An aerial view of Valley Health Hampshire Memorial Hospital on June 17, 2025 in Romney, W.V.

Ricky Carioti | The Washington Post | Getty Images

President Donald Trump’s “big beautiful bill” would make sweeping changes to U.S. health care, leaving millions of vulnerable Americans without health insurance and threatening the hospitals and centers that provide care to them. 

The Senate on Tuesday voted 51-50 to pass the spending measure after a marathon overnight voting session on amendments. But the bill will face another major test in the House, where Republicans have a razor-thin majority and some members have already raised objections to the legislation. 

Recent changes to the bill would cut roughly $1.1 trillion in health-care spending over the next decade, according to new estimates from the nonpartisan Congressional Budget Office.

More than $1 trillion of those cuts would come from Medicaid, a joint federal and state health insurance program for disabled and low-income Americans, according to the CBO. The funding cuts go beyond insurance coverage: The loss of that funding could gut many rural hospitals that disproportionately rely on federal spending.

The CBO estimates that the current version of the bill would result in 11.8 million people losing health insurance by 2034, with the majority of those people losing Medicaid coverage.

But the implications could be even bigger. Trump’s bill combined with separate policy changes could result in an estimated 17 million people losing health insurance, said Robin Rudowitz, director of the program on Medicaid and the uninsured at health policy research organization KFF.

She said those other changes include new regulations that would dramatically limit access to Affordable Care Act Marketplace coverage and expiring enhanced ACA tax credits.

“If all of this comes to pass, it would represent the biggest roll back of health insurance coverage ever due to federal policy changes,” Cynthia Cox, KFF’s director of the program on the ACA, said in an analysis published Tuesday. 

Approximately 72 million Americans are currently enrolled in Medicaid, about one-fifth of the total U.S. population, according to government data. Medicaid is the primary payer for the majority of nursing home residents, and pays for around 40% of all births. 

The Trump administration and its allies insist the cuts in the bill aim to eliminate waste, fraud and abuse. Democrats have said they break the president’s repeated promises not to touch the Medicaid program. Medicaid has been one of the most divisive issues throughout negotiations in both chambers, and some House Republicans have expressed reservations about how deep the cuts are. 

“I get that they want to cut fraud, but taking a swipe across the top is not going to solve the issue,” said Jennifer Mensik Kennedy, president of the American Nurses Association. 

She said the cuts could shutter hospitals and health centers in rural areas and lead to job losses for health-care staff such as nurses. 

Millions of Americans will lose coverage

The cuts in the bill come from several different provisions, but the lion’s share of Medicaid savings will come from two changes. 

One would establish a new, strict national work requirement for certain Medicaid beneficiaries ages 19 to 64. It would require childless adults without disabilities and parents of children older than 14 to work, volunteer or attend school for at least 80 hours a month to keep their insurance coverage, unless they qualify for an exception. 

Current law prohibits basing Medicaid eligibility on work requirements or work reporting rules, according to KFF. 

The new work requirement in the bill won’t kick in until 2026. It is projected to save about $325 billion over a decade, the CBO said. 

An analysis published June 23 by the UC Berkeley Labor Center said that the work requirement would cause the most people to lose insurance and “poses an especially draconian barrier to older adults.” The center said there is a steady drop-off in employment after age 50 due to factors “outside [people’s] control,” including deteriorating health, age discrimination and increasing responsibility to provide care for aging family members. 

“These same factors make older adults particularly vulnerable to coverage loss under Medicaid work requirements,” the analysis said.

People living in rural communities, such as seasonal farmers, may also struggle to find employment for parts of the year, Mensik Kennedy said.

AARP, an advocacy group focusing on issues affecting those 50 and older in the U.S., sent a letter over the weekend to Senate Majority Leader John Thune, R-S.D., and Senate Minority Leader Chuck Schumer, D-N.Y., opposing another provision that would disqualify people who fail to meet Medicaid work requirements from receiving premium tax credits to purchase coverage through the ACA Marketplaces.

“This creates a steep coverage cliff for those in their 50s and early 60s — particularly for those nearing retirement or working part-time — who may be left with no affordable coverage option at all,” the group said. 

Hospitals, health centers, patients in rural areas at risk 

A surgeon walks past in the surgical unit at Valley Health Hampshire Memorial Hospital on June 17, 2025 in Romney, W.V.

