As the Senate takes up the House-passed “One Big Beautiful Bill Act,” new data from KFF paints a clear picture: Americans across party lines have concerns about the bill, especially when it comes to health care. The legislation, which pairs tax cuts with major structural changes to Medicaid and the Affordable Care Act, is already facing strong headwinds with voters. 

At first glance, about a third of the public (35%) appears to support the bill but that number quickly falls once respondents are told that the legislation would lead to higher uninsured rates and cuts to hospital funding. Support drops to 25% when people hear about a projected loss of health insurance for 10 million Americans and it falls even further (to just 21%) when told the bill would reduce funding for local hospitals. This shift is not limited to one political group. Support also drops among MAGA-aligned Republicans, who initially backed the bill by wide margins, by more than 20 points once these impacts are explained. 

The legislation includes significant cuts to Medicaid and rolls back provisions impacting the ACA Marketplace protections. Rural hospitals, which often rely on state provider assessments and Medicaid reimbursements to stay afloat, would be among the hardest hit. According to the Congressional Budget Office, these changes combined with other proposed policies are projected to increase the number of uninsured Americans by 16 million by 2034, worrying politicians serving rural communities. 

Despite years of partisan debate, both Medicaid and the ACA now enjoy their highest favorability ratings on record. 83% of Americans say they have a favorable view of Medicaid, including 74% of Republicans. Notably, proposals to shorten ACA enrollment windows and increase paperwork are opposed by a majority of voters, including half of Republican respondents. 

According to the KFF data, voter support also drops for a nationwide Medicaid work requirement. While initially popular (with 62% of adults in favor), after hearing that the policy could lead to eligible individuals losing coverage due to paperwork issues, support drops to 38%. Respondents also shift their opinions when told that the policy would not increase employment but would raise administrative costs. This policy is one that is not going away though.  

Other provisions in the bill are similarly controversial. A majority of the public (67%) oppose cutting off Medicaid funding to clinics like Planned Parenthood for non-abortion services. While the proposal has strong support among MAGA voters, Republican women and non-MAGA Republicans are more evenly split. Public opposition grows once it’s made clear that services such as birth control and cancer screenings would be harder to access if the proposal becomes law. 

These findings suggest that lawmakers, particularly in the Senate, face a tough road ahead. While Congress wants to address these concerns, they also have to extend expiring tax cuts that would increase taxes for Americans if not reauthorized by the end of this year. These taxes have to be funded by payment cuts elsewhere.