Burcum: ‘Big Beautiful Bill’ takes hatchet to health care

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The U.S. House passed what President Donald Trump calls his “Big Beautiful Bill” early Thursday. Minnesotans understandably might come up with a less flattering label when they discover a potential downstream consequence: higher property taxes.

The sprawling budget legislation containing Trump’s signature policy agenda, if enacted, would impose significant new administrative burdens on medical assistance programs, such as work requirements and twice-yearly eligibility checks. These might sound reasonable at first. But in reality, these create massive amounts of red tape for enrollees and, in turn, require substantial additional sums to administer.

Compliance will fall heavily on Minnesota’s counties, who already face some cost-shifting from the state. The new federal obligations would require time and resources that they don’t have, especially rural counties. That leaves their main revenue-raising mechanism, property taxes, to fill the gap.

“We have communicated to the congressional delegation our concerns about the amount of administrative work that these changes will be for counties who are already strapped for resources,” said Julie Ring, the Association of Minnesota Counties’ executive director. ”We do have concerns about just strictly having enough staff to do the work in a timely manner and just the cost of doing that work.“

The new administrative costs could be substantial, something known from a previous legislative attempt in Minnesota to add medical assistance work requirements in 2018. State officials at the time put the price tag at $160 million a year, a sum that‘s likely gone up seven years later due to inflation.

Keep in mind this price tag just estimates the costs of overseeing the work mandate. It does not include the new eligibility checks or new administrative requirements for other programs, such as food assistance.

The House bill now heads to the Senate, where these provisions hopefully will undergo changes before a floor vote that could come midsummer. But the reconciliation process means that a simple majority is needed in the upper chamber vs. the usual 60-vote threshold. The troubling House provisions could remain in place despite Democrats’ best efforts.

Congressional Republicans are “taking us backwards, they are hurting people, and I plan to fight it every step of the way,” said U.S. Sen. Tina Smith, a Democrat, on Friday.

As the bill makes its way through Congress, it‘s important to understand that this is as dramatic a health care overhaul as the Affordable Care Act (ACA). The difference is that the ACA expanded access to coverage while the current House bill could roll back the ACA’s progress to help offset tax cuts for the wealthy.

The changes are sweeping and likely to impact a substantial number of Minnesotans. Currently, 1.2 million people here access health care thanks to Medicaid, the federal-state program providing coverage for low-income people. Medicaid also pays for many elderly people’s long-term care as well as disability services.

“Medicaid is the largest single source of health insurance in Minnesota,” according to state Department of Human Services (DHS) officials. The Minnesota counties with the highest percentage of residents enrolled in Medicaid are rural.

The House bill could result in $716 billion in cuts to Medicaid and other health initiatives nationally over the next decade, the “most significant” funding reductions in the program’s 60-year history. The savings mainly come from measures likely to kick people off coverage. The bill‘s sweeping changes could result in 253,000 Minnesotans losing coverage, according to an analysis shared by DHS.

The new work requirements, for example, have been tried in Arkansas and resulted in eligible people getting caught up in red tape and losing their coverage. The requirements didn’t boost employment.

The additional eligibility checks could also result in coverage losses. Many Medicaid enrollees are facing a health care crisis, such as substance-use disorder or housing challenges or both. That makes it difficult to contact them and get them to return eligibility forms.

In addition, Minnesota could also see a 10% reduction in federal support for adults who became newly eligible for Medicaid coverage under the ACA. That group could face significant hikes in out-of-pocket copays for care as well.

But the House bill goes beyond Medicaid. There are concerns that the bill‘s passage could trigger $500 billion cuts to Medicare, the popular health insurance program for seniors.

Coverage losses could also occur for those who buy private health insurance on their own instead of getting it through a job. About 186,000 Minnesotans (3.2% of us) buy health plans this way.

The legislation proposes cutting in half the open-enrollment time period for buying plans like this on MNsure or elsewhere. Other changes boost red tape, such as requiring manual verification of income and other eligibility checks instead of relying on the current system, which seems to be functioning just fine. That could lead to backlogs and additional administrative staff.

The biggest problem, though, is what the House bill does not do. It fails to renew expiring enhanced subsidies that allowed many people to newly qualify for the ACA’s financial assistance to pay monthly health insurance premiums. Many farm families and entrepreneurs fall into this category and could see steep hikes in monthly premiums beginning in 2026.

The private health insurance market changes could result in “over 62,000 Minnesotans” losing their private health plans in coming years, said MNsure CEO Libby Caulum on Thursday. That‘s “as many as 45% of our current enrollees.”

It might be easy to consider these changes as painful but necessary measures to reduce the nation’s red ink. That‘s not the case, however. The House bill not only fails to do that, but “is shaping up to add roughly $3.3 trillion to the debt” through fiscal year 2034, states the Committee for a Responsible Federal Budget.

A far more accurate name for that “Big Beautiful Bill”? I suggest “Taking a Huge Hatchet to Health Care Act of 2025.”

Hopefully, enough responsible leaders in the Senate see the legislation for what it is and act accordingly. There’s still time to head off truly harmful impacts on consumers, state and local governments and the nation’s medical providers.