The One Big Beautiful Bill Act, passed by the U.S. House of Representatives on May 22, 2025, by a narrow 215-214 vote, is a sweeping budget reconciliation bill that could significantly reshape Medicare and Medicaid for seniors in New Jersey. Currently under Senate consideration, the legislation introduces substantial changes to these critical healthcare programs, raising concerns about reduced coverage, increased costs, and limited access to care for the state’s elderly population. New Jersey, with its 1.8 million Medicaid enrollees and significant Medicare population, faces unique challenges if the bill becomes law.
For Medicare, the bill does not explicitly outline direct cuts in its text but triggers automatic reductions due to its projected $2.3 trillion addition to the national debt over the next decade. Under the Statutory Pay-As-You-Go Act, this deficit increase would mandate across-the-board spending cuts, including up to $500 billion from Medicare over eight years, starting in 2026. These reductions, capped at 4% annually, could lower provider reimbursements, potentially limiting seniors’ access to doctors and hospitals. New Jersey’s seniors, many of whom rely on Medicare for essential care, might face longer wait times or fewer provider options, particularly in urban areas like Newark or rural regions where healthcare access is already strained. The bill also pauses a Biden-era rule designed to streamline enrollment in Medicare Savings Programs, which help low-income seniors cover premiums and cost-sharing. By delaying this rule until 2035, an estimated 2.3 million people nationwide, including many in New Jersey, could lose access to these financial supports, increasing out-of-pocket costs for medications and care. Additionally, the bill allows working seniors enrolled in Medicare Part A and high-deductible health plans to contribute to Health Savings Accounts with increased limits—$4,300 for individuals earning under $75,000 and $8,550 for families under $150,000. While this could help some offset costs, it primarily benefits higher earners and does little for low-income seniors. Medicaid faces even steeper challenges under the bill, with proposed cuts exceeding $700 billion over ten years, potentially stripping coverage from 360,000 New Jerseyans, or 20% of the state’s NJ FamilyCare enrollees. These cuts stem from several provisions: new work requirements for adults aged 19 to 64, mandatory twice-yearly eligibility checks, and restrictions on state funding mechanisms like provider taxes. The work requirements, set to begin in December 2026, mandate 80 hours per month of work, volunteering, or education, with exemptions for seniors and disabled individuals. However, these exemptions are vague, and administrative burdens could still disenroll eligible seniors who struggle with paperwork. New Jersey’s Department of Human Services warns that the state could lose $3.6 billion in annual federal funding, forcing difficult choices between cutting coverage or absorbing a $700 million penalty to maintain benefits for vulnerable groups like children. For seniors, Medicaid is a lifeline for long-term care, covering nursing homes and home-based services. Reduced funding could close facilities or limit services, pushing seniors toward costlier alternatives or inadequate care. Governor Phil Murphy and state officials, including Acting Health Commissioner Jeffrey Brown, have criticized the cuts as “inhumane,” arguing they destabilize New Jersey’s safety net by increasing uninsured rates and straining providers.
The bill also tightens Medicaid eligibility for non-citizens, explicitly limiting benefits to those meeting strict residency criteria, despite current laws already restricting undocumented individuals from receiving benefits. This could disproportionately affect New Jersey’s diverse communities, where lawfully present immigrants who have worked for decades might lose coverage. Additionally, the legislation bans Medicaid funding for gender-affirming care and abortion services, further narrowing care options for some seniors. To address fraud, the bill allocates $25 million for AI-driven audits to recover improper Medicare payments, but critics argue this targets legitimate claims rather than systemic abuse.
New Jersey’s healthcare system, already grappling with 1.8 million Medicaid enrollees and rising costs, faces a precarious future. Rural hospitals, reliant on Medicaid funding, risk closure, while urban providers may reduce services due to lower reimbursements. Seniors like Valerie Brown, a 62-year-old Mays Landing resident battling lung cancer, exemplify the stakes: without Medicaid to cover her $20,000 monthly medication, survival becomes uncertain. As the bill heads to the Senate, where revisions are expected, New Jersey’s leaders and advocates urge rejection of these cuts, warning of a healthcare crisis for the state’s most vulnerable. If passed unchanged, the One Big Beautiful Bill Act could leave New Jersey’s seniors facing higher costs, reduced access, and a fraying safety net, fundamentally altering their ability to afford and receive care.
