A sweeping Republican tax and healthcare overhaul, President Donald Trump’s “One Big Beautiful Bill,” would result in 10.9 million more Americans becoming uninsured by 2034, according to a report published June 4 by the Congressional Budget Office.
The legislation, passed by the House on May 22 and now under Senate consideration, proposes major changes to Medicaid and the ACA that the CBO says would dramatically reduce health coverage. Combined with other scheduled policy changes, total coverage losses are projected to reach 16 million by 2034.
The 1,116-page bill also includes Medicare funding cuts, restrictions on federal loans for medical students and a permanent inflation-based formula for Medicare physician payment updates — drawing growing concern from hospitals, physician groups and other healthcare stakeholders.
Seven things to know:
1. The bill would leave 10.9 million more Americans uninsured by 2034. Of those 10.9 million, 7.8 million would lose coverage as a result of Medicaid changes, including work requirements and redetermination frequency and 2.3 million would be uninsured due to changes in ACA marketplace eligibility.
2. The expiration of expanded premium tax credits under current law in 2025 would result in 4.2 million more uninsured, according to the CBO. A proposed HHS rule narrowing marketplace access would contribute to 900,000 more uninsured.
3. Gross benchmark premiums for ACA marketplace plans would fall by an average of 12.2%, but largely due to reduced enrollment and benefit adjustments, not broader affordability, according to the report.
4. Work requirements (80 hours per month) would lead to 4.8 million adults losing Medicaid coverage, according to the report. Tighter redeterminations every six months — instead of annually — would result in 700,000 disenrollments.
5. State-funded coverage for undocumented immigrants would be curtailed, adding 1.4 million uninsured.
6. Limits on provider taxes, a financing mechanism for state Medicaid programs, could prompt enrollment restrictions, adding 400,000 uninsured, according to the CBO.
7. The bill, now in the Senate, faces further debate among lawmakers and increasing scrutiny from hospital leaders and other stakeholders. Revisions are likely as Republican lawmakers work to unify support and advance the legislation to President Trump’s desk before July 4.
