Write a commentI recently attended a Community Meeting conducted by Indivisible- Oswego County.
The information I received regarding the BBB far exceeded any of my expectations. In fact, it was alarming. The so so-called Big Beautiful Bill means massive changes in how needed services will be allocated and will have far-reaching damaging effects to all of us. Here’s an overview of those changes:
Beginning in 2026, states will be required to bear more administrative costs for programs like Medicaid and SNAP. Those increases will be passed on to counties, including a 50% increase on Oswego County taxpayers. And new programs costs, which previously were funded 100% by federal government, will now require counties to pay up to 15%. By 2028, NYS taxpayers will be responsible for an additional $790 million. Should our state not be able to support those costs, programs will either be reduced or cut entirely.
Additionally, the BBB’s new work requirements are expected to strip more than three million people of food assistance each month nationwide—which translates to about 300,000 in New York State. In reality, most SNAP recipients already are working, are caregiving or are disabled. (In Oswego County, between 16 and 18 percent of residents are currently eligible for SNAP, including 25 percent of children.) This change will most impact older adults (55-64); parents with older children (14+); veterans and former foster youth; people in areas with high unemployment.
All this will mean more hungry people in our communities, more hungry children struggling to focus on learning at school and an increase in crimes of desperation. It also means additional labor (and cost!) for processing these changes. Since SNAP accounts for about 12% of all grocery spending in the country, much more in rural and low-income areas like Oswego County—where some retailers say SNAP dollars pay for half or more of their sales—this will mean cuts in grocery spending, endangering small retailers who operate on low profit margins.
The BBB will also change how we in Central New York can access needed insurance coverage. Right now, in New York State, families with household incomes up to twice the poverty level (up to about $64,000—too much to qualify for Medicaid but not enough to be able to afford insurance on the private marketplace) can enroll in a lower-cost insurance program that receives some federal support. Others who make more but who don’t have employer-provided health insurance can purchase coverage through the ACA marketplace, again with some federal tax incentives. This has allowed New York State to achieve one of the lowest rates of uninsured people in the nation, under 5%. But all of that is about to change because of new provisions in the “BBB.”
Changes will include no more automatic renewals; those insured will have to re-enroll with increased documentation. By the end of this year, the bill will also stop ACA Premium Tax Credits, bringing significant increases in healthcare premiums for 20 million Americans who purchase coverage through the ACA Marketplace, resulting in nearly 40,000 residents in NY District24 to lose their ACA tax credits. This will increase those residents’ costs by at least 33%, estimated to be more than a $250 increase in premiums for a family per month. Combining these cuts with Medicaid cuts, more than 31,000 residents of NY District 24 will likely become uninsured.
All of us will feel the impact the “BBB” has on our healthcare systems. Health systems will experience losses of $263 million in revenue across our District 24, with hospitals alone set to lose more than $31 million. Here are some ways this bill will affect healthcare:
- An anticipated $10 billion reduction in Pell Grants (which students from low-income families have long relied on to pay for higher education)
- Caps for ParentPLUS loans will make higher education unaffordable for many lower income families
- The GradPLUS loan program will be eliminated, putting many degree programs out of reach those not well off
- Elimination/freezing of research funding has led many universities to significantly reduce graduate and professional admissions, with many projects fully halted
- Curtailment of student visas and outright travel ban from 12 countries has created uncertainty for international students has led applying to our medical schools (About 40% of internal medicine specialists come from abroad.)
- Medicare will face estimated $45 billion cuts in January 2026
But perhaps the biggest and most immediate impacts of the “BBB” will be the change in Medicaid funding. The bill plans to cut nearly $1 trillion from Medicaid spending over the next 10 years, meaning that hundreds of millions of dollars will be shifted to state taxpayers. New York currently has a 36/64 cost-sharing arrangement with the federal government; currently, counties fund half of the state’s share—when state’s share increases, county expenses will grow accordingly. Think about the impact in Oswego County, where Medicaid costs already comprise more than half of the county’s budget!
While we are still determining all the harm this will do, right now we know that states will no longer be able to use Federal tax money help providers cover the costs for Medicaid. States will be required to pay more. The bill ends Medicaid coverage for legal residents who were previously covered, increasing the burden on hospitals still legally required to provide care. It requires cost-sharing for enrollees at 100-138% of poverty level—up to $35 for non-exempt services, reducing access to care for many. Increased work requirements and more frequent redeterminations will create new costs for states, including more work from our already understaffed DSS staff.
Those who support the “BBB” claim that this is necessary to eliminate waste, fraud, and abuse, but 92% of those covered by Medicaid are already working, providing full-time care, or are children or elderly folks who are not able to work. In reality, where is the waste?
When states cannot cover their full costs, they will need to make changes, starting with eliminating funding that is not mandated by law. Those threatened to be affected include home- and community-based care for seniors and people with disabilities; loss of Medicaid support for about 10% of children in military families (for whom Medicaid covers services that TRICARE does not); cuts for 10% of veterans (more than 1.6 million people) who receive Medicaid coverage due to disability or having low incomes; loss of support to help cover gaps for about 28,000 people with disabilities across NY-24; OT/PT/speech/counseling services provided in schools; loss of support for more than 6 in 10 seniors who need skilled nursing home care; cuts to those with substance use disorders (Medicaid is the largest payer of behavioral health services in the US, covering nearly 60% of drug treatment programs).
Nursing homes will be especially hard hit, with Medicaid being the primary payer for 60% of their patients. Almost 70% of home care is covered by Medicaid. Hospitals will also suffer. On average, 20% of hospitals’ revenues come from Medicaid, but in rural areas like Oswego County, it’s closer to 40-50%. Three hospitals across NY-24 are expected to close as a result of Medicaid cuts. Others (including nearby Rome and Oneida hospitals) are already operating in the red; here in Oswego County, the Oswego Hospital’s profit margin is under 3%. The federal government is establishing a new grant program (Rural Health Transformation Program) to support rural hospitals, slating to fund up to $50 billion. But keep in mind that they’re cutting almost $1 trillion!
Altogether, just over 40,000 Oswego County residents (1/3 of our population) are covered by Medicaid or by NY’s ACA marketplace plans—that’s a large portion of the County likely to see changes in their health coverage in the next two years.
Even those who don’t need extended healthcare right now will be affected by the “BBB.” Healthcare is the second largest sector in our economy. Our access to care will be stressed if providers downsize or close, meaning we all travel farther and/or wait longer for care. There will an elimination of good-paying healthcare jobs. According to the July 2025 jobs report, almost all of the jobs added to the nation’s economy in the last three months were in healthcare. Three of the 10 largest employers in Oswego County are healthcare providers. (Oswego Health is our county’s second largest employer.) This will lead to higher unemployment and higher costs to state- and county-funded safety nets (and thus higher taxes), and will likely contribute to ongoing depopulation—people leaving the county.
Please consider these devastating changes about to change life in Oswego County and NY District 24. Please contact your local lawmakers to share your concerns. Join Indivisible-Oswego County to help push back against this BBB. For more information about our group log on to InvisisibleOC.com
Lynn Hogan Lyons
Fulton, NY 13069
