There’s some understandable confusion over just how many Americans would lose their health care coverage under the Republicans’ domestic policy mega bill — the inaptly named “One Big Beautiful Bill Act.” For example, Russell Vought, the far-right director of the White House Office of Management and Budget, told CNN last week that “no one will lose coverage as a result of this bill.”
That might’ve sounded encouraging to health care advocates, but there’s overwhelming evidence to the contrary. A report from The Associated Press, for example, on the latest Congressional Budget Office score, said that 10.9 million Americans would lose their coverage if the GOP legislation became law. Democratic Sen. Elizabeth Warren of Massachusetts, however, said “nearly 14 million” would join the ranks of the uninsured.
Meanwhile, a variety of prominent Democrats, including House Minority Leader Hakeem Jeffries, have said the actual number would be 16 million.
So, which is it? I reached out to the nice folks at the Center on Budget and Policy Priorities to help sort this out, and they referred me to the CBPP’s helpful breakdown of the data.
Roughly 16 million people by 2034 would lose health coverage and become uninsured because of the Medicaid cuts, the bill’s failure to extend enhanced premium tax credits for ACA marketplace coverage, and other harmful ACA marketplace changes, according to estimates from the Congressional Budget Office (CBO).
This gets a little wonky, but according to the CBO’s nonpartisan analysis, the Republicans’ Medicaid cuts alone, if implemented, would strip coverage from 7.8 million people. The same analysis added, however, that 4 million people would become uninsured due to cuts to Affordable Care Act marketplaces, and an additional 4.2 million people would lose their coverage because the Republicans’ package fails to extend the Biden-era subsidies (the premium tax credit enhancements) that made ACA plans far more affordable.
And that is where the overall tally comes from: 7.8 million + 4 million + 4.2 million = 16 million.
When Trump and his party tried to “repeal and replace” the ACA eight years ago, the CBO determined that the Republicans’ plan would take health coverage from 23 million people, which was enough to cause a couple of Senate Republicans — Maine’s Susan Collins and Alaska’s Lisa Murkowski — to balk. (The late Sen. John McCain also gave the bill a thumbs-down, objecting to the party’s rushed and incoherent process.)
Eight years later, there’s a reason the new Republican plan is being derided as “Obamacare-repeal lite”: Scrapping coverage from 16 million is certainly within shouting distance of ending coverage for 23 million, especially given the fact that the GOP’s reconciliation package isn’t exclusively a health care bill.
To date, no Congress has ever approved legislation that would force so many people to lose their health security. Watch this space.
