By the Numbers: Senate Republican Leadership’s Health Agenda Takes Health Coverage Away From Millions of People and Raises Families’ Costs | Center on Budget and Policy Priorities
How did your country report this? Share your view in the comments.
Diverging Reports Breakdown
Senate GOP Dumps Gasoline on ‘Five-Alarm Fire’ by Proposing Even Deeper Medicaid Cuts
Senate Republicans are considering a bill that would expand Medicaid. The bill would also cut back on the federal government’s role in funding the program. The House passed a similar bill earlier this year. The Senate bill is expected to be voted on in the next few weeks, if not sooner. The proposal would cut funding for the Medicaid program by up to $100 billion over the next 10 years. It would also make it harder for states to fund the program by cutting back on federal funding for other programs, such as food stamps and health insurance. The measure is likely to face fierce opposition in the House, which passed the bill with a vote of 54-45. It is expected that the Senate will vote on the bill in the coming weeks, possibly before the end of the year.
The legislative text unveiled by the GOP-controlled Senate Finance Committee is a central component of the sprawling reconciliation package that Republicans are hoping to send to President Donald Trump’s desk by next month.
The bill contains broader Medicaid work requirements than the House-passed legislation, expanding the ineffective and punitive mandates to low-income adults with children over the age of 14.
The Senate version would also sharply limit provider taxes that states use to fund their Medicaid programs. Edwin Park, a research professor at Georgetown University’s Center for Children and Families, warned the provision would “devastate” state finances, particularly where lawmakers have expanded Medicaid under the Affordable Care Act (ACA).
“This will create huge budget holes over time, some in as little as two years, forcing states to make severe, highly damaging cuts,” Park wrote in an analysis of the new legislation.
“Senate Republicans have made this cruel, heartless bill even worse as they continue on their endless pursuit to destroy our healthcare system.”
Senate Republicans released the bill text less than two weeks after the nonpartisan Congressional Budget Office estimated that the House-passed reconciliation package would strip healthcare from nearly 11 million Americans over the next decade—a number that rises to 16 million when accounting for the GOP’s refusal to renew ACA tax credits set to expire at the end of the year.
Even more people would lose healthcare if Republicans adopt the Senate plan, analysts and advocates warned. One recent study estimated that around 51,000 additional people across the U.S. would die unnecessarily each year due to large-scale health insurance losses caused by the GOP’s proposals.
“It shocks the conscience that Senate Republican leaders saw the impacts of the House bill—16 million more people uninsured and millions losing help buying groceries, including families with children—and chose to double down,” said Sharon Parrott, president of the Center on Budget and Policy Priorities.
Leslie Dach, chair of the advocacy group Protect Our Care, said in a statement that “this bill was already a five-alarm fire for American healthcare, and Senate Republicans have just poured gasoline on it.”
“Contrary to what they’ve repeatedly promised, Republicans are torching Medicaid, ripping apart the Affordable Care Act, and leaving 16 million people without the critical care they need, all so Trump and the GOP can funnel more money to their billionaire and corporate friends,” said Dach. “Seniors will be thrown out of nursing homes, people fighting cancer will be cut off from treatment, and rural hospitals will shutter. Senate Republicans have made this cruel, heartless bill even worse as they continue on their endless pursuit to destroy our healthcare system.”
If Senate Republicans adopt the proposed changes, the House would have to pass the reconciliation bill again before it can reach Trump’s desk. One House Republican, granted anonymity by Politico, said “hell no” in response to the Senate language pertaining to Medicaid provider taxes, a signal that the proposal is likely to face intraparty opposition.
But experts stressed that both the House and Senate versions of the reconciliation bill would be disastrous for low-income Americans and a boon for the rich.
“Now that we’ve seen Senate text, we can say for certain: Either the House or the Senate version would be the largest transfer from the poor to the rich in a single law in history,” wrote Bobby Kogan, senior director of federal budget policy at the Center for American Progress.
