When President Donald Trump signed the One Big Beautiful Bill Act into law last July 4, health advocates, academics and economists warned that the spending legislation — which cut trillions of dollars from Medicaid and food assistance budgets — would force millions of people to forgo health care and push millions more to the brink of hunger.
The budget law and its anticipated effects were so controversial that Vice President J.D. Vance cast the tie-breaking vote after the Senate split 50-50.
A year later, a range of experts say those predictions are coming true. The budget cuts are landing hardest on the low-income Americans who rely on them most — and hitting Black communities especially hard.
The law’s dismantling of the health and nutrition safety net is already measurable. Medicaid and enrollment in the Children’s Health Insurance Program, or CHIP, fell by 4.6 million people nationwide between April 2025 and March 2026, according to an enrollment tracker by KFF, a nonprofit health policy research organization.
Enrollment in Affordable Care Act marketplace plans has dropped even further, from roughly 22.3 million enrollees in 2025 to as few as 16.5 million this year. Average deductibles on ACA plans have simultaneously climbed 37% to a record $3,786, squeezing people who have managed to keep their coverage.
What’s more, the expiration of the enhanced ACA premium tax credits at the end of 2025 caused many households purchasing coverage through the Affordable Care Act marketplace to see their monthly premiums soar.
The cuts have hit Black Americans particularly hard because Black households depend on Medicaid, the ACA marketplace and SNAP at higher rates than the general population. Almost 26% of SNAP participants, or approximately 10.2 million people, are Black. Participants receive an average of $187 a month — just over $6 a day.
The strain is also visible in the loss of health infrastructure that many Black and low-income communities depend on.
More than 1,000 hospitals, clinics and maternity wards have closed or reduced services since the law passed. Nearly 30 Planned Parenthood health centers have also closed, two-thirds of them in rural or medically underserved areas. Researchers caution that most of the law’s provisions will not be fully phased in until 2027 and 2028, meaning the full scope of their impact on Black health outcomes is still to come.
The law also cut nearly $187 billion from SNAP funding — the largest reduction in the program’s history. The changes led to the nation’s first interruption of SNAP benefits last November.
By March, more than 4 million people, or 10% of enrollees, had lost SNAP benefits, and participation had declined in every state. All but eight states saw decreases of at least 5%. In 21 states, SNAP enrollment dropped by at least 10%, and at least 700,000 children nationwide lost food assistance.
U.S. Department of Agriculture Secretary Brooke Rollins has attributed the decline in SNAP participation to the administration’s efforts to prevent what it says is widespread fraud in the program and to an improving economy.
The law also defunded Planned Parenthood, contributing to the closure of nearly 30 health centers since July 2025. Two out of three of the closed facilities were in rural or medically underserved communities or in areas with shortages of primary care providers. All were located in counties considered “contraceptive deserts.”
Since the law took effect, Planned Parenthood says its distribution of birth control packs has fallen by 25%, visits for breast exams have dropped 20%, and STI testing has declined 10%.
Though the law has been in effect for a year, many of its largest Medicaid and SNAP changes will not take effect until 2027 and 2028. Last year, the nonpartisan Congressional Budget Office estimated that the nation’s poorest households would lose about $1,200 in annual income on average because of the health care and food assistance cuts, while the wealthiest households would gain about $13,600 through the law’s tax provisions.
The Commonwealth Fund, a public-interest nonprofit, projected an even steeper impact for the lowest-income households, estimating they would lose an average of $1,600 annually while the highest-earning 10% of households would gain about $12,000.
Researchers say the full effect of the law on Black Americans — and on the nation’s health and wealth disparities — may not become clear for several more years.
This story originally appeared here.