On July 4, President Trump signed his 1,000-page “Big Beautiful Bill” (BBB) into law. The bill permanently enacts several income tax cuts that were originally passed in 2017 while providing additional benefits to the wealthiest. It also includes significant funding for Immigration and Customs Enforcement (ICE) while rolling back environmental protections.

The bill is a massive attack on the working class and will harm the most marginalized, all while adding $3.3 trillion to the national debt. It makes severe cuts to the social safety net, especially healthcare programs like Medicaid and Medicare, as well as other programs such as the Supplemental Nutrition Assistance Program (SNAP), otherwise known as food stamps. While the bill offers some small but likely temporary benefits to precarious workers (e.g., by removing federal income taxes on tips and overtime), it ultimately provides the greatest advantages for the wealthy — all while devastating the health of the working class.

The BBB Is Kicking People Off Their Insurance, and Making Health Care Worse

To offset both the tax cuts for the rich and increased funding to ICE, Republicans aimed to “balance” the budget by making significant cuts to the social safety net. The largest of these cuts will occur in Medicaid over the next 10 years. Medicaid is the largest health insurance program in the country, covering about 70 million Americans. Traditionally, the program covered pregnant women, children, and people with disabilities, among others. But with the expansions under Obamacare, Medicaid also covered “working poor” adults without children, which led to an additional 20 million people gaining healthcare coverage.

Now, this bill is likely to kick an estimated 12 million off their healthcare coverage. That number could shoot as high as 17 million next year, when changes are set to expire from Obamacare. That’s on par with the number of people who would have lost their health insurance if Obamacare had been repealed outright. In a way, Republicans learned from their past mistakes of attempting to repeal Obamacare during Trump’s first term, finding an alternative way to cut people from health care by using this bill as their backdoor strategy.

So how is the BBB accomplishing this?

The law’s most significant change to Medicaid is the imposition of strict work requirements. Adults covered by Medicaid will be required to prove that they work or volunteer at least 80 hours a month or that they qualify for an exemption. Even those who are exempt will have to navigate complex bureaucratic processes to remain covered. These barriers are not designed to promote work — even accepting the ridiculous notion that health care should be something you prove you have “earned” rather than a basic right — but to complicate the system so that people risk losing their health care. Arkansas’s earlier attempt at similar mandates led thousands to lose coverage, with no meaningful increase in employment. When Republicans looked at state models of work mandates, they ensured this bill was modeled after examples that resulted in the highest numbers of people losing their health care.

This is not only inhumane but also counterproductive. Preventing people from accessing health care makes it harder for them to stay healthy enough to work. Republican rhetoric about ending “waste and fraud” is a pretext to deny access under the guise of budget-cutting and productivity—while pushing people into poorer health and deeper poverty.

Unfortunately, that’s not all. The BBB also changes how Medicaid is funded. Traditionally, federal and state governments have shared the cost of Medicaid. Under the new law, states will bear a larger percentage of the costs, particularly in certain regions. This will lead to significant reductions in payments made to hospitals, clinics, and nursing homes. Rural hospitals, already operating on thin margins, will likely be impacted the hardest — over 300 are now facing the immediate possibility of closure.

The bill also dismantles access to health care in more insidious ways. It caps federal loans for graduate students at $50,000 a year, forcing future health providers to rely on expensive private loans or drop out of school. This will hinder access to the healthcare profession for everyone except those from the most privileged backgrounds — reducing diversity in a field already lacking representation — and exacerbating the shortage of providers.

While Medicaid faces the steepest cuts, the BBB also reduces Medicare, jeopardizing care for seniors and people with disabilities. Over the next 10 years, Medicare will see almost $500 billion in cuts, even though Trump campaigned on the promise that he would not cut Medicare.

The BBB Will Devastate Public Health

While the BBB showers billions on the wealthy, it unleashes the largest-ever cuts to food assistance in U.S. history. SNAP and similar programs will be gutted, pushing millions deeper into food insecurity — especially Black, Indigenous, and immigrant communities who already suffer disproportionately from hunger. Inadequate nutrition is a public health crisis waiting to erupt.

Meanwhile, the bill repeals crucial environmental protections and slashes funding for clean energy programs — all amid a worsening climate crisis. The week the bill passed, flash floods in Texas claimed over 120 lives. Instead of investing in infrastructure or protecting vulnerable communities, the U.S. government — under bipartisan rule, but accelerated under Trump — is choosing to deepen the crisis through deregulation and disinvestment in green technology.

