President Donald Trump and congressional Republicans’ massive tax and spending bill will affect millions of Americans, particularly vulnerable populations, but some of those impacts won’t be felt for some time.
The bill’s current language staggers the start date for tax changes and the federal budget until after the November 2026 elections. Some expire at the end of Trump’s term in office.
Here is a look at when you’ll start to see the impact of the bill:
Medicaid
Though Trump campaigned on protecting Medicaid, the program that provides health care for low-income and elderly Americans is one of the largest federal programs targeted in the bill.
The bill imposes new 80-hour per month work requirements on able-bodied Medicaid recipients aged 19 to 64 who don’t have dependents. These requirements include working or other approved activities, such as volunteering.
There are exemptions for parents or guardians of children under age 14 and those with disabilities.
These work requirements won’t kick in until 2026.
Health policy experts say the population of able bodied Americans on Medicaid who don’t work is fairly small — but that many more might lose their coverage because of the burdensome paperwork requirements that will come with regularly proving work status.
Another Medicaid funding cut will come from a change to provider taxes, or taxes on health care organizations, which states use to fund their Medicaid programs. The biggest impacts will felt through the closing of health centers in rural areas, health care employers say, because there are already longstanding struggles to stay open for many of them.
Health policy experts and health care workers say the biggest impacts will felt through the closing of health centers throughout the country, especially in rural areas that were heavily funded by Medicaid. Others will lose coverage because of the work requirements and the additional paperwork required under the bill.
The original measure passed by the House made around $600 billion in cuts to Medicaid, but that grew with the Senate bill: new estimates from the non partisan Congressional Budget Office project federal spending on Medicaid will be reduced by $1 trillion and the number of uninsured people will increase by nearly 12 million by 2034.
The Senate added a $50 billion rural hospital fund to the package to placate senators who had concerns about the impact of Medicaid cuts on their constituents, but it’s unclear how the funding will be distributed or whether it will be sufficient to make up the anticipated shortfall from changes to the Medicaid provider tax.
Affordable Care Act
There are also proposed changes to the Affordable Care Act that take effect in 2026 and could result in millions more people losing coverage, increasing the number to 17 million.
Under the bill, automatic renewal processes would be eliminated and open market insurance applicants would also be subjected to more paperwork.
Food assistance programs
The bill changes work requirements for adults who are part of the Supplemental Nutrition Assistance Program, SNAP, which would greatly reduce the number of eligible Americans.
The bill raises the work requirement age from 54 to 64 and adds parents with children older than 6. Parents with dependent children at home, regardless of age, are currently exempt from these requirements.
A sign on a door in the frozen food aisle, “We accept SNAP food stamp cards” at a Walgreens in New York, March 30, 2024.
UCG/Universal Images Group via Getty Images
Those changes will go into effect as early as this year.
The Republican spending bill also forces states to shoulder at least 5% of SNAP benefit costs starting in 2028. Currently, the program is 100% federally funded.
The SNAP cuts total an estimated $230 billion over 10 years.
Tax changes
Some of the tax changes will go into effect this year and be reflected when Americans file their taxes in 2026.
The bill allows tax deductions on tips and overtime pay. Deductions on tips is capped at $25,000 per year while deductions on overtime is capped at $12,500 per year.
The standard deduction would rise by $750 for single filers and $1,500 for those filing jointly.
One of the biggest changes was the state and local taxes (SALT) deduction, which allows taxpayers to itemize state and local taxes in their filing, including property taxes.
Trump’s 2017 tax bill capped the deduction at $10,000. The 2025 spending bill increases the cap to $40,000 for households making under $500,000 and will rise 1% every year until 2029.
The cap resets to $10,000 in 2030.
The bill will remove tax credits for buying electric vehicles starting on Sept. 30 and tax credits for green home upgrades, such as solar power, at the end of the year.
Tax breaks for businesses enacting green projects will end next year.
ABC News’ Kelly McCarthy, Mary Kekatos, Ben Siegel and Cheyenne Haslett contributed to this report.