“Each would kick millions of people off their health insurance and each would rip food assistance away from millions of households,” Kogan noted. “Each would increase deficits by trillions of dollars while making the poorest Americans poorer and making the richest Americans richer.”
Why millions of Americans would lose health insurance under House GOP megabill
The House proposal would cut more than $800 billion over 10 years from Medicaid. The provision that would lead most people to lose Medicaid and therefore become uninsured would be new work requirements. The CBO has estimated the work requirements would cause 5.2 million adults to lose federal Medicaid coverage. Overall, 10.3 million people would lose Medicaid, which would lead to 7.8 million people losing health insurance, KFF’s Burns said. The House legislation would “dramatically” reduce ACA enrollment — and, therefore, the number of people with insurance — due to the combined effect of several changes rather than one big proposal, Drew Altman of KFF wrote. “Many of the changes are wonky, even if they are consequential,” Altman wrote, “but they add to coverage costs at an all-time high” The House bill would also delay until 2035 two Biden-era eligibility rules that were intended to make Medicaid enrollment and renewal easier for people, especially older adults and individuals with disabilities, according to the Center on Budget and Policy Priorities.
No population ‘safe’ from proposed Medicaid cuts
Speaker of the House Mike Johnson, R-La., pictured at a press conference after the House narrowly passed a bill forwarding President Donald Trump’s agenda on May 22 in Washington, DC. Kevin Dietsch | Getty Images
Federal funding cuts to Medicaid will have broad implications, experts said. “No population, frankly, is safe from a bill that cuts more than $800 billion over 10 years from Medicaid, because states will have to adjust,” said Allison Orris, senior fellow and director of Medicaid policy at the Center on Budget and Policy Priorities, a left-leaning think tank. The provision in the House proposal that would lead most people to lose Medicaid and therefore become uninsured would be new work requirements that would apply to states that expanded Medicaid under the Affordable Care Act, according to Orris. The work requirements would affect eligibility for individuals ages 19 to 64 who do not have a qualifying exemption. Affected individuals would need to demonstrate they worked or participated in qualifying activities for at least 80 hours per month. States would also need to verify that applicants meet requirements for one or more consecutive months prior to coverage, while also conducting redeterminations at least twice per year to ensure individuals who are already covered still comply with the requirements.
watch now
In a Sunday interview with NBC News’ “Meet the Press,” House Speaker Mike Johnson, R-La., said “4.8 million people will not lose their Medicaid coverage unless they choose to do so,” arguing the work requirements are not too “cumbersome.” The CBO has estimated the work requirements would cause 5.2 million adults to lose federal Medicaid coverage. While some of those may obtain coverage elsewhere, the CBO estimates the change would increase the number of people without insurance by 4.8 million. Those estimates may be understated because they do not include everyone who qualifies but fails to properly report their work hours or submit the appropriate paperwork if they qualify for an exemption, said KFF’s Burns. Overall, 10.3 million people would lose Medicaid, which would lead to 7.8 million people losing health insurance, Burns said.
Proposal creates state Medicaid funding challenges
Protect Our Care supporters display “Hands Off Medicaid” message in front of the White House ahead of President Trump’s address to Congress on March 4 in Washington, D.C. Paul Morigi | Getty Images Entertainment | Getty Images
While states have used health-care provider taxes to generate funding for Medicaid, the House proposal would put a stop to using those levies in the future, Orris said. Consequently, with less revenue and federal support, states will face the tough choice of having to cut coverage or cut other parts of their state budget in order to maintain their Medicaid program, Orris said. For example, home- and community-based services could face cuts to preserve funding for mandatory benefits such as inpatient and outpatient hospital care, she said. The House proposal would also delay until 2035 two Biden-era eligibility rules that were intended to make Medicaid enrollment and renewal easier for people, especially older adults and individuals with disabilities, Burns said. States would also have their federal matching rate for Medicaid expenditures reduced if they offer coverage to undocumented immigrants, she said.