Ricky Carioti | The Washington Post | Getty Images

Another driving source of Medicaid savings will come from a provision that will cap and gradually reduce the tax that states can impose on hospitals, health plans and other medical providers. Those provider taxes are designed to help fund state Medicaid programs, with the federal government matching a portion of the state’s spending. 

Some members of the Trump administration and conservative lawmakers argue that it is a loophole for states to receive disproportionately more federal funds than they contribute. 

The bill’s restrictions on provider taxes and another strategy called state-directed payments would cut spending by a combined $375 billion, according to the CBO report.

But some GOP senators and experts raised concerns that capping provider taxes would threaten a critical funding stream for rural hospitals, which could force them and other health centers to close. Mensik Kennedy said health-care providers in rural areas, particularly critical access hospitals, rely more on Medicaid funding to support them compared with those in urban areas. 

“You’re going to see closures of rural hospitals that are the backbone of their community and were already struggling financially. You’re going to see half a million job losses,” Mensik Kennedy said. 

She said pregnant women in rural areas could be forced to drive 30, 40 or more miles to deliver a baby, while emergency medical services could have to drive an hour to reach a patient having a heart attack. 

Patients in rural communities already have higher rates of chronic illnesses and mortality because they have limited access to care, according to the Centers for Disease Control and Prevention. 

Senate Republicans have added a $25 billion fund to the bill to help rural hospitals stay open in the face of Medicaid cuts. 

But Mensik Kennedy said that fund is “putting a bucket of water on the house fire,” adding that it is not enough to offset the cuts from the cap on provider taxes and other provisions. 

Cuts in overall Medicaid funding for rural hospitals would exceed 20% in more than half of states, according to a report from the National Rural Health Association.

A win for pharma 

Senate Republicans handed a win to drugmakers after they added back a provision into the bill that would exempt more medicines from the Inflation Reduction Act’s Medicare drug price negotiations. 

Under the bill, medicines used to treat multiple rare diseases will be exempt from those price talks between Medicare and manufacturers. The Senate initially left out that provision, called the ORPHAN Cures Act, in its first draft of the bill last month. 

The pharmaceutical industry argues that excluding those drugs from the negotiations will encourage more investments in treatments for rare conditions. Currently, only drugs that treat a single rare disease or condition can be exempted from price talks.

“The ORPHAN Cures Act will enable more options for Americans living with rare disease,” the trade group Biotechnology Innovation Organization wrote Wednesday in a post on X. The group also said only 5% of rare diseases have an approved treatment, while the economic toll of rare conditions in the U.S. surpassed $997 billion in 2019. 

But on Tuesday, drug pricing group Patients For Affordable Drugs Now called on the House to remove the ORPHAN Cures Act from the bill and allow Medicare drug price negotiations to deliver more savings to patients. 

The decision to include it in the legislation “moves us in the wrong direction, undermining hard-fought progress to lower drug prices,” Merith Basey, executive director of the group, said in a statement. 

“Pharma lobbyists will stop at nothing to maintain industry profits, and when a majority of the Senate caves to their interests, it’s a reminder to Americans why they’re paying the highest drug prices in the world. Simply put: it’s because Congress allows it,” Basey said.

She called it a “completely unnecessary $5 billion giveaway” to the pharmaceutical industry, referring to CBO estimates for how much the ORPHAN Cures Act would cost taxpayers over the next decade. 

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John Cangialosi, Senior Hurricane Specialist at the National Hurricane Center, inspects a satellite image of Hurricane Beryl, the first hurricane of the 2024 season, at the National Hurricane Center on July 1, 2024 in Miami, Florida.

Joe Raedle | Getty Images News | Getty Images

Government scientists on Thursday released a forecast for the 2025 hurricane season, predicting a 60% chance it will be an above-average season.

The National Oceanic and Atmospheric Administration, or NOAA, predicts this season will bring 13 to 19 named storms with winds 39 miles per hour or higher. It predicts six to 10 of the forecasted storms will grow to hurricane status, and three to five will become major hurricanes.

Laura Grimm, the acting administrator of the NOAA and a marine scientist, sidestepped specific questions about how budget cuts aimed at climate science would affect the organization’s work and highlighted the vital work of the agency to help communities prepare and save lives.

“Weather prediction, modeling and protecting human lives and property is our top priority. So we are fully staffed at the hurricane center, and we definitely are ready to go,” Grimm said in a news conference held in Jefferson Parish, Louisiana, to commemorate 20 years since Hurricane Katrina.

