The Congressional Budget Office estimated on Wednesday that the House-passed Republican reconciliation package along with other federal policies expected to take effect would increase the number of uninsured people in the country by 16 million at the end of 10 years.
That’s combining the impact of the House’s “big, beautiful” bill with an expiration of health insurance subsidies and stricter eligibility requirements for the health marketplaces.
The updated estimate, calculated in response to an inquiry from Democrats, comes as Senate Republicans began conference-wide briefings Wednesday on how they plan to modify the $2.4 trillion House package.
Letting the premium tax credits expire and implementing a proposed Trump administration marketplace rule would lead to an additional 5.1 million uninsured in 2034, CBO said.
The reconciliation package would raise the uninsured population by another 10.9 million.
The agency sent the projections to Senate Finance ranking member Ron Wyden, D-Ore.; Energy and Commerce ranking member Frank Pallone Jr., D-N.J.; and Ways and Means ranking member Richard E. Neal, D-Mass.
Pallone lambasted the coverage loss in a statement.
“It’s shocking House Republicans rushed to vote on this bill without an accounting from CBO on the millions of people who will lose their health care or the trillions of dollars it would add to the national debt,” he said.
House Budget ranking member Brendan F. Boyle, D-Pa., called the estimated outcomes “profoundly immoral” and the “largest loss of health care coverage in U.S. history” in a statement Wednesday.
Currently, low-income individuals who do not qualify for Medicaid and get their insurance on the exchanges are eligible for premium tax credits. Since 2021, tax credit eligibility has been expanded to cover those earning 400 percent of the federal poverty level. These expanded credits are set to expire at the end of this year.
CBO estimated that letting those tax credits lapse would lead to 4.2 million uninsured, while implementing a proposal to tighten eligibility for marketplace coverage would result in 900,000 fewer people having coverage.
Most of the projected coverage losses, though, would come from implementing the reconciliation package the House passed.
The Energy and Commerce Committee’s Medicaid provisions would result in 7.8 million people losing coverage at the 10-year mark. Five provisions account for most of those projected losses: implementing work requirements, increasing eligibility check frequency, prohibiting coverage for undocumented immigrants, sunsetting a Biden-era Medicaid eligibility rule and limiting new or increased state provider taxes to subsidize