In mid-2025, as President Donald Trump’s budget package, the One Big Beautiful Bill Act, progressed through Congress, Democrats claimed it would result in 13.7 million Americans losing health insurance.
However, a deeper analysis of the Congressional Budget Office (CBO) estimates reveals that the situation is more complex than initially portrayed.
According to a preliminary estimate by the CBO, approximately 13.7 million people could lose health insurance by 2034 due to a combination of various policy actions. This figure includes the impact of the GOP’s proposed bill, as well as other policy decisions, such as the expiration of an expanded tax credit program initiated by Democrats.
The GOP’s Impact:
The CBO’s May 11, 2025, letter, requested by Democratic lawmakers, specified that the One Big Beautiful Bill Act would directly result in 8.6 million people losing health insurance by 2034. This number includes:
7.7 million people losing coverage due to proposed changes to Medicaid.
900,000 beneficiaries losing coverage due to new eligibility requirements for health insurance under the Affordable Care Act (ACA).
Other Contributing Factors:
The remaining 5.1 million people at risk of losing health insurance coverage by 2034 are due to factors unrelated to the GOP’s bill. Specifically, 4.2 million people would lose coverage due to the expiration of the expanded premium tax credits, which were established by Democrats as part of COVID-19 relief legislation and are set to expire on January 1, 2026.
CBO’s Final Thoughts:
The CBO emphasized that its estimate is preliminary and does not account for potential interactions between these policy proposals. It suggested that the actual number of people losing health insurance could be higher once these interactions are considered.
Current Status of the Bill:
The One Big Beautiful Bill Act passed the House of Representatives on May 22, 2025, but has not yet become law. It must pass the Senate and be signed by President Trump to take effect. The bill is likely to undergo further changes during Senate debate.
Conclusion:
While it is true that millions of Americans could lose health insurance coverage due to various policy decisions, attributing the entire 13.7 million figure solely to the GOP’s bill is inaccurate. The CBO’s estimates highlight the need for a nuanced understanding of the multiple factors at play. As the legislative process continues, it remains crucial to consider the broader context and potential impacts of these policy changes on healthcare access.
