Despite strong and sustained opposition from the California Medical Association (CMA), the medical community, and patient advocates, Congress passed HR 1, the  “One Big Beautiful Bill Act.” Signed into law on July 4, 2025, the bill enacts more than $1 trillion in federal health care cuts and jeopardizes coverage for millions of Californians.

“This law will do irreparable harm to the health of our nation,” said CMA President Shannon Udovic-Constant, M.D., in a statement following final passage. “It strips coverage from millions, guts provider funding, and makes it harder for patients to access care – particularly in our most vulnerable communities.”

A direct attack on California’s health care system:

• Massive coverage losses: An estimated 2.5 million Medi-Cal enrollees and up to 2.6 million Covered California participants will lose coverage.
• Making health care less affordable: The bill imposes new $35 copays per service on the Medicaid expansion population starting in 2028, a barrier to care for low-income patients. By allowing the ACA premium tax credits to expire, nearly 2 million face premium hikes of up to 66%, making coverage unaffordable for many.  
• Devastating provider tax cuts and payment caps: The bill slashes as much as $128 billion from California’s health care system over 10 years by cutting provider taxes and capping state-directed payments. These cuts are expected to reduce hospital and physician payment rates and force service reductions or closures.
• Uncompensated care surge: With fewer patients insured, California’s hospitals and physicians  are expected to face $9.5 billion in new uncompensated care costs over the next decade.
• Economic consequences: Health system contractions are projected to eliminate 217,000 California health care jobs, reduce economic output by $37 billion, and cut $1.7 billion from state and local tax revenues.
• Burdensome requirements: The law imposes 80-hour monthly work, school, or community service requirements on many adult Medicaid enrollees, with complex paperwork and reporting. This administrative red tape could cause more than 4.8 million otherwise eligible adults to lose coverage nationwide.
• Planned Parenthood defunding: One-year Medicaid defunding of Planned Parenthood will strip $305 million from California and threaten more than 80% of the state’s 1.2 million annual patient visits to Planned Parenthood clinics.

• Student loan cuts: The bill also imposes multiple cuts on student loan programs, including capping medical school government borrowing at $200,000, which will create barriers for those wanting to attend medical school and exacerbate existing physician workforce shortages. (The provision that eliminated Public Service Loan Forgiveness for hours worked during a medical residency or internship was removed.)

Although the law includes a temporary 2.5% Medicare physician payment increase in 2026, CMA warns that it does not address the structural underfunding of physician services and is dwarfed by the broader damage to health care access. The bill also triggers an additional 2% Medicare sequestration cut starting in 2026.

CMA will not back down. We will continue fighting to reverse the damage of this law and to protect access to care for all Californians. Our health care system – and the patients and communities it serves – cannot withstand these kinds of short-sighted, catastrophic  attacks. CMA thanks the physician advocates across the state whose powerful voices helped lead this fight. We look forward to working together in the months ahead to mitigate the harm of this law and continue advancing equitable, patient-centered health care in California.