025). House Resolution 1: One Big Beautiful Bill Act. Retrieved from https://www.congress.gov

Note: Members should consult with their healthcare providers and insurance representatives regarding how these changes may specifically affect their individual situations.