About 10 million more Americans will be uninsured over the next decade under provisions passed in the GOP megabill signed by President Donald Trump on July 4, according to estimates released by the Congressional Budget Office on Wednesday.
The One Big Beautiful Bill Act makes substantial changes to Medicaid and Obamacare marketplace insurance plans that some experts have called the largest changes since the Affordable Care Act of 2010.
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This would be an additional 10 million on top of the approximately 25 million people already uninsured in the United States as of 2023, according to the left-leaning healthcare think tank KFF.
CBO’s final estimates after the Senate’s passage of the bill are roughly 1 million less than the 11.8 million the agency predicted in its calculations based on the House version of the bill from early June.
The main reason for the difference between the initial estimate and Monday’s is the dropping of a provision that reduced federal matching funds for states providing state-only coverage to undocumented immigrants.
Niklas Kleinworth, policy analyst for the right-leaning Paragon Health Institute, told the Washington Examiner before the release of the CBO figures on Monday that the nonpartisan agency often “overshoots these coverage loss estimates.”
He also suggested that the felt effects of coverage losses will be significantly less than critics say, particularly because the law gives the Centers for Medicare and Medicaid Services the authority to remove benefit recipients enrolled in multiple states or simultaneously enrolled in Medicaid and an Obamacare plan.
CMS on Thursday announced that the agency had identified 2.8 million people either enrolled in two state Medicaid programs or enrolled in both Medicaid and an Obamacare plan, which amounts to $14 trillion in spending annually.
“I think that all of those things get backed into those coverage loss estimates,” said Kleinworth, adding, “I just don’t think that very many people are going to feel the coverage losses given how it actually breaks down.”
Coverage losses are also expected due to highly technical changes to the Obamacare insurance exchange program that will have significant effects for enrollees. These include shortening the open enrollment period, eliminating automatic enrollment, and eliminating self-attestation of income to continue to receive subsidies.
The CBO estimated Monday that benchmark premium rates, or those without subsidies, would decrease by 0.6% over the next 10 years, but this does not take into account the subsidies that are set to expire at the end of this year.
Millions of other patients are expected to drop their Obamacare exchange plans if premium tax credits are not renewed before the start of 2026. The expiration of premium tax credits is slated to drive up out-of-pocket premium payments on average by more than 75%, according to KFF.
The coverage losses from the expired premium subsidy were not accounted for in the CBO analysis, but higher premiums will likely have the most effect on those with the lowest subsidy rates who might lose their subsidies altogether. That demographic tends to be older, middle-income people who have retired but are not yet eligible for Medicare.
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Republicans have suggested that although premium tax subsidies were not addressed in the One Big Beautiful Bill Act, it is still possible to renew them by the end of the year, either in stand-alone legislation.
House Speaker Mike Johnson (R-LA) has also floated the idea of passing another reconciliation bill that circumvents the Senate filibuster by the end of the year, which could be an avenue by which to tackle premium subsidies.