The massive ICE expansion is also related to public health. Militarized community raids, detentions, and deportations inflict widespread trauma, tear families apart, and destabilize already-vulnerable communities. The health consequences will be severe.

Under capitalism, human suffering is often viewed as a business opportunity. Detention and imprisonment serve not only as mechanisms of control but also as means of accumulation — making money from incarcerating people while blaming them for the very circumstances created by the capitalist system.

The BBB Is a Sign of Growing Bipartisan Crisis

While Trump and the Republicans wreak havoc on public health, the Democratic Party’s response has been pathetic. As politicians like Alexandria Ocasio-Cortez (AOC) staged dramatic displays of outrage, party leadership did little to organize effective resistance, instead reverting to their tired playbook of urging supporters to “call your representatives” and to vote blue. After the bill’s signing, for example, AOC said, “There have to be consequences to these votes, and we have to decide if this is just a joke or just for TV, or if this is our real lives. And I hope people vote like it’s our real life.” In other words, vote the Democrats back into power in 2026.

This sentiment has been echoed by several Democratic politicians expressing similar sentiment. But there is growing anger among the Democratic base over the party’s failure to mount any real opposition.

This reflects the deeper crisis of the Democratic Party. As Madeline Freeman explains, neoliberalism — the decaying bipartisan project to address the capitalist crisis — has rendered the party institutionally incapable of advocating for working-class interests. Having defended the for-profit medical system for years and promoted austerity, the Democrats lack a genuine alternative.

We should ask ourselves: If we had a universal healthcare system — a policy the Democrats have largely resisted for many years — would we need to discuss how various aspects of our broken healthcare system are being cut?

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The Democrats, as a capitalist party, support the notion that health care is a commodity. Their “lesser evil” strategy has come full circle: lacking any means to mobilize their base on issues other than being “anti-Trump,” they have become bystanders as Republicans dismantle what little remains of the social safety net. As Freeman notes, the Democratic Party has always “acted to mediate the relationship between the ruling class and the working class, using the rhetoric of the social movements to mobilize working people out of the streets, out of their unions and organizations, and to the ballot box.”

Even as millions stand to lose their health care, this is all the party can offer.

This growing crisis of the two-party regime needs to be understood within the broader breakdown of the neoliberal order. The bipartisan regime of the late 20th century — in which Democrats and Republicans collaborated to implement neoliberal capitalism — is now in deep collapse. Trump’s Bonapartist tendencies are just one potential response to this crisis. The combination of Trump’s populism with austerity and increased repression, as reflected in his bill, represents the Right’s attempt to address the crisis. Meanwhile, the Democrats, clinging to their role as defenders of a dying neoliberal consensus, can offer only more of the same failed policies that enabled Trump’s rise.

The narrow passage of this bill indicates the divisions among ruling-class politicians. Trump, who campaigned on a promise not to cut Medicare, has now double-crossed his own base — a base that has seen a rise in poor and working-class voters, many of whom rely on the very services this bill cuts. Many Republican politicians have openly expressed concern about how this bill will harm the Republican base. The bill had to be pushed through the Senate by manipulating the process of reconciliation, and still, Vice President J. D. Vance had to cast the tiebreaking vote to pass it. In the House, it passed by only four votes thanks to backroom deals and maneuvering.

Putting Up an Independent, Working-Class Fight for Health Care

As the consequences of this bill take effect, much of Trump’s base will inevitably be harmed, leading to increased discontent and potentially more questioning of the regime from the right. As hospitals close and services disappear, and as more people fall into medical debt and hunger, dissatisfaction with the two ruling-class parties will likely grow.

Our task is to channel that rage into organized struggle, raising demands that address both immediate needs and calls for systemic change. We must fight to wipe out all medical debt, to nationalize health care under workers’ control, and to achieve open borders and full rights for all workers. 

This means organizing where we are the strongest: our workplaces. We must use working-class methods like the strike, and call on unions across sectors to mobilize all their members to fight attacks from the Right, and fight for public health. We’ve already seen recent, inspiring examples of what this can look like, including recent mobilizations for immigrant rights. 

Above all, we must build independent working-class organizations that can fully break from the bipartisan regime. The “Big Beautiful Bill” isn’t just a horrible, anti-worker, and anti-health law; it’s a red flag signaling the impending battles over who will pay for the crisis of capitalism. It is only through class struggle and socialist organization that we have any hope of fighting back.