By the Numbers: Harmful Republican Megabill Will Take Health Coverage Away From Millions of People and Raise Families’ Costs
The harmful Republican megabill, enacted on July 4, will take health coverage away from millions of people and dramatically raise health care costs for millions more. The so-called “Big Beautiful Bill” is anything but beautiful; it will cause widespread harm by making massive cuts to Medicaid, Affordable Care Act (ACA) marketplace coverage, and SNAP, which will raise costs on families and make it much harder for them to afford the high cost of groceries and health care.
The law cuts $1.1 trillion from Medicaid and ACA marketplaces, according to Congressional Budget Office (CBO) estimates. Major cuts include a provision that takes away Medicaid from people who are eligible for the ACA Medicaid expansion but can’t show that they meet a work requirement, other red tape that will block people from enrolling in health coverage they are eligible for, and provisions that take away health coverage, across all major programs, from most categories of immigrants living lawfully in the U.S.
Under the Republican health plan:
- Roughly 15 million people will lose health coverage and become uninsured by 2034 because of the Medicaid and ACA marketplace cuts in the Republican megabill, the law’s failure to extend enhanced premium tax credits for ACA marketplace coverage, and other harmful ACA marketplace rule changes, according to CBO estimates.
- CBO estimates that 10 million people will become uninsured due to Medicaid and ACA marketplace cuts in the law, including 7.5 million people who will lose Medicaid in 2034 (with interactions).
- An additional 4.2 million will lose marketplace coverage because the law failed to extend the premium tax credit enhancements, which lower annual premiums by more than $700, on average, for people who receive them.
Another 900,000 in losses come from earlier CBO estimates related to an ACA marketplace rule the Trump Administration has since finalized. (Updated estimates accounting for the final rule and its potential interactions with the law are not available at this time.)
When people lose their health coverage, they lose access to preventive and primary care, care for life-threatening conditions, and treatments for chronic conditions. For example, a person with diabetes who loses health coverage will lose the ability to properly manage their condition so they can maintain their health as well as their employment.
Medicaid
- According to CBO, the law will cut Medicaid by more than $900 billion, the largest cut in the program’s history.
- CBO estimates that 7.5 million people will lose Medicaid as a result of these cuts and become uninsured in 2034. (This estimate accounts for interactions among multiple policies in the bill.)
- CBO estimates that 5.3 million people will lose Medicaid and become uninsured in 2034 as a result of the provision that will take coverage away from people who don’t meet a harsh work requirement. Many analysts think the number could be higher.
- CBPP estimates that under the final legislation, between 9.9 million and 14.9 million people will be at risk of losing Medicaid coverage. If coverage losses mirror those experienced in Arkansas when it implemented similar requirements, some 7 million people will lose coverage.
- Two-thirds of people aged 19-64 receiving Medicaid in 2023 worked during the year, and many of those who didn’t work were taking care of a family member or had an illness or disability.
- This expansive work requirement will harm parents, people with disabilities, and those with other chronic illnesses because past experience shows that exemptions don’t work. Even people who are supposed to be protected — and those who are working — lose coverage when they get caught in bureaucratic red tape.
- The law will eliminate federal funding for Medicaid and the Children’s Health Insurance Program (CHIP) provided to most categories of immigrants living lawfully in the U.S. (People without documented immigration status are already ineligible for these programs.) Groups who will no longer be eligible for federally funded coverage include people granted humanitarian protections by the U.S., such as refugees, people granted asylum, and certain victims of domestic violence and sex or labor trafficking. CBO estimates that 100,000 people will become uninsured in 2034 as a result of the elimination of federal funding for Medicaid and CHIP for these groups.
- One provision in the law will take Medicaid coverage away from people, mostly seniors and those with disabilities, who also have Medicare due to provisions that make it harder to get and stay enrolled in Medicaid.
- CBO estimates that 700,000 people will lose Medicaid and become uninsured in 2034 due to new requirements that expansion enrollees re-prove their eligibility every six months (instead of annually). These requirements frequently end up pushing eligible people off Medicaid because they don’t receive or submit the necessary paperwork, or because the state fails to process the paperwork.
- Forcing states to implement the work requirement, along with all the other sludge this legislation adds to the enrollment process, puts all Medicaid enrollees at risk of having their coverage held up and their questions left unanswered because of the burden on state agencies.
- At the same time that states need to implement all these changes and will have more uninsured people, some states will lose federal funds due to new restrictions on how they finance their Medicaid programs, and all states will be limited in how they can finance their programs in the future. The law includes draconian limits on provider taxes for expansion states, which nearly all states use to help finance their Medicaid programs. CBO estimates that 1.2 million people will lose Medicaid and become uninsured in 2034 due to provider tax restrictions in the law.
- The law also significantly cuts the federal funding states receive for emergency services provided to individuals who would qualify for the Medicaid expansion if not for their immigration status, adding more costs onto states.
- The law will raise costs for many Medicaid expansion enrollees and will lead many of them to defer needed care. The legislation requires states to charge working people with incomes just above the poverty line — $16,000 year for an individual — new cost-sharing charges for many services when they go to the doctor.
- A new, five-year, $50 billion “Rural Health Transformation Fund” will offset some Medicaid funding losses in some states, but it will not come close to replacing the stable nationwide coverage or long-term federal funding that Republican megabill cuts.
ACA Marketplace Coverage
- About 22 million people, including 5 million small business owners and self-employed workers, will see their health coverage costs skyrocket or lose coverage altogether in 2026 because the law fails to extend the premium tax credit enhancements, which are critical to making health coverage in the ACA marketplace more affordable — even while extending huge tax cuts for millionaires.
- Without an extension of this vital credit, an estimated 4.2 million people will be uninsured in 2034 because costs would rise to an unaffordable level.
- Onerous marketplace changes that the law includes will make it harder for millions of working people to enroll in and afford health coverage. Burdensome verification requirements and red tape will make it harder for eligible people to maintain affordable marketplace coverage.
- The law will also take premium tax credits and Medicare away entirely from many immigrants who live and work in the U.S. lawfully. (People without a documented immigration status are already ineligible.) Groups who will no longer be eligible include people granted humanitarian protections by the U.S., such as refugees, people granted asylum, and certain victims of domestic violence and sex or labor trafficking. CBO estimates that provisions restricting premium tax credit and Medicare eligibility will leave 1.3 million people uninsured in 2034.