Grimm also pointed out, thanks to improvements in the science and technology over the last 20 years, that NOAA’s hurricane prediction was spot-on last year.

Hurricanes Helene and Milton caused more than $37 billion in insured losses in 2024, according to a report from Aon.

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Despite those losses, the U.S. property casualty insurance industry saw its best underwriting performance since 2013, according to a report from the Insurance Information Institute and Milliman.

But the report concludes that January’s devastating wildfires in California and economic challenges related to tariffs could dampen the industry’s results in 2025.

Insurers and reinsurers are collectively facing more than $50 billion in losses from the Los Angeles wildfires.

The Midwest has also suffered outbreaks of severe thunderstorms with damaging hail, wind and tornadoes this spring. The Storm Prediction Center had tallied 883 local tornado reports this year as of Monday, 35% higher than average for this time of year.

Aon said the severe convective storms have caused an estimated $10 billion in insured losses in the first quarter. A storm over three days in May added another estimated $7 billion to insurers’ tally.

The last 10 years have averaged more than $33 billion annually in insured losses, a 90% increase from the previous decade.

It’s an existential threat to the insurance industry and its ability to provide affordable insurance to homeowners, according to Bill Clark CEO of Demex, a reinsurance analytics group. And the problem is getting worse, not better.

“Reinsurance (insurance for insurance) costs for severe convective storm losses are at a 20-year high and, coupled with limited availability, it is leaving insurers hamstrung and unable to transfer most of their mounting losses, ” Clark said in an email to CNBC.

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Whether hurricanes, wildfires or severe storms. Aon blames the skyrocketing losses on growing exposure, meaning more people are living where climate risks are higher and the cost of their homes, cars and all the stuff inside is more expensive.

The insurance industry is working to push state and local efforts to build resiliency and improve mitigation efforts — meaning better building codes, public works projects that protect homes and properties, and tough standards on defensible spaces around buildings, for instance.

The president of Jefferson County Parish, Cynthia Lee Sheng, pointed to all the efforts made in the 20 years since Hurricane Katrina hit Louisiana, killing 1,392 people in 2005. The government overhauled levees, flood walls, and pumping stations.

“It’s estimated that $13 is saved for every $1 spent on mitigation efforts,” Sheng said. “Hurricane Katrina also changed the face of disaster recovery. Key agencies have learned to work together to provide assistance, coordinate efforts and ensure efficient response.”

— CNBC’s Dawn Giel contributed to this report.

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Men work with a jet engine at General Electric (GE) Celma, GE’s aviation engine overhaul facility in Petropolis, Rio de Janeiro, Brazil.

YASUYOSHI CHIBA | AFP | Getty Images

RTX and GE Aerospace expect a more than $1 billion impact combined from President Donald Trump’s tariffs on imported goods and materials, the latest sign of higher prices for major U.S. manufacturers that rely on a global supply chain.

Neil Mitchill, chief financial officer of defense contractor and commercial aerospace supplier RTX, said on an earnings call on Tuesday that the company will likely take a $850 million hit this year from tariffs, including the sweeping 10% tariffs that Trump imposed earlier this month alongside higher duties on countries like China and separate duties on imported steel and aluminum.

That estimate doesn’t include RTX’s own tariff mitigation measures, Mitchill said.

GE Aerospace, which makes engines for popular Boeing and Airbus planes, kept its 2025 earnings outlook in place during its quarterly report Tuesday and said it would seek to save about $500 million by cutting costs and raising prices.

GE Aerospace CEO Larry Culp said on Tuesday’s analyst call that he recently met with Trump and discussed the U.S. aerospace sector’s trade surplus. GE has a joint venture with France’s Safran to make popular airplane engines.

The new tariffs are a shift for a global industry that has enjoyed mostly duty-free trade for decades.

“All we have suggested is the administration works through a myriad of issues, is they can consider the position of strength that the country enjoys as a result of this tariff-free regime,” Culp said.

The White House didn’t immediately comment.

Boeing, a major customer of both companies and the top U.S. exporter, reports quarterly results before the market opens on Wednesday.

Airlines have recently announced cuts to U.S. domestic capacity plans this year because of softer demand, but executives have emphasized that it is hard to predict the direction of the economy or future trade policies. United last week provided two earnings outlooks for 2025, one in the event of a recession, one assuming status quo.

“There is uncertainty,” Culp said Tuesday. “None of us, I think, know for sure how this plays out.”

