An updated Congressional Budget Office analysis of Republicans’ reconciliation bill finds that the number of people without health insurance would increase by about 10 million people by 2034 because of the legislation.
The One Big Beautiful Bill Act — the bill’s formal name — would result in 7.6 million fewer people receiving care through Medicaid in 2034 relative to the baseline, CBO said. Another 3.1 million would be uninsured through changes made to the federal health care exchanges operated under the Affordable Care Act.
The reduction in coverage in the Medicaid program would result from changes in the law written by the Energy and Commerce Committee, while the losses in ACA coverage would be produced by changes written by both the Energy and Commerce and the Ways and Means Committees. As KFF’s Larry Levitt notes, the total of all projected coverage losses is a bit unclear, since CBO has not reviewed the interaction between reductions driven by the two committees among those who would otherwise be covered under the ACA.
The loss in coverage includes an estimated 1.4 million people who would be unable to document their citizenship status or satisfactory immigration status, CBO said.
With respect to savings, the Energy and Commerce Committee is estimated to reduce spending by about $900 billion between 2025 and 2024 relative to the baseline, with much of the savings resulting from changes in the Medicaid program. New work requirements in Medicaid are projected to save about $280 billion, though that estimate will likely increase if Republicans make those requirements take effect in 2027 rather than 2029, as expected.
CBO has yet to deliver an overall cost estimate for the GOP plan.