What Could OBBB Mean for Families with Children in DC?: Monte Carlo Simulation 2025
Posted in Blog SDOH What's New
September 2025
By Simon Esserman-Rice
EXECUTIVE SUMMARY
Objective: Model the impacts of proposed OBBBA cuts to major social safety net programs — Medicaid, CHIP, and SNAP.
Approach: Simulated 1,000 families with diverse income levels and demographic profiles.
Method: For each family, calculated indicators of instability and burden using formulas that combined household data with stochastic elements.
Policy Scenario: Applied OBBBA cuts within the formulas and recalculated outcomes to estimate changes in family well-being.
1. SIMULATION WORLD
Sample population – representative of typical patients served by HCFI partner hospitals in DC (Department of Community Pediatrics):
1000 relatively low-income DC families:
- Lowest: $16,590, Low: $36,400, Medium: $54,696, High: $72,240
Single mother of 2 children
- Youngest child age 0-6 / 7-13 / 14-17
- Each individual has 0 / 1 / 2+ chronic conditions

Each individual has 1 health visit / year
- Population entirely reliant on Medicaid

Each family has chance of 1 financial surprise / year
- Covers possibility of non-medical surprises (popped tire, broken phone, etc.)

2. PREDICTED SNAP IMPACTS
Work requirement for parents of child age 14+ → $239 lost / month, down from $785
- Parents with inconsistent hours vulnerable
Any family of child age 14+ at risk of red tape → 28% rate (due to risk of not turning in paperwork)
3. PREDICTED CHIP IMPACTS
No explicit CHIP cuts put in motion for US citizens
However, more frequent parent renewals, paperwork burdens, and disenrollment processes for expansion parents
- Children may subsequently lose coverage → 10% rate
4. PREDICTED MEDICAID IMPACTS
Work requirement for parents of child age 14+ → parents cut off (8.3%)
Semi-annual renewals for ACA expansion enrollees → 36% cut off annually
- 37% regain benefits in 6 months
- 10% regain in 6 – 12 months
- 53% regain after 12 months
- ≈ 28% total chance Simulation expansion adult will be uninsured during their yearly health visit
$35 co-pay per health visits for expansion enrollee
- ≈ 25% less Medicaid utilization for expansion enrollees
5. SIMULATION: OUTCOMES DEFINED
Simulation process:
- Each run has 1000 families/observations, 5 total runs
- Results are the average of these 5 runs
Burden measurements
- Food burden → food cost exceeds 17% income
- Financial burden → cost of living exceeds income + benefits
- Healthcare burden → health cost exceeds 5-10% income
All compared to the $ saved by the government
- ≈ $1475 cut per Sim. Family
- Vast majority of cuts are in Medicaid (88%)

6. SIMULATION OUTCOMES: MEDICAID
17.7% more Simulation Families healthcare burdened
- 33.3% of lowest income group newly burdened, 28.4% of low
Lowest income (targeted by work req.) most impacted
- Some red tape, child admin. churn
Low income (targeted by semi-annual renewal, co-pay) similarly impacted
- More red tape, more child admin. churn
Oldest age group (14+) experienced largest increase in healthcare burden (+28%)
The lowest and low-income classes are vulnerable to loss, because they make up the majority of Medicaid eligible people before
- Had been fully protected from financial risk, 22.3% Medicaid eligible families now burdened




7. SIMULATION OUTCOMES: SNAP
Average recipient spent 1.51% more of income on food
- Mostly impacting the lowest income class, who are targeted by the SNAP work req.
Because they must pay more out of pocket for food, many families might newly only be able cover <50% of their Cost of Living
- 2.65% increase


8. POLICY IMPLICATIONS
OBBBA may introduce new financial risk factors / exacerbate existing ones:
- Age of youngest child is a new vulnerability (families with youngest child of 14+ experience disproportionate damage)
- Individuals with chronic conditions are extremely vulnerable to financial catastrophe if removed from Medicaid
- The most underprivileged groups are the most likely to have their benefits decreased, and if cut, they are the most likely to be unable to recover
If families are uninformed of how to comply with the changes, many more people will experience SNAP cuts / Medicaid loss despite continuing to qualify (semi-annual renewals + increased vulnerability of child administrative churn)
In light of this, providers serving SNAP/Medicaid recipients might be encouraged to:
- Advise expansion-adults about semi-annual renewals
- Note that their kids are also additionally vulnerable
- Remind parents of kids 14+ of 80hr/month work requirement
- Advise them on alternative ways to qualify (volunteering, school)
Note: This Monte Carlo Simulation was developed by Simon Esserman-Rice, a rising sophomore in Economics at the University of Chicago, under the guidance of Carol B. Davis, PhD, MBA, Assistant Research Professor & Associate Director of the Health Care Financing Initiative. For a narrative application of this model, see the blog post “What Do OBBB’s Medicaid Provisions Mean for Families with Children in DC?” available on this same webpage.