H. R. 1, the federal budget and tax megabill, which was passed by Congress and signed into law by President Trump in July, will have devastating impacts on many Louisiana families who rely on essential government programs for their health care, food and other services. More than 1 in 3 Louisianans rely on Medicaid coverage for affordable access to care, while 1 in 6 state residents rely on the Supplemental Nutrition Assistance Program (SNAP) to help feed their families.
The megabill makes the 2017 federal tax cuts for wealthy individuals and large corporations permanent, and pays for them by slashing federal safety-net programs. The new law cuts federal funding for Medicaid by almost $1 trillion over the next 10 years. And for the first time ever, the federal government is forcing states to pay a share of SNAP benefits through their own budgets. Everyday Louisianans will bear the brunt of this legislation, with less access to health care, less money to feed their families and less money in the state budget to go around for essential services.
Attacks on the Medicaid Expansion
H. R. 1 undermines the Affordable Care Act (ACA) through targeted attacks on the Medicaid expansion. Though the 2017 attempts to repeal the ACA failed, H. R. 1’s multifaceted assault on Medicaid expansion and the federal Health Insurance Marketplace serves as “death by a thousand cuts.” The legislation makes it harder for the almost 500,000 Louisianans covered through Medicaid expansion to get and keep their coverage. The new law adds red tape and bureaucratic requirements intended to reduce costs by kicking and keeping people off the rolls.
H. R. 1 forces states to make drastic changes to how they implement expansion provisions and how some adults pay for health care services. States will be required to implement harsh work reporting requirements. Adults who receive their coverage through Medicaid expansion will have to meet these new onerous requirements at application for and renewal of coverage, and further, these adults must renew their coverage every six months to stay enrolled. In addition, some of these adults will face copayments for services that had been covered fully by Medicaid.
The Congressional Budget Office estimates that, over the next 10 years, the federal government will spend over $900 billion less on Medicaid and that 10 million more people will become uninsured because of these changes.
Many of the people disenrolled from Medicaid because of these changes will likely still be eligible for the program, but will lose coverage because they cannot keep up with the paperwork required to keep their coverage. In Louisiana, 94% of adults enrolled in Medicaid are working or should qualify for an exemption, but estimated coverage losses exceed 190,000.
Additionally, some expansion enrollees with income between 100-138% of the Federal Poverty Level ($15,650 – $21,597 for an individual, and $26,650 – $36,777 for a household of three) would be required to pay copayments at many of their doctors’ appointments. Though many traditional services are exempt, research shows that copayments create barriers to accessing care for people with low incomes, and can lead to reduced access to care and worse health outcomes. These barriers would be disproportionately burdensome for people with chronic conditions who need to go to the doctor more frequently just to stay healthy.
Key Medicaid Implementation Dates
| October 1, 2026 | Ends Medicaid eligibility for some lawfully present immigrants |
| December 31, 2026 | Medicaid work reporting requirements implementation begins |
| December 31, 2026 | Increased frequency for Medicaid redeterminations |
| January 1, 2027 | Shortens retroactive Medicaid coverage periods |
| October 1, 2027 | Limits on Medicaid provider taxes |
| October 1, 2028 | Requires states to impose cost-sharing requirements on Medicaid enrollees |
Making private insurance more expensive
For people making too much money to qualify for Medicaid expansion – above 138% of the federal poverty limit – H. R. 1 makes it more difficult to purchase affordable private insurance through the federal Marketplace. The law effectively eliminates “auto-enrollment” into Marketplace coverage, which keeps people from losing their health insurance if they do not take action to pick a new plan, and eliminates the special enrollment period that allowed people who earn income below 150% of the federal poverty level to enroll in Marketplace coverage throughout the year. It also shortens the annual open enrollment period to 45 days, shuts out many lawfully present immigrants from accessing premium tax credits and eliminates protections for people receiving advanced premium tax credits. Additionally, anyone who loses Medicaid coverage because of work reporting requirements would not be eligible for premium tax credits to purchase a Marketplace plan.
Notably, the law did not extend enhanced premium tax credits that help make premiums affordable for Americans who get health insurance through the Marketplace. Without congressional action, premiums could dramatically increase for many consumers and make insurance unaffordable. The Congressional Budget Office estimates that, nationally, an additional 4 million people will become uninsured over the next 10 years because of the expiration of enhanced premium tax credits.
Key Affordable Care Act Implementation Dates
| December 31, 2025 | Enhanced Affordable Care Act (ACA) premium tax credits expire under current law |
| December 31, 2025 | Premium tax credit recapture begins |
| January 1, 2026 | Eliminates premium tax credit eligibility for low-income, lawfully present immigrants |
| January 1, 2026 | Eliminates premium tax credit eligibility for low-income special enrollment period enrollees |
| January 1, 2027 | Makes some lawfully present immigrants ineligible for premium tax credits |
| January 1, 2027 | Prohibits individuals denied Medicaid due to work reporting requirements from qualifying for premium tax credits |
| January 1, 2028 | Institutes preenrollment verification |
Restrictions on raising revenue for Medicaid
In addition to shifting costs from the federal government to the states, H. R. 1 severely restricts how states can raise revenue for Medicaid. The law phases down the long-standing cap on provider taxes—from 6% of providers’ net patient revenue to 3.5% by 2032—and prohibits states from developing new provider taxes to fill the gap. Louisiana’s Medicaid program, like in 48 other states, relies heavily on provider taxes, with at least one existing tax currently above 5.5% that will have to be cut.
