In an age where bold language dominates headlines, it can be easy to overlook the real-world effects of complex legislation. But this is not just a matter of political branding. The proposed One Big Beautiful Bill Act has implications that, based on current research, could lead to substantial and preventable harm to public health.
As a fourth-year medical student with a background in public health, I’ve spent years studying how health systems impact patient outcomes. That’s why I find this bill particularly alarming. It’s not simply a disagreement over policy details. According to researchers from Yale and the University of Pennsylvania, provisions in the bill could result in over 51,000 additional preventable deaths annually if implemented as written.
These projections draw from several proposed changes, including:
- Rolling back Medicaid coverage
- Ending enhanced ACA tax credits
- Eliminating Medicare drug subsidies for low-income seniors
- Walking back proposed nursing home staffing standards
These aren’t theoretical concerns. Access to health insurance is strongly linked to improved survival. For example, following the 2006 Massachusetts health reform, one death was prevented for every 830 adults who gained insurance—a finding from a 2014 Annals of Internal Medicine study by Sommers, Long, and Baicker that observed a 2.9 percent reduction in mortality compared to similar populations.
Medicaid expansion has similarly shown tangible benefits. A 2021 study using national survey and mortality data found that Medicaid expansion was associated with a 2.5 percent drop in mortality among low-income adults, totaling over 27,000 lives saved between 2014 and 2017.
Other studies have shown similar benefits for dialysis patients, gynecologic cancer surgery outcomes, and overall state-level mortality rates after expansion.
The reverse is also true: When people lose coverage or subsidies, health outcomes often worsen. For instance, losing Medicare drug subsidies increased mortality by 4 percent to 22 percent, depending on the subgroup.
These effects are measurable and significant.
In clinical training, I’ve seen what happens when patients delay or skip care due to cost. People end up in the ICU with preventable complications. Seniors ration medications and suffer avoidable crises. Nursing homes already struggle with staffing, and easing those standards could exacerbate the problem.
Yes, lawmakers must weigh difficult budgetary decisions. But the public deserves transparency about what’s at stake. Reducing access to coverage and care doesn’t just shift choices—it often leads to poorer health and, tragically, preventable deaths.
Public health policy should aim to ensure that everyone has a fair shot at living with stability and dignity. From both my clinical and public health perspective, this bill carries serious risks—and those risks deserve careful scrutiny.
Trevor Lyford is a medical student.
