Introduction
Americans are already struggling with high prices and economic uncertainty because of President Donald Trump’s sweeping tariffs. House Republicans are proposing to make life even less affordable by passing the One Big Beautiful Bill Act, which is currently being considered by the Senate. The legislation would enact the largest cuts to Medicaid and food assistance in American history, increase gas and electricity prices, and add trillions of dollars to the national debt—which would depress Americans’ wages and raise interest rates—while providing new tax breaks that overwhelmingly benefit the wealthiest Americans. If enacted, the bill would initiate the largest transfer of wealth from working-class Americans to the ultrawealthy in history. Here are specific ways the One Big Beautiful Bill Act would harm residents of Missouri.
Medicaid (MO HealthNet) cuts threaten coverage, lives, and rural hospitals in Missouri
Medicaid provides health coverage to an estimated 1.2 million Missourians. The One Big Beautiful Bill Act’s historic cuts, as well as its burdensome work reporting requirements, would contribute to 210,000 Missourians losing coverage. The bill’s Medicaid coverage losses alone would lead to 233 avoidable deaths per year in Missouri.
Thirty-two percent of Missouri’s Medicaid enrollees live in rural areas, and cuts to Medicaid would destabilize a key financial lifeline that hospitals and other health care providers rely on to keep their doors open. The Center for American Progress projects that the bill’s Medicaid cuts, along with House Republicans’ refusal to extend the enhanced premium tax credits of the Affordable Care Act, would drive up uncompensated care costs in Missouri by more than $597 million by 2034, threatening the financial stability of the state’s rural hospitals, 16 percent of which are already at immediate risk of closure. These uncompensated costs could lead to the closure of Missouri’s rural hospitals, making it harder for all Missourians to access care regardless of their source of health coverage. Losing out on significant federal Medicaid funds could also force the state to reduce or eliminate optional Medicaid benefits for people with disabilities, including home- and community-based care that enables them to live independently.
Cuts to SNAP jeopardize food assistance for families in Missouri and would cost the state tens of millions of dollars per year
The Supplemental Nutrition Assistance Program (SNAP) is a lifeline for families and local economies in Missouri, with 10 percent of households, or nearly 675,000 residents, participating in SNAP. House Republicans’ plan would enact the largest cuts to SNAP in history by implementing harsher paperwork requirements for older beneficiaries and families with school-age children, shifting benefit costs and increased administrative costs onto states, and preventing future increases to SNAP benefits. At a time of rising food costs, House Republicans’ plan to cut SNAP benefits would greatly affect families in Missouri:
- 150,000 residents would be at risk of losing some or all SNAP benefits from expansions in who is subject to paperwork requirements. The average SNAP family would lose $239 per month in food assistance.
- Nearly 148,000 children could lose access to free school meals.
- 112 grocery stores and other SNAP retailers would face increased risk of financial instability due to decreased business from SNAP recipients.
- $29.3 million more would be spent on state administrative costs each year.
Read more
Cuts to clean energy tax credits would increase prices for Missouri families and businesses
Clean energy tax credits lower electricity and gasoline costs and create hundreds of thousands of jobs by expanding energy supply in the United States. Cutting off these investments would raise energy prices, shut down energy production facilities, and reduce energy supply. These are the impacts in Missouri:
- Average annual electricity costs would increase by $176 for households and 18 percent for businesses in 2026.
- The average household would spend $423 more on gasoline annually by 2035.*
- $3.3 billion in investments would be at risk, largely in solar and energy storage.
- 4,643 jobs would be at risk.
- Missouri is already experiencing utility rate increases, with Spire proposing a 15 percent increase in residential gas bills, and Ameren Missouri proposing a $16 monthly increase in residential gas bills. The reconciliation bill would cause energy bills to rise even further.
Changes to the Pell Grant program would increase student loan debt for students from low- and middle-income families in Missouri
House Republicans’ One Big Beautiful Bill Act threatens to increase the cost of higher education for low- and moderate-income students receiving Pell Grants by imposing new eligibility rules that would require students to be enrolled for at least 30 credits per academic year. Because many students also work and/or are parents or caregivers, many may not be able to enroll in additional coursework. Instead, as a result, they may need to take on additional student loans in order to make up for their lost grant funding. Here are the estimated impacts of the House reconciliation bill on students and colleges in Missouri:
- Students who could see cuts to their Pell Grant funding: 45,910
- Students at risk of losing all Pell Grant funding: 21,050
- Pell Grant funding at risk: $124 billion**
Conclusion
House Republicans’ One Big Beautiful Bill Act would give the wealthiest Americans huge tax breaks while harming Missouri by enacting massive cuts to health care and food assistance, raising utility bills, and increasing the cost of higher education. These impacts will be felt not only by vulnerable families but also by local communities and businesses.
* This figure includes both the rollback of vehicle emission regulations and the repeal of the Inflation Reduction Act’s energy and climate provisions in the reconciliation bill. Data were obtained from Rhodium Group’s ClimateDeck.
** Authors’ calculations are based on Federal Student Aid, “Pell End-of-Year Reports: Table 22: Distribution of Federal Pell Grant Recipients by State of Legal Residence and Control of Institution Award Year 2022-2023” (last accessed May 2025); National Center for Education Statistics, “Beginning Postsecondary Students (BPS): 2012/2017” (last accessed May 2025) (retrieval code ‘wjdqqk’); Integrated Postsecondary Education Data System, “Number of students enrolled in postsecondary institutions annually, by sector of institution: 2022-23” (last accessed May 2025); Integrated Postsecondary Education Data System, “Percent of undergraduate students receiving Pell grants, by sector of institution: 2022-23” (last accessed May 2025).