Read more CNBC airline news

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A “Keep America Great” hat tops off a Christmas tree at a “Merry Christmas” rally hosted by President Donald Trump at the Kellogg Arena in Battle Creek, Michigan, Dec. 18, 2019.

Scott Olson | Getty Images News | Getty Images

Black Friday is poised to take on a new tint of red, white and blue this year after an election that many say was won and lost on consumer sentiment and the economy. 

CNBC analyzed shipping trends in red and blue states and spoke with shoppers in Texas, Michigan, New Jersey, New York, Connecticut, North Carolina and Virginia to better understand how the 2024 presidential election results could influence the holiday shopping season. 

People who voted for President-elect Donald Trump were overwhelmingly positive about the future of the economy, while supporters of Vice President Kamala Harris were more pessimistic, concerned that the incoming president’s policies could make things harder on the middle class. In a world where sentiment drives purchasing decisions, these differences in opinion could shape how much people end up spending this holiday season.

For example, Harris voter Amanda Davila, a 30-year-old New York City educator, told CNBC she’s planning to spend less on the holidays this year and is “trying to be more cautious” about spending in the leadup to Trump taking office in January. 

“I’m worried about my own student loans and whether things will be taken out of forbearance, how much I’m going to be owing if the SAVE Plan [for student loan repayment] goes away and things like that,” said Davila. “It’s very hard being a millennial and having to worry about buying a house, affording groceries, rent, all that stuff. With our income, it’s not enough for everything these days.” 

Meanwhile, Trump voter Armando Duarte, a 62-year-old retired utility worker from Fort Lee, New Jersey, told CNBC he’s feeling a lot better about the holiday shopping season since Trump won. 

“I’m optimistic that people are going to feel a little bit more encouraged to spend because they may feel that the economy might be on the mend and coming back,” said Duarte. “I think things are going to really pick up for the better … I think that inflation is going to come down. Jobs are good, but they’re going to get a lot better, and hopefully wages are going to go up, and people are going to be able to afford to just basically live.” 

In the months before the 2024 election, retailers fretted over whether it would hurt sales and the all-important holiday shopping season, which was already facing a bleak outlook due to the shortened time between Thanksgiving and Christmas, among other challenges. Many companies issued cautious guidance for the back half of the year, in part over concerns that the election would distract consumers from shopping or a drawn-out election certification process would lead to unrest and dampen sales. 

However, now that Trump has won, it appears the election result could boost sales — at least in many parts of the country — because his supporters largely believe that economic conditions will improve under his direction. If people are feeling better about the economy, it means they’ll likely spend more, too, experts said. 

“If they feel optimistic about what comes ahead, then they are willing to spend more, even if it is on a credit card, knowing or expecting that they’re going to have the money to then pay it off,” said Meir Statman, an expert in behavioral finance and a professor at Santa Clara University’s Leavey School of Business. “So the general optimism of Republicans, on the whole, is likely to affect their spending. We know that sentiment generally affects what people do, including spending, and conversely, it might depress, of course, the sentiment of Democrats, and in all likelihood, negatively affect their spending.” 

The way some Americans were shopping online in the aftermath of the election bolsters that argument.

Shipping data gathered by e-commerce logistics provider Grip, which ships billions in merchandise across the country every year and specializes in the delivery of perishable goods, shows different shipping patterns in blue and red states. The firm examined the total number of packages it sent in the two months before the election and what percentage went to each state, and how that changed in the two weeks after the election.

In GOP-won states, shipping volumes increased by 50.4% after the election, while Democrat-won states saw volumes decrease by an average of 11.2%. Only two blue states — Illinois and Minnesota — saw shipping volumes increase after the election, while all others saw rates fall.

“Our data shows how major events like elections can significantly impact consumer sentiment, driving changes in eCommerce shopping behavior and logistics patterns,” Grip’s CEO Juan Meisel told CNBC. “After this year’s election, we saw significant shifts in spending activity, with some regions experiencing increased volumes as consumer confidence surged, while others saw declines.”

In a national consumer survey taken after the election, GlobalData found 51.3% of respondents believe a Trump presidency will positively affect the economy, while 13.5% plan to spend more this season now that he’s been elected. Conversely, 7.2% said they plan to spend less.

In another survey conducted by retail analytics firm First Insight, a third of consumers said they are planning to reduce their holiday spending budgets because of the election.

