Abstract
Introduction The ‘One Big Beautiful Bill’ is framed by its proponents as the largest middle-class tax cut in U.S. history and a catalyst for economic growth. Yet, beneath the marketing of ‘jobs, tax cuts, and American prosperity’, the legislation conceals sweeping rollbacks of Medicaid, food assistance, education, reproductive care, and expanded immigration enforcement, alongside tax windfalls for venture capital and immigration enforcement.Theory Drawing on David Harvey’s concept of accumulation by dispossession, we argue that the bill advances upward redistribution under the guise of tax relief, at the expense of public health.Method We synthesize statutory provisions with congressional budget projections, policy organizations’ analyses, and peer-reviewed research on comparable policies to assess plausible impacts on economic security and population health.Results The bill threatens to unravel decades of incremental gains in health equity by shifting resources away from public goods and toward private markets. The resulting toll, in preventable deaths, untreated illnesses, food insecurity, and exacerbating wealth inequality, could be staggering.Discussion We contend that public health scholars must actively resist these harms, by championing a more just distribution of shared resources and treating such legislation as a threat to population health, subject to the same rigorous scrutiny as any grave epidemiologic exposure.