‘Big beautiful bill’ will end Medicaid for people in Macomb and Oakland counties this year. Here’s how many will lose it—and who’s responsible

The representative who voted to take away health care from nearly 20,000 Michiganders in his district also plans to run for governor.

President Donald Trump’s Republican-backed “One Big Beautiful Bill Act” was signed into law on the Fourth of July. It cuts taxes for billionaires and the wealthiest people in the US, and is projected to create a $1.1 billion annual budget shortfall for the state, with an estimated 700,000 Medicaid beneficiaries losing coverage across the Mitten.

Local health officials warned that Medicaid cuts could overwhelm rural hospitals and disrupt care for seniors and low-income families. Despite these concerns, several Michigan Republicans, including Rep. John James, who represents parts of Macomb and Oakland counties, voted to support the tax bill.

Rep. James’s decision to support the bill, which he called a “huge win for Michigan and the entire country,” will result in thousands of his constituents losing access to health care through Medicaid, and soaring premiums, deductibles, and co-pays for other Michiganders who aren’t on Medicaid. 

Related: Trump’s tax bill passed—How many Michiganders will lose Medicaid benefits?

How many people will lose Medicaid benefits in parts of Macomb and Oakland counties?

In Michigan’s 10th Congressional District, which includes southern Macomb County and a portion of Oakland County, 181,400 residents are enrolled in Medicaid—nearly 24% of the district’s population. They’re from St. Clair Shores, Warren, Sterling Heights, Rochester Hills, Shelby Township, Utica, and other nearby towns.

Under Trump’s tax bill, which introduces strict work requirements and paperwork verification for Medicaid enrollees, many adults will be forced to prove they meet certain criteria every six months, putting low-income populations, like the working-class, seniors, people with disabilities, and those living in rural areas. 

The work requirements target people whose working hours fluctuate from week to week, whose school schedules change from term to term, or who are newly out of work. They’ll especially impact employees working for small businesses, and in hospitality, retail, or gig work. 

They’ll also seriously affect older adults—who are less likely to be employed consistently and face more difficulties finding new work due to age discrimination—and family caregivers.

Michigan has experience with this. In 2018, then-Gov. Rick Snyder, a Republican, signed similar restrictive requirements into law. The state spent over $30 million implementing them, and the requirements lasted around two months before a federal judge blocked them, ruling them unlawful. 

Experts have found that many people who will lose Medicaid as a result of these latest cuts will do so because of administrative burdens—not ineligibility. 

Related: Opinion: Dear John James, Medicaid is a lifeline. Please don’t let my family down. 

At least 20,000 enrollees in District 10 are at risk

In Rep. James’s district, at least 20,000 Medicaid enrollees are at risk of losing coverage altogether, resulting in an estimated 63 extra deaths per year, according to the Center for American Progress. 

Additionally, the “big beautiful bill” formally ends a variety of federal subsidies under the Affordable Care Act (ACA). As a result, Michiganders who get their health care through the federal marketplace—like the 59,800 ACA adult residents in District 10—are set to see their premiums increase by over $700 a year, according to estimates released by state officials. 

Michiganders have tried to hold Rep. James accountable for his decisions, but he has been dodging questions and town halls since his re-election in 2024. However, the Congressman will have to face his constituents sooner or later, especially as he plans to run for governor in 2026. 

Read more: 7 things to know about Republican US Rep. John James