Utah health and anti-hunger advocates warn the “Big, Beautiful Bill” — a sweeping mega-budget package backed by President Donald Trump — could strip health coverage from nearly 200,000 Utahns, deepen hunger, strain rural hospitals and eliminate local jobs.
Their concerns were raised Wednesday, the day after the U.S. Senate narrowly passed a heavily amended version of the bill in a 51-50 vote, with Vice President JD Vance breaking the tie and Utah Sens. Mike Lee and John Curtis voting in favor. On Thursday, the House narrowly approved the measure 218-214, largely along party lines, sending it to Trump’s desk ahead of his self-imposed July 4 deadline.
This came after clearing a key procedural hurdle late Wednesday, following hours of negotiations by House Speaker Mike Johnson to win over Republican holdouts.
At a virtual press conference Wednesday afternoon, as House leaders were still working to shore up votes, a coalition of health, disability and anti-hunger groups said the legislation’s steep cuts to Medicaid and food assistance would be “devastating” for Utah families and communities — threatening long-term health, food security and the state’s economy.
“While the impacts on some communities will be immediate, the aftershock will be felt by all Utahns,” said Nate Crippes, an attorney with the Disability Law Center and member of the Protect Medicaid Utah Coalition.
‘Biggest rollback in federal support of health coverage ever’
At the heart of the legislation are steep cuts to social programs to help pay for an extension of the 2017 Trump tax cuts and additional tax relief measures, along with higher spending on defense and immigration enforcement and a $5 trillion debt limit increase. One of the biggest cuts is to Medicaid, which provides health coverage to more than 70 million low-income, elderly and disabled Americans.
A Commonwealth Fund analysis estimates the bill would cut about $863 billion from Medicaid and roughly $268 billion from the ACA marketplaces over the next decade as reductions phase in. KFF Executive Vice President for Health Larry Levitt called it “the biggest rollback in federal support for health coverage ever,” warning it would reduce premium tax credits, raise out-of-pocket costs and increase the number of uninsured Americans.
Nationwide, the Congressional Budget Office estimates the bill could lead to 11.8 million people nationwide losing health coverage, while a separate Washington Post analysis released Tuesday suggested the number could be as high as 17 million. It would also let enhanced ACA tax credits expire, impose new work requirements and frequent eligibility checks for Medicaid, and shift some SNAP costs to states that exceed a 6% payment error rate starting in fiscal year 2028. Utah’s rate was 5.74% in 2024, according to the U.S. Department of Agriculture.
In Utah, the changes to Medicaid and the ACA under the Senate bill could put the health coverage of more than 188,000 people at risk, according to an estimate done by the Congressional Joint Economic Committee’s Democratic staff released Monday. That’s an increase from an earlier estimate by the committee’s minority staff that projected, based on the House bill, that 31,000 Utahns could lose access to Medicaid, while another 109,000 could lose access to the ACA.
Rural hospitals and Medicaid under threat
Crippes explained over the past couple of months, the newly formed Protect Medicaid Utah Coalition — which includes groups like the Disability Law Center, Utahns Against Hunger and Utah Health Policy Project — has gathered stories from impacted Utahns and met repeatedly with policymakers at every level.
“Our coalition has been fighting Medicaid cuts every way possible,” Crippes said.
Advocates expect rural areas in the state to be among the hardest hit, with estimates that at least 10,000 rural residents could lose Medicaid and nearly three-quarters of a billion dollars could be pulled out of rural health systems.
Matt McCullough, rural hospital improvement director with the Utah Hospital Association, said in the press conference nearly half of rural hospitals in non-expansion states already operate in the red, and critical access hospitals nationwide average just a 2.5% margin.
“This is today, before these cuts even go into effect,” he said, noting 188 rural hospitals across the country have already closed or converted to emergency-only facilities over recent years. He warned the bill would effectively slash “21 cents out of every dollar” hospitals get from Medicaid, driving reduced services — like maternity care — and shrinking local workforces.
“These are real people who need care,” McCullough said. “They need access to care in these rural communities, and this bill really does not support them and their families.”
Food insecurity, local pantries bracing
The bill would also cut about $295 billion from the Supplemental Nutrition Assistance Program (SNAP), also known as food stamps, over 10 years. It would add new work requirements and could shift some program costs to states with payment error rates above 6% starting in fiscal year 2028.
Utah’s rate was 5.74% in 2024, according to the U.S. Department of Agriculture.
Utah food security advocates worry the SNAP changes and new work requirements could overwhelm local food banks. Neil Rickard, child nutrition advocate for Utahns Against Hunger, said Utah pantries are already seeing higher demand alongside rising housing costs.
“The impact on people is already being felt, so we’re very concerned by developments that further cut access to necessary food resources,” Rickard said. “There are [absolutely people] who are simply going to be going without [food], and it’s very concerning.”
He noted that while Utah has a strong private charity network, it can’t fill every need.
“Some gaps are too big,” Rickard said.
Glenn Bailey, executive director of Crossroads Urban Center in Salt Lake City, said his organization’s two food pantries now serve between 12,000 and 13,000 people a month — a figure that has grown as more residents rely on emergency aid.
“This is absolutely the wrong time to make cuts in the safety net, particularly in food resources that help … the most vulnerable people in our community,” Bailey said.
Advocates warn of ripple effects
Former state Rep. Marsha Judkins, who served on Utah’s social services appropriations subcommittee, said it would be difficult for the state to fill funding gaps of this scale without cutting other essential priorities like education, transportation or public safety. She warned that the effects would ripple well beyond those who rely directly on Medicaid and SNAP.
“These cuts are going to have real consequences,” Judkins said. “Not only on people who use these services, but throughout our communities.”
Anne Asman, a gerontologist with the University of Utah’s Geriatric Psychiatry Clinic, cautioned that cuts to Medicaid and food benefits, paired with already strained long-term care resources, would be “devastating, primarily to older adults.”
“Food insecurity is one of the most pressing issues,” Asman said. “Any threat to programs like Meals on Wheels will only increase anxiety and decrease quality of life for so many older adults and their families.”
Utah advocates urged the state’s congressional delegation to weigh how the proposed reductions could ripple through hospitals, families and local economies.
“We urge our delegation to stand with Utahns [on] how this will impact everyone across the state,” Crippes said. “Until that bill is signed by the president, we’re going to hold out hope that we have a chance to change course.”
This story was first published by The Times-Independent.