How the ‘Big Beautiful Bill’ Will Impact Tennesseans’ Health

Just ahead of the Fourth of July, the United States Congress passed a sweeping domestic policy bill. 

Days prior, local health care advocacy organization Tennessee Justice Center held a briefing, updating participants on just how devastating the impact of the so-called “One Big Beautiful Bill” would likely be. Officials with TJC said that, since December, they have been sounding the alarm over the federal appetite for cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP), and hoping to bring their concerns to local legislators’ attention.

The legislation, passed by the U.S. House and Senate just ahead of Trump’s July 4 deadline, cuts as much as $1 trillion from Medicaid funds, which will trickle down in impact to Tennessee’s offering, TennCare. 

Here are five things to know about how the budget will affect Tennesseans’ health.  

TennCare will still see cuts, even as a non-expansion state. 

Tennessee is one of 10 states that have not expanded Medicaid, leaving childless adults in the coverage gap. Even so, TennCare covers children and families, behavioral health services for children, and families with higher income but a child with profound care needs. That amounts to between 1.4 and 1.5 million members in Tennessee — and half of Tennessee’s children, 60 percent of nursing home residents, 9 percent of veterans and 24 percent of small business owners. 

In a previous draft of the legislation, rural hospitals stood to take a bigger hit, as they depend largely on Medicaid reimbursements, but Senate Republicans added in a $25 billion stabilization fund for rural hospitals over five years. 

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The states that have expanded will basically be forced to roll back their expansion. But that doesn’t leave Tennessee free and clear, according to Gordon Bonnyman, staff attorney and co-founder of TJC.   

“Medicaid is a matching program,” said Bonnyman during last week’s press conference. “So when you take the federal dollars out, you’re likely to lose the matching state dollars, which would be another $300 million. We’re looking at $1.3 trillion out of Medicaid, which is a number that’s difficult to even fathom.” 

In addition, the bill will make it “if not impossible, extraordinarily difficult” for Tennessee to expand Medicaid in the future, Bonnyman pointed out. 

Hospital organizations — including Ascension Saint Thomas locally — have condemned the bill.  

People might not be able to turn to ACA coverage.

When as many as 500,000 Tennesseans lost TennCare coverage in 2023 following a pandemic freeze, many of them went to healthcare.gov to secure Affordable Care Act coverage. In the 2024-25 enrollment season, 642,867 enrolled, compared to 521,341 in the 2023-24 season, which also saw a spike due to outreach and lower prices.

Under the new federal budget, cuts will be made to that program too. Those include prohibiting access for people ineligible for Medicaid due to immigration status, the shortening of the open enrollment period and the narrowing of eligibility for enhanced tax credits, which made the coverage more affordable. 

SNAP waivers will be cut, affecting free school lunches.

While a work requirement already exists for individuals on SNAP who don’t have children, families with children ages 14 to 18 will now have a work requirement. The same is true for people up to age 65 (previously 54), single moms raising children, veterans, homeless individuals, people aging out of the foster care system, asylees, refugees, and victims of forced labor and sex trafficking — all of whom had waivers prior.  

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Sixty-six percent of households that participate in SNAP in Tennessee have children, and children who are enrolled in SNAP are directly certified to get free lunch at school. 

“We know from experience in other states, it doesn’t get people to work,” Bonnyman said. “What it does do is it ensnares them in another level of paperwork where they can’t get their employers to submit the necessary documentation. They can’t document if they have fluctuating incomes, if they have more than one job, all of that. It’s hard to over-emphasize for those of us who deal with bureaucracy.”

In recent years, SNAP benefits were upped to $6 per person per day. States pay 50 percent of administrative fees for SNAP, but under the new budget, states are required to pay for up to 75 percent of those costs starting in 2028. 

The state is not off the hook.

In addition to the aforementioned matching funds in jeopardy, and setting new requirements for TennCare members, the state could be responsible for picking up the slack in the money lost from the federal level.    

“If these costs shift to the state, these are hundreds and thousands of dollars that the state has to come up with, and so they’ll have to battle that out in our General Assembly to determine how we’re going to cover those costs,” said Signe Anderson, senior director of nutrition advocacy with the Tennessee Justice Center.   

Bonnyman added: “States, by constitutional requirements, cannot run deficits. They have to have balanced budgets, unlike the federal government. When the federal government offloads this, the financial repercussions of that for the states are potentially enormous.”