This story was originally produced by the New Hampshire Bulletin. NHPR is republishing it in partnership with the Granite State News Collaborative.
A new national report estimates that 14,000 to 29,000 people in New Hampshire could lose Medicaid because of the One Big Beautiful Bill Act, the signature legislation of President Donald Trump’s first year back in the White House.
The report, created by the Robert Wood Johnson Foundation and the Urban Institute, notes that how New Hampshire implements the provisions of the new law will have a big impact on how many people lose coverage.
The One Big Beautiful Bill Act, a sprawling omnibus law that touches nearly every segment of the federal government, was enacted in July. Some of its biggest impacts will be felt by Medicaid, the country’s public health coverage program for people with low incomes and disabilities. The biggest Medicaid-related provisions in the law are ones instituting a work requirement for enrollees and increasing the frequency with which enrollees have to prove their eligibility for the program. The bill includes exemptions for people who are medically frail, though critics argue the bill is too vague in how it defines frailty. Critics also say that the bureaucracy required to institute the new mandates will do more to kick off people who are truly eligible but struggle to keep up with the paperwork than remove waste, fraud, and abuse as its proponents argue.
The report gives a low estimate — 14,000 — which it says could happen if New Hampshire leaders work to mitigate the impact. It also gives a high estimate — 29,000 — which it argues could happen if New Hampshire leaders don’t take mitigation measures.
Specifically, the report argues that the number of people losing their Medicaid coverage will be determined by things such as:
How New Hampshire defines medical frailty and other exemptions.
- What documentation it will require enrollees to show in order to prove they are working and eligible.
- The number of months New Hampshire applicants must meet work requirements before enrolling.
- The number of months enrollees must comply between eligibility redetermination periods.
- And how frequently verification of compliance or an exemption is required in New Hampshire.
While the bill has been criticized by liberals and Medicaid proponents, it does have some support, particularly among conservatives. Trump and his allies deny that the bill will kick off Medicaid enrollees that are truly eligible. Other conservatives — including Drew Cline of the New Hampshire-based conservative think tank The Josiah Bartlett Center for Public Policy, who spoke to the Bulletin in the days and weeks following the law’s passage — argue that Medicaid has grown too big in recent years and shrinking it would have a positive impact on the state’s financial outlook.
Still, polling shows Americans are largely not on board. A September Morning Consult poll found that 51% of U.S. voters disapproved of the law (37% “strongly” disapproved) while 35% supported (19% “strongly” supported) and 14% didn’t know or had no opinion.