Affordable Care Act cuts are ‘wonky’ but ‘consequential’
Senate Minority Leader Chuck Schumer, D-N.Y., speaks about the health care impacts of the Republican budget and policy bill, also known as the “One Big Beautiful Bill Act,” during a June 4 news conference in Washington, D.C. Saul Loeb | Afp | Getty Images
More than 24 million people have health insurance through the Affordable Care Act marketplaces. They’re a “critical” source of coverage for people who don’t have access to health insurance at their jobs, including for the self-employed, low-paid workers and older individuals who don’t yet qualify for Medicare, according to researchers at the Center on Budget and Policy Priorities, or CBPP. The House legislation would “dramatically” reduce ACA enrollment — and, therefore, the number of people with insurance — due to the combined effect of several changes rather than one big proposal, wrote Drew Altman, president and chief executive of KFF. “Many of the changes are technical and wonky, even if they are consequential,” Altman wrote.
Expiring ACA subsidies add to coverage costs
ACA enrollment is at an all-time high. Enrollment has more than doubled since 2020, which experts largely attribute to enhanced insurance subsidies offered by Democrats in the American Rescue Plan Act in 2021 and then extended through 2025 by the Inflation Reduction Act. Those subsidies, called “premium tax credits,” effectively reduce consumers’ monthly premiums. The credits can be claimed at tax time, or households can opt to get them upfront via lower premiums. Congress also expanded the eligibility pool for subsidies to more middle-income households, and reduced the maximum annual contribution households make toward premium payments, experts said.
watch now
The enhanced subsidies lowered households’ premiums in 2024 by $705, or 44%, to $888 a year, from $1,593, according to KFF. The House Republican legislation doesn’t extend the enhanced subsidies, meaning they would expire after this year. About 4.2 million people will be uninsured in 2034 if the expanded premium tax credit expires, according to the Congressional Budget Office. “They might just decide not to get [coverage] because they simply can’t afford to insure themselves,” said John Graves, a professor of health policy and medicine at Vanderbilt University School of Medicine. Coverage will become more expensive for others who remain in a marketplace plan: The typical family of four with income of $65,000 will pay $2,400 more per year without the enhanced premium tax credit, the CBPP estimated.
Adding red tape to eligibility, enrollment
More than 3 million people are expected to lose Affordable Care Act coverage as a result of other provisions in the House legislation, the CBO projected. Other “big” changes include broad adjustments to eligibility, said Kent Smetters, professor of business economics and public policy at the University of Pennsylvania’s Wharton School. For example, the bill shortens the annual open enrollment period by about a month, to Dec. 15, instead of Jan. 15, in most states. It ends automatic re-enrollment into health insurance — used by more than half of people who renewed coverage in 2025 — by requiring all enrollees to take action to continue their coverage each year, CBPP said.
Senate Majority Leader Sen. John Thune (R-SD) (C) speak alongside Sen. John Barrasso (R-WY) (L) and Sen. Mike Crapo (R-ID) (R) outside the White House on June 4, 2025. The Senators met with President Donald Trump to discuss Trump’s “One, Big, Beautiful Bill” and the issues some members within the Republican Senate have with the legislation and its cost. Anna Moneymaker | Getty Images News | Getty Images
The bill also bars households from receiving subsidies or cost-sharing reductions until after they verify eligibility details such as income, immigration status, health coverage status and place of residence, according to KFF. Graves says adding administrative red tape to health plans is akin to driving an apple cart down a bumpy road. “The bumpier you make the road, the more apples will fall off the cart,” he said.
