The 2025 One Big Beautiful Bill Act is producing health care consequences before its broader Medicaid reductions take effect. Thousands of lawfully present immigrants, including refugees, asylees without green cards, survivors of domestic violence and sex-trafficking victims, lost Medicaid coverage on Oct. 1. The Congressional Budget Office estimated that roughly 100,000 lawfully present immigrants would lose health insurance, while advocates say the number could rise as green-card applications slow. The law leaves green card holders and some other groups unaffected and preserves state options to cover immigrant children and pregnant immigrants with federal matching funds. Republicans made the bill’s tax cuts effective immediately but delayed controversial Medicaid and other health-program reductions until after the midterm elections. Meanwhile, millions lost Obamacare coverage after Covid-era subsidies expired last year, and premiums rose sharply for many who retained coverage. The law is projected to cut Medicaid spending by $900 billion through 2034, while more than 1 million immigrants are projected to lose Affordable Care Act subsidies and Medicare coverage starting next year. Advocates warn that coverage losses will disrupt access to doctors, medication and chronic-disease treatment, increase uninsured emergency-room visits and costs, and affect care for U.S.-citizen children in mixed-status families.