President Donald Trump promised to lower health insurance premiums, but residents of one deeply Republican state are now confronting higher costs under his signature economic law, the One Big Beautiful Bill.

"A new round of Medicaid changes tied to the 'One Big Beautiful Bill' went into effect Oct. 1, impacting around 1,000 people in Nebraska, including refugees and asylum-seekers, according to the state Department of Health and Human Services," reported Darsha Dodge of News Channel (KOLN) on Thursday. Medicaid, the public health insurance program for Americans with low incomes, is funded and administered jointly by the federal government and the states — which is why the impact figures come from a state agency.

Dodge quoted Kelsey Arends, a senior staff attorney for health care access at Nebraska Appleseed, who warned that the changes would raise costs across the entire health care system.

"That means higher insurance costs for all of us, higher costs at the hospital, at the doctor, longer wait times in the emergency room for everyone because folks aren't able to access the preventive care they need," Arends told the Nebraska outlet.

She added that once their insurance disappears, people will be forced to choose between health care and other essentials, such as food and rent.

"When your neighbor doesn't have access to health care, when your neighbor is forced to choose between paying for food and going to the doctor, paying for rent, it destabilizes our communities as a whole," Arends told Dodge.

The changes come despite an ongoing health insurance affordability crisis in the United States. Texas Attorney General and U.S. Senate nominee Ken Paxton has argued for cutting spending on programs such as Medicaid and Medicare while supporting further tax cuts for the wealthy. Medicaid and Medicare are entitlement programs that fall under mandatory spending — outlays required by existing law rather than set through the annual congressional appropriations process.

"There's no doubt we have to cut some of the mandatory spending," Paxton said in a secret recording that was leaked on Thursday. He added, "Making some reasonable cuts to mandatory spending — you're gonna have to do it. Or there is no solution. That's just the reality. We have to suck it up."

The coverage squeeze is also playing out in the private insurance market, particularly in Medicare Advantage (MA), the privately administered plans offered as an alternative to traditional Medicare. In September, Axios reported that UnitedHealthcare "has dropped around 13 percent of plans offered across 18 states." Healthcare Dive reported that the company "expects to end 2026 with up to 1.1 million fewer MA members than it had last year."

"UnitedHealthcare — the largest MA insurer in the US — offered plans in one fewer state and 109 fewer counties this year, cut allowances for certain over-the-counter health and wellness items, and prioritized plan designs with more limited provider networks," Axios reported, basing its article on a study by Healthcare Dive. "The company also shifted commissions to brokers to incentivize enrollment in more profitable plans."

Whether through a public program or a private plan, the pattern these reports describe runs in the same direction: fewer ways to get covered, and more places where the cost of that gap — in emergency rooms, household budgets, and communities — ultimately shows up.