Uncapping subsidy repayments
Another biggie: The bill would eliminate repayment caps for premium subsidies. Households that get federal subsidies must estimate their annual income for the year, which dictates their total premium tax credit. They must repay any excess subsidies during tax season, if their annual income was larger than their initial estimate. Current law caps repayment for many households, but the House bill would require all premium tax credit recipients to repay the full amount of any excess, no matter their income, according to KFF. While such a requirement sounds reasonable, KFF’s Altman said it’s unreasonable and perhaps even “cruel” in practice. “Income for low-income people can be volatile, and many Marketplace consumers are in hourly wage jobs, run their own businesses, or stitch together multiple jobs, which makes it challenging, if not impossible, for them to perfectly predict their income for the coming year,” he wrote.
Curtailing use by immigrants
The Senate Must Tear Up the Cruel House Budget and Start Again
The bill would drive up hunger and deepen poverty, including among children. It would take access to life-saving healthcare away from millions of people. In 2027, it gives households earning more than $1 million a year an average tax cut of roughly $90,000, while low-income households receive an average of just $90 from the tax cuts. There’s a better path forward, but it requires the Senate to tear up this legislation and start again, says Julian Zelizer, the author of a new book on the U.S. tax code, “The Taxpayer’s Dilemma,” which is published by Simon & Schuster at $16.99. The book is also published by Verso at $12.99, and is available from the publisher’s online store.
The bill will drive up hunger and deepen poverty, including among children, and take access to life-saving healthcare away from millions of people. The Senate must reject it.
Congressional Budget Office data and other analyses make the House Republican agenda’s harmful impacts crystal clear: about 15 million people losing health coverage; millions losing food assistance or having their food assistance cut, including 2 million or more children; the 10% of households with the lowest incomes made worse off while the richest get richer by tens or even hundreds of thousands of dollars each year; and trillions of dollars added to our debt over the decade, worsening our long-term fiscal picture and increasing the risk to our economy.
In 2027, it gives households earning more than $1 million a year an average tax cut of roughly $90,000, while low-income households receive an average of just $90 from the tax cuts.
The bill’s SNAP provisions are so extreme that some states, faced with backfilling deep federal funding cuts that total billions of dollars a year nationally, could take steps to dramatically take food assistance away from large numbers of people and could even decide to end their SNAP programs entirely. Simply put, House Republicans are walking away from a 50-year, bipartisan commitment to ensure that children in families with low incomes get the help they need, no matter what state they live in—with potentially devastating impacts on their health, education, and future success.
The extreme health provisions would lead to an unprecedented drop in health coverage and drive up health costs for millions. Make no mistake—the main way the bill cuts more than $800 billion from healthcare is by taking away Medicaid and affordable marketplace coverage from people who are eligible.
The bill also makes higher education more expensive for millions by driving up the cost of student loans and reducing the level of Pell education grants for college students.
The bill directs some of its harshest cuts toward people who are immigrants and their families. House Republicans falsely claim that they are restricting access to basic needs programs for people who don’t have a documented status. But the reality is that people without a documented immigration status already do not qualify for these benefits. The cuts in federal benefits will fall entirely on immigrants in the country lawfully—including some pregnant women and children who need food assistance. Refugees, people granted asylum, and victims of trafficking—people who have had to prove that they face persecution in their home countries or have been victimized by sex or labor traffickers—are among those who would see their food assistance, Medicare benefits they paid into, and affordable health marketplace coverage terminated. And the bill will also take away the Child Tax Credit from millions of U.S. citizen children in immigrant families.
The House Republican bill showers more tax cuts on the wealthy, extending the highly skewed provisions of the 2017 tax law and adding permanent expansions for wealthy households, while leaving millions of children in working families with low incomes out of even the temporary increase in the Child Tax Credit. In 2027, it gives households earning more than $1 million a year an average tax cut of roughly $90,000, while low-income households receive an average of just $90 from the tax cuts—even while these households bear the brunt of cuts to Medicaid and SNAP and face higher prices due to the president’s tariffs, which the bill does nothing to address.
There’s a better path forward, but it requires the Senate to tear up this legislation and start again, rejecting any proposals that raise costs on families, take health coverage and food assistance away from families who need them, or drive up poverty and the number of people who are uninsured.