10 million more people will be uninsured because of Trump's mega-package, CBO forecasts

CNN

21-07-2025

The sweeping tax and spending cuts package that President Donald Trump signed into law on July 4 is expected to leave 10 million more people without health insurance in 2034, according to a Congressional Budget Office estimate released Monday.
The projection reflects last-minute alterations to the Senate legislation that changed the CBO's prior forecast that 11.8 million more people would be uninsured in a decade. (The Senate version of the 'big, beautiful bill' ultimately became the law.)
Just before it approved its version of the bill, the Senate yanked a provision that would have reduced federal Medicaid support for states that use their own funds to provide undocumented residents and others with health insurance similar to Medicaid. The CBO's prior coverage loss estimate included 1.4 million people in such state programs.
Separately, the CBO has projected that an additional 5.1 million more people would be uninsured in 2034 due to the expiration of the enhanced Affordable Care Act premium subsidies that are set to lapse at year's end, as well as a rule proposed by the Centers on Medicare and Medicaid Services governing Obamacare enrollment and eligibility. (The rule has since been changed and finalized, but CBO has yet to update that part of its estimate.)
Although the CBO's latest estimate did not break down the impact of different provisions in the law, it previously provided details of the House-passed version, which has some differences.
The Medicaid provisions are expected to drive the most loss in coverage by far. Some 7.8 million more people would be uninsured in 2034 due to the changes, with 4.8 million of them being affected by the addition of work requirements for many low-income adult enrollees who gained coverage under Medicaid expansion, according to the CBO's review of the House bill.
(The final law extends the requirement to work, volunteer, enroll in classes or attend job training for at least 80 hours a month to parents of children ages 14 and older. The House bill exempted parents of dependent children.)
Other Medicaid provisions that are expected to result in coverage loss include requiring more frequent eligibility reviews of Medicaid expansion enrollees, delaying implementation of two Biden administration enrollment and eligibility rules, and barring states from levying new or increased taxes on health care providers, according to the CBO's review of the House bill. (The final law also reduces the cap on provider taxes in expansion states.)
The CBO estimate released Monday reaffirmed its earlier forecast that the mega-package is expected to increase the deficit by $3.4 trillion over the next decade when compared with current law, under which the individual income tax provisions of the 2017 tax cuts law would have expired at year's end.