Key Takeaways
• Starting 2026, Green Card holders below poverty lose Obamacare subsidies; all lose by 2027 with Medicaid limits.
• H-1B rule tightens from January 17, 2025, requiring proof of specialty jobs and employer control with increased audits.
• CBP budget rises over $60B to 2029; remittance tax hits non-citizens; healthcare premium help excluded for many workers.
As of July 6, 2025, the United States 🇺🇸 has entered a new era of immigration and healthcare policy with the passage of the “One Big Beautiful Bill.” This sweeping legislation, sometimes called the “megabill,” brings major changes for immigrants, especially Green Card holders and H-1B workers. The bill introduces strict limits on healthcare access for many immigrants and tightens rules for skilled foreign workers. These changes are already causing concern among immigrant families, employers, healthcare providers, and state governments.
Let’s break down what’s happening, who is affected, and what it means for the future.
Major Healthcare Changes for Green Card Holders
The One Big Beautiful Bill, passed by the Senate in early July 2025, marks a turning point for healthcare access among immigrants. The law’s most immediate impact falls on Green Card holders—lawful permanent residents—who have relied on federal help to afford health insurance.
What’s Changing and When?
- Starting in 2026: Green Card holders and other lawfully present immigrants who earn below the federal poverty level will no longer be able to get subsidized health insurance through the Affordable Care Act (Obamacare) marketplace.
- Starting in 2027: Those earning above the poverty level will also lose access to these subsidies.
- Medicaid Access: The bill further limits Medicaid, the main public health insurance for low-income people, for both undocumented immigrants and many legal immigrants. This means taxpayer-funded healthcare benefits will end for these groups.
Who Is Affected?
- About half a million immigrants who currently get low-cost health insurance through state programs like New York’s Essential Plan will be directly impacted.
- Many of these individuals are Green Card holders who work low-wage jobs or are between jobs and rely on these programs for basic medical care.
Why Does This Matter?
- Higher Out-of-Pocket Costs: Without federal subsidies, many Green Card holders will face much higher health insurance bills. Some may be forced to go without coverage altogether.
- State Budgets Under Pressure: States like New York must now cover these uninsured immigrants themselves, due to state court orders. This is expected to cost New York an extra $3 billion each year.
- Community Health Centers and Hospitals: Clinics and hospitals are already seeing fewer immigrant patients. Many are confused or afraid about their eligibility, even if they are in the country legally. Hospitals warn that when immigrants lose coverage, the whole system suffers—leading to service cuts that can affect everyone.
Political and Policy Drivers
- Supporters: Republican leaders, including Rep. Vern Buchanan (R-FL), argue that healthcare dollars should go to U.S. citizens first. They say the bill will save federal money and make the system fairer.
- Opponents: Democratic governors in states like California 🇺🇸 are scaling back free healthcare for undocumented immigrants because of the loss of federal funds. Hospital groups and immigrant advocates warn that the changes will destabilize healthcare systems and hurt public health.
Tougher Rules and Enforcement for H-1B Workers
The One Big Beautiful Bill doesn’t just target healthcare. It also brings a new wave of enforcement and regulation for H-1B workers—skilled foreign professionals, often in technology and engineering, who are vital to many U.S. companies.
What’s New for H-1B Workers?
- New Rule Effective January 17, 2025: The Department of Homeland Security (DHS) has put in place a final rule that makes the H-1B visa program stricter and more closely monitored.
- Key Changes:
- Stricter Definition of “Specialty Occupation”: Employers must now prove that a real, specialized job exists at the time they file for an H-1B visa. No more “placeholder” or speculative job offers.
- More Site Visits and Audits: U.S. Citizenship and Immigration Services (USCIS) will conduct more surprise visits to workplaces, including third-party client sites where H-1B workers are placed.
- Employer-Employee Relationship: Employers must show they have real control over the H-1B worker’s job, especially for contractors and consulting firms.
- Mandatory Attestations: Both employers and workers must sign statements to help prevent fraud.
- Greater Scrutiny at Visa Stamping and Entry: H-1B workers can expect more questions and document checks when applying for visas or entering the United States 🇺🇸. There will be more Requests for Evidence (RFEs) and Notices of Intent to Deny or Revoke (NOIDs/NOIRs).
What Does This Mean for Employers and Workers?
- For Employers:
- They must keep detailed records about job roles, worker qualifications, and work locations.
- The process will take longer and require more paperwork.
- Companies that place workers at client sites (like IT consulting firms) will face the most scrutiny.
- For H-1B Workers:
- They may wait longer for visa approvals and face more questions.
- There is a higher risk of visa denial if paperwork is not perfect or if the employer fails a compliance check.
- Workers must be ready to prove their job matches their degree and that their employer is following all the rules.
Expert Advice
Immigration lawyers are urging employers to be extra careful. Job descriptions must match the worker’s degree exactly, and all documents must be kept up to date. Legal experts expect more unpredictability in how cases are decided and warn that both employers and workers should prepare for more site visits and requests for extra information.
Broader Enforcement and Financial Changes
The One Big Beautiful Bill goes beyond healthcare and H-1B rules. It also brings a huge increase in funding and enforcement for immigration agencies.
