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 North Dakota.
Medicaid cuts threaten coverage, lives, and rural hospitals in North Dakota
Medicaid provides health coverage to an estimated 105,000 North Dakotans. The One Big Beautiful Bill Act’s historic cuts, as well as its burdensome work reporting requirements, would contribute to 23,000 North Dakotans losing coverage. The bill’s Medicaid coverage losses alone would lead to 17 avoidable deaths per year in North Dakota.
More than half of North Dakota’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 North Dakota by more than $65 million by 2034, threatening the financial stability of the state’s rural hospitals, 13 percent of which are already at immediate risk of closure. These uncompensated costs could lead to the closure of North Dakota’s rural hospitals, making it harder for all North Dakotans 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 North Dakota and would cost the state millions of dollars per year
The Supplemental Nutrition Assistance Program (SNAP) is a lifeline for families and local economies in North Dakota, with 6 percent of households, or more than 52,000 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 North Dakota:
- 12,000 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 $260 per month in food assistance.
- More than 7,000 children could lose access to free school meals.
- 28 grocery stores and other SNAP retailers would face increased risk of financial instability due to decreased business from SNAP recipients.
- $6.1 million more would be spent in administrative costs each year.
Read more
Cuts to clean energy tax credits would increase prices for North Dakota 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 North Dakota:
- Average annual electricity costs would increase by $85 for households and 9 percent for businesses in 2026.
- The average household would spend $161 more on gasoline annually by 2035.*
- $4.87 billion in investments would be at risk, largely in sustainable aviation fuels and critical minerals.
- 4,297 jobs would be at risk.
- North Dakota is already experiencing utility rate increases, with Xcel Energy raising residential electricity bills by about 12 percent this year. 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 North Dakota
House Republicans’ One Big Beautiful Bill Act threatens to increase the cost of higher education for low- and moderate-income students who receive 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 North Dakota:
- Students who could see cuts to their Pell Grant funding: 4,398
- Students at risk of losing all Pell Grant funding: 2,016
- Pell Grant funding at risk: $11.8 billion**
Conclusion
House Republicans’ One Big Beautiful Bill Act would give the wealthiest Americans huge tax breaks while harming North Dakota by enacting massive cuts to health care and food assistance, raising utility bills, and increasing the cost of higher education. These impacts would 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).