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BISMARCK 鈥� Under the 鈥渂ig, beautiful bill鈥� being championed by President Donald Trump and a Republican-dominated Congress, hundreds of thousands of Midwesterners are slated to lose access to health care coverage over the next decade as part of a greater effort to cut taxes and reduce federal spending.

Medicaid administrators and providers, from state health departments to clinics, are scrambling to determine the exact number of people who will be impacted by the sweeping changes.

The Congressional Budget Office over the next decade under The Congressional Budget Office, or CBO, is a nonpartisan group that works to inform Congress and its actions.

Program recipients are expected to experience increased copays, paperwork and work requirements, while program administrators would see fewer federal dollars funneled into states to be used by hospitals and clinics.

Beginning January 2027, "able-bodied" Medicaid recipients between the ages of 19 and 64 who have no dependents would be required to work 80 hours monthly if the bill passes into law.

Those with incomes between 100% and 138% of the federal poverty level would be asked to foot copays costing up to 5% of household earnings beginning January 2028, according to the CBO.

Medicaid recipients would also have to reapply for the program semiannually, twice as often as what's currently required.

The bill further prohibits Medicaid coverage that reduces premium costs for migrants who are lawfully present in the U.S., which extends to trafficking survivors, refugees and those seeking asylum. The rule would not apply to green card holders.

On the state and local levels, Republican and Democratic leaders are drawing their approval of the changes to Medicaid along party lines.

Republicans generally say the cuts will eliminate fraud within the system and preserve its services. Meanwhile, Democrats decry the cuts, claiming they will lead to more debt and negatively impact low-income Americans, especially the elderly and those with disabilities.

Of the approximately 105,000 North Dakotans on Medicaid, an estimated 18%, or 18,900, wouldn鈥檛 be enrolled by 2034 because of the changes, according to

The state would lose approximately $1.42 billion, or 12%, of its federal Medicaid dollars over the next decade, the analysis further found 鈥� a loss largely due to the mandatory work requirement.

That money is designed to cover medical costs for low-income adults, pregnant women, children and people with disabilities.

North Dakota鈥檚 Department of Health and Human Services told Forum News Service it cannot "speculate the potential impacts鈥� of the legislation, but said it鈥檚 鈥渃losely monitoring鈥� the situation.

The state's Hospital Association shared a similar sentiment.

Tim Blasl, the organization's director, pointed to the CBO's estimate and said the number sounds slightly inflated, but added that "it's too early to tell," and "any cuts to coverage are concerning."

"If people don't have coverage, they don't get their preventative care and regular wellness checks. Then, you have hospitals and physicians that aren't getting paid for the services," he said.

In a Wednesday, July 2, press conference, Sen. John Hoeven, R-N.D., said increasing Medicaid requirements will make the system "more sustainable" and stronger for the people who need it most.

He also pointed to $50 billion in subsidies for rural hospitals in the bill, saying the changes to Medicaid will only benefit the state.

The $50 billion allocation is intended to increase services provided in rural clinics and hospitals. It would be disbursed over the next five years as part of the "Rural Transformation Program," according to the bill.

Approximately 1 in 5, or 1.3 million, Minnesotans depend on Medicaid services. Under the bill, 253,000 could lose coverage over the next decade, and the state would miss out on up to $500 million in federal dollars for the program annually, according to the

The Minnesota Department of Health did not respond to a request for comment by publication time.

"Our organization, or any of our rural partners, are on small margins," Madison Health Care Services CEO Erik Bjerke said in a message shared by the Minnesota Hospital Association. "Any cuts to Medicaid will be detrimental in any of our areas, from the clinic to our hospital, and especially on our long-term care side."

In a Tuesday press release, Sen. Tina Smith, D-Minn., said, "What Republicans did here is simple: they voted to kick 16 million people off health insurance while giving massive tax breaks to billionaires and corporations, and managed to still raise the debt by a staggering $5 trillion."

Fewer individuals in South Dakota would be impacted by changes to Medicaid compared to North Dakota and Minnesota, but an analysis from the nonpartisan health policy group KFF determined around 13,000 of the approximately 115,000 South Dakotans who use Medicaid would lose coverage by 2034.

Overall, the state would lose between $780 million and $1 billion, or an average 11%, of its federal funding for the program over the next decade.

South Dakota鈥檚 Health Department said it鈥檚 鈥渦nable to comment at this time鈥� about the impacts on the state's Medicaid recipients.

In his statement celebrating the Senate's passage of the bill, Senate Majority Leader John Thune, R-S.D., did not acknowledge changes to Medicaid or impacts to health care. He emphasized economic impacts to the state and said the bill "puts even more money in the pockets of South Dakota families" through changes to tax policy.

South Dakota Democratic Party Chair Shane Merrill said the bill "targets our most valuable citizens, robbing them of their health insurance, taking food off the table, increasing energy bills, and killing good-paying jobs."

Both chambers of Congress passed the bill by a one-vote margin. In May, the House of Representatives voted 215-214 to approve it. After undergoing changes in the Senate, the bill advanced in that chamber on a 51-50 vote Tuesday, with Vice President J.D. Vance as the tie-breaking vote.

The House took up the altered version of the bill Wednesday. If it receives approval there, it will head to Trump's desk. The president has made his eagerness to sign the bill into law clear.

Lawmakers have a goal of passing the bill by July 4.