Key Points:
- Customs and Border Protection (CBP): The bill gives over $60 billion to CBP through 2029, quadrupling its budget. This money will pay for more staff and advanced technology, like surveillance and biometric systems.
- Immigration Detention and Enforcement: Funding is set at about $146.3 billion, showing a strong focus on detaining and removing people who are in the country without permission.
- Remittance Tax: There is now a 3.5% tax on money sent abroad by non-citizens. This will hit many immigrant workers who send money home to support their families.
- Healthcare Premium Tax Credits and Medicare: Most temporary workers, including H-1B visa holders, are now excluded from getting help with health insurance premiums or Medicare. This means higher healthcare costs for these workers.
Background: Why These Changes Now?
The One Big Beautiful Bill is the latest in a series of efforts by Republican lawmakers to limit public benefits for immigrants. The goal is to save federal money and make sure citizens come first. These ideas have been around for years, but this bill is the most sweeping yet.
The H-1B program, meanwhile, has long been criticized for fraud and abuse, especially in the IT sector. The new rules are meant to stop companies from using the program to fill jobs that don’t really require special skills or to undercut American workers.
These changes reflect a broader push by the current administration to tighten immigration, strengthen border security, and cut federal spending on non-citizens.
What’s Next? Future Outlook and Pending Developments
The new healthcare rules for immigrants will start taking effect in 2026 and 2027. States are already scrambling to figure out how to pay for the extra costs and keep their healthcare systems running smoothly.
Hospitals, clinics, and advocacy groups are closely watching the impact. There may be calls for Congress to delay or adjust the rules if the effects are too harsh.
For H-1B employers and workers, the message is clear: strict enforcement is here to stay. There is no sign that the government will relax these rules anytime soon. Companies and workers must stay alert and keep up with all compliance requirements.
Legal experts and employer groups are waiting for more detailed guidance from USCIS and DHS on how the new rules will be enforced. Everyone involved should keep checking for updates and be ready to respond quickly to any new requirements.
Practical Guidance for Affected Groups
For Green Card Holders:
– Check your eligibility: If you rely on subsidized health insurance, find out when your coverage may end.
– Explore state options: Some states may offer their own programs, but these could be limited or more expensive.
– Talk to a legal or healthcare advisor: Get help understanding your options and rights.
For H-1B Workers:
– Keep all documents up to date: Make sure your job description, degree, and work location match what your employer filed with USCIS.
– Stay in close contact with your employer: Be ready for site visits or extra questions from immigration officers.
– Seek legal advice if needed: If you get an RFE or NOID, respond quickly and with complete information.
For Employers:
– Review hiring practices: Make sure all H-1B positions are real specialty jobs and that you have proof.
– Prepare for audits: Keep detailed records and be ready for site visits.
– Train HR staff: Make sure everyone understands the new rules and what is required.
Official Resources and Where to Get Help
- U.S. Citizenship and Immigration Services (USCIS): For the latest on H-1B visa rules, compliance, and forms, visit the USCIS H-1B Program page.
- Department of Homeland Security (DHS): For enforcement policies and updates on immigration programs.
- State Health Departments: For information about changes to state health insurance programs for immigrants.
- Congressional Committees: For updates on the One Big Beautiful Bill and related legislation.
If you need to file or check on an immigration form, always use the official government website. For example, the Form I-129 is used for H-1B petitions.
Conclusion: A Time of Change and Uncertainty
The One Big Beautiful Bill brings some of the most sweeping changes to U.S. immigration and healthcare policy in years. Green Card holders, H-1B workers, and their families face new challenges and higher costs. States and healthcare providers must adjust to a new reality, while employers and workers must be more careful than ever to follow the rules.
As reported by VisaVerge.com, these changes are already causing confusion and concern in immigrant communities and among businesses that rely on skilled foreign workers. The coming months and years will show how these policies play out in real life—and whether further changes will be needed to keep the system fair and workable for everyone.
For now, staying informed, keeping good records, and seeking help when needed are the best ways to manage these new challenges. The official government websites remain the most reliable sources for up-to-date information and forms. As the situation develops, all eyes will be on how the One Big Beautiful Bill shapes the future of immigration and healthcare in the United States 🇺🇸.
Learn Today
One Big Beautiful Bill → 2025 U.S. law limiting immigrant health benefits and tightening H-1B visa rules significantly.
Green Card holder → A lawful permanent resident allowed to live and work permanently in the U.S.
H-1B visa → A visa for skilled foreign workers in specialty occupations requiring theoretical or technical expertise.
Affordable Care Act → U.S. federal healthcare law providing subsidized insurance through marketplaces for eligible residents.
Requests for Evidence (RFE) → A USCIS request for additional documents to support visa or immigration benefit applications.
This Article in a Nutshell
The One Big Beautiful Bill changes U.S. immigration and healthcare policies, cutting health subsidies for immigrants. H-1B rules tighten, increasing audits and paperwork. It boosts border security funding and taxes remittances. Immigrants and employers face higher costs and stricter compliance, reshaping legal residency and skilled worker programs significantly through 2027.
— By VisaVerge.com