“Consumers have mixed feelings about the election result. However, on balance, there are more who see it as positive for the economy than those who see it as negative,” said GlobalData managing director and retail analyst Neil Saunders. “If people feel good, they are more likely to spend a little more over the holidays. Trump may not have had a huge impact on Christmas, but as far as spending is concerned, he is more of a Santa-like figure than a Grinch.”

Can Trump save Christmas? 

In the lead-up to the holiday shopping season, sales projections from the National Retail Federation and several consulting firms fell a bit flat after several years of strong growth, buoyed by inflation and pandemic stimulus checks.

In the 10 years before the pandemic and after the Great Recession, holiday retail sales grew on average by 3.68% each year. In some ways, this year’s forecast is a return to that historical average.

The NRF said it expects winter holiday spending in November and December to grow between 2.5% and 3.5%. At the high end, that’s close to the pre-pandemic, 10-year average, but on the low end, it’s 32% lower than the historical average. 

Either way you slice it, the forecast would represent the slowest growth since 2018, when holiday retail sales grew 1.8% from the year-ago period. 

“I think we’re gonna have a tough Christmas this year,” said Isaac Krakovsky, the consulting retail leader for EY Americas. “All my clients, big clients, are telling me they’re spending less in [capital expenditures]. All of them, right? When it’s every single one of them, and it’s driven by what they’re seeing in the market, that leads me to think we’re gonna have a tough holiday season.” 

A man dressed as Santa Claus holds up a sign that says “Merry Christmas Trump” as he arrives at a campaign event for Republican presidential candidate former President Donald Trump in Waterloo, Iowa, Dec. 19, 2023.

Kamil Krzaczynski | Afp | Getty Images

Most holiday forecasts came out before the election, so they had not factored in any effects from Trump’s win. But most experts agree that a decisive result is good for business one way or the other. 

“The good news is, certainty is better than uncertainty, even if your person didn’t win … So I suppose that will help,” said Aaron Cheris, a partner with consulting firm Bain & Company. “Usually, in election years, you see a little bit of back-loading, where people maybe didn’t do stuff earlier because they were waiting to see what happened, and so, will you see a little of that at the margin? Probably.”

While many Americans appear to be feeling better about the economy in the aftermath of Trump’s election, inflation pain lingers and is expected to dampen holiday spending. Plus, some categories are expected to outperform others, which could create another winners-and-losers situation for retailers come January.

Holiday sales for furniture and home furnishings are expected to decline in the high single digits, electronics and appliances are forecast to be flat, while apparel and grocery are expected to grow in the low single digits, according to Bain’s forecast. Those differences across categories came out earlier this week when companies including Abercrombie & Fitch and Best Buy reported earnings. Abercrombie issued robust holiday guidance ahead of expectations, while Best Buy fell short, warning demand for consumer electronics was waning.

The retail sales forecast gets a bit murkier, and a bit worse, when inflation is taken into consideration. The NRF’s forecast isn’t adjusted for inflation, nor are Bain and EY’s outlooks of 3% growth. When higher prices are stripped out of the guidance, real growth is expected to land around 0.5%, Krakovsky estimated. Cheris agreed that real growth should be much lower after inflation is taken into consideration.

“It’s not negative, it’s not recessionary, but it’s not exciting,” said Cheris. 

Between 2010 and 2019, holiday retail sales grew on average by 4.41% when adjusted for inflation, according to an analysis of data published by Bain. If real sales grow only between 0.5% and 1% this holiday season, it would be a major drop from the pre-pandemic historical average. 

Shoppers browse for dresses during the Black Friday sale at the Vivo Activewear women’s clothing store in downtown Nairobi, Kenya November 24, 2023. 

Thomas Mukoya | Reuters

Overall, inflation has been propping up retail sales for the last few years, and many of the shoppers interviewed by CNBC lamented the impact of higher prices, regardless of their political affiliation. Some said they plan to spend more this year, but that’s only because prices are higher — not because they’re buying more things. 

For Meri Pitts, a 24-year-old college student in Detroit who works in customer care, higher prices have made the holiday season feel more like a chore than something to look forward to.

“I am the type of person, even if it’s not the holiday time, I love to go shopping. I love to, like, get my friends little gifts and things like that,” said Pitts. “Prices have skyrocketed so much that a pastime of mine that I’ve literally been enjoying since I was in high school … it’s just not as fun as it used to be, because now I’m more worried about breaking my bank than I am about getting people gifts that I feel like they deserve.”

— Additional reporting by CNBC’s Michael Wayland, Melissa Repko, Sarah Whitten and Kristian Burt

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