About 17 Million More People Could be Uninsured due to the Big Beautiful Bill and other Policy Changes

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The reconciliation package currently making its way through Congress would make significant cuts to federal funding for Medicaid and the Affordable Care Act. According to the Congressional Budget Office (CBO), an additional 11.8 million people could be uninsured in 2034 if the version introduced by the Senate is passed. (This is a fast-moving piece of legislation and additional changes could be made, though the reconciliation bill is likely to be put up for a vote before another CBO score can be completed).

The bill’s cuts to Medicaid and the ACA come at the same time other changes are being made to the Affordable Care Act. The Trump administration recently finalized a rule that would result in more people becoming uninsured. And later this year, enhanced premium tax credits are set to expire, leaving even more people uninsured. The CBO previously estimated that these two changes would result in another 5.1 million more people being uninsured on top of the drops in health coverage from the Big Beautiful Bill. 

Based on what we know from previous estimates, most of the drops in health insurance coverage resulting from the Senate version of the bill would come from Medicaid cuts, with the remaining coming from changes to the ACA Marketplaces. However, when considering other changes to the ACA Marketplaces (that are not in the bill), millions more people are expected to lose health insurance coverage.

In total, due to the One Big Beautiful Bill Act and other policy changes, the number of people without health insurance is expected to increase by about 17 million. If all of this comes to pass, it would represent the biggest roll back of health insurance coverage ever due to federal policy changes.