Because provider tax revenue is used to draw down federal matching funds, these restrictions mean Louisiana will lose both state and federal Medicaid funding. Combined with the bill’s deep reductions in federal Medicaid spending, Louisiana will have few choices to balance its budget. State policymakers will likely be forced to consider limiting coverage, scaling back optional benefits or reducing already-strained health care provider payment rates–jeopardizing health care access and quality for low-income Louisiana residents.
H. R. 1 represents a fundamental restructuring of the federal-state partnership that undercuts Medicaid and SNAP, shifting billions in costs from the federal government to Louisiana taxpayers while restricting the very tools the state uses to sustain these programs.
A shortfall for rural health
To win support from lawmakers worried about H. R. 1’s impact on rural health care, Congress added a last-minute, $50 billion Rural Health Transformation Fund, which will be paid out in $10 billion annual increments starting in 2026. Half of the money ($25 billion) will be divided evenly among all states that apply, regardless of rural population or financial need. Louisiana is among 12 states expected to absorb half of all Medicaid spending reductions in rural areas, yet it would receive the same share as states facing smaller losses.
The other $25 billion will be distributed to states at the discretion of the Trump administration. Though this pot of money was presented as a way to safeguard financially vulnerable rural health care systems from devastating Medicaid cuts, providers and advocates doubt its effectiveness. The fund falls far short of the estimated $137 billion in rural Medicaid losses and lacks safeguards to ensure the money actually reaches Louisiana’s most vulnerable rural health care systems.
Making it harder to feed families
H. R. 1 includes two major changes to SNAP that shift costs to states and make it harder for people to access food. For the first time in the program’s history, states will be required to pay for a share of the benefits people receive—costs that have always been fully covered by the federal government. The megabill also forces states to pay more for administering the program, raising their share of administrative costs from 50% to 75% by the 2027 fiscal year. Beginning in the 2028 fiscal year, states must also cover 5% to 15% of benefit costs, based on their so-called “error rates”—a broad measure that often reflects paperwork or processing issues, not fraud.
For Louisiana—where more than 1 in 6 residents currently relies on SNAP—these changes will saddle the state with hundreds of millions of dollars in new costs each year. More than half of Louisiana’s total state revenue comes from federal programs like Medicaid and SNAP—one of the highest shares in the nation. Cuts of this scale will blow a hole in the state budget and force impossible choices: Either reduce services like education and health care, or limit access to food assistance. Louisiana already faces high error rates and an overburdened eligibility system, making it likely to fall in the highest cost tier. Local officials have warned that even modest cost shifts are unmanageable, and food banks cannot absorb the fallout.
H. R. 1 also expands SNAP work reporting requirements by raising the reporting age from 49 to 64, and by increasing penalties for noncompliance. Under the new rules, adults without dependents in that age group must verify 80 hours of work or qualifying activities each month to keep their benefits.
These reporting rules do nothing to increase employment—they increase paperwork. Many people lose benefits not because they are unemployed, but due to unstable hours, caregiving responsibilities, or missed documentation. In Louisiana, the impact will fall hardest on low-wage workers in retail, food service and home care—jobs with unpredictable schedules that make compliance difficult. Older adults, unpaid caregivers and people with undiagnosed disabilities are especially vulnerable. With wide variation in parish-level unemployment and an already strained eligibility system, these new requirements will overwhelm caseworkers, increase wrongful terminations and deepen food insecurity. The result will not be greater employment—it will be more hunger and hardship across Louisiana.
Key snap implementation Dates
| July 4, 2025 | Restrictions on immigrants’ access to SNAP |
| July 4, 2025 | Harsher Supplemental Nutrition Assistance Program (SNAP) paperwork requirements are passed into law |
| October 1, 2026 | States’ share of SNAP administrative costs increases |
| October 1, 2027 | States begin paying for a portion of SNAP benefits based on error rates |
A structural disinvestment in Louisiana families
H. R. 1 represents a fundamental restructuring of the federal-state partnership that undercuts Medicaid and SNAP, shifting billions in costs from the federal government to Louisiana taxpayers while restricting the very tools the state uses to sustain these programs. These changes will not only destabilize coverage and access for hundreds of thousands of Louisianans, but also blow a hole in the state budget that threatens education, infrastructure, and other core services. At the same time, new administrative burdens will overwhelm an already strained eligibility system, causing eligible people to lose coverage and worsening disparities in health and food security. Taken together, the megabill is less a budget measure than a long-term disinvestment in Louisiana’s people and economy–one that leaves the state with fewer resources, more bureaucracy, and deeper inequities in health and well-being.