A new national report estimates that between 14,000 and 29,000 people in New Hampshire could lose their Medicaid coverage. The cause: the One Big Beautiful Bill Act, the sweeping legislation that defined President Trump’s first year back in office.
The report was produced by the Robert Wood Johnson Foundation and the Urban Institute. According to its findings, the final number will depend heavily on how New Hampshire chooses to implement the law’s provisions. If state leaders take steps to soften the blow, losses could stay closer to 14,000. Without those efforts, the figure could climb to 29,000.
The One Big Beautiful Bill Act, signed into law in July, is a massive omnibus package that touches nearly every corner of the federal government. Among its most significant impacts are changes to Medicaid — the country’s public health coverage program for people with low incomes and disabilities.
What the law actually changes
Two provisions stand out above the rest. First, the law introduces a work requirement for Medicaid enrollees. Second, it increases how often enrollees must prove they’re still eligible for coverage.
There are exemptions for people classified as medically frail. However, critics argue the law is too vague in how it defines frailty. They also warn that the added bureaucracy will do more harm than good. Rather than eliminating waste or fraud, opponents say, the paperwork burden will knock off people who genuinely qualify but can’t keep up with the documentation demands.
What will determine the impact in New Hampshire
According to the report, several state-level decisions will shape the outcome. These include how New Hampshire defines medical frailty and other exemptions, what documentation enrollees need to prove they’re working, and how many months applicants must meet work requirements before enrolling.
On top of that, the state will also need to decide how many months enrollees must stay in compliance between eligibility checks. The frequency of those compliance verifications will matter too. Each of these choices could either limit the damage or amplify it significantly.
A divided debate
The law has drawn sharp criticism from liberals and Medicaid advocates. But it does have supporters, particularly among conservatives. Trump and his allies maintain that the bill won’t affect enrollees who are truly eligible.
Some conservative voices in New Hampshire have gone further. Drew Cline of the Josiah Bartlett Center for Public Policy argued that Medicaid has grown too large in recent years. In his view, scaling it back would benefit the state’s financial outlook.
Still, public opinion leans the other way. A September Morning Consult poll found that 51% of U.S. voters disapproved of the law, with 37% expressing strong disapproval. Only 35% supported it, and 14% had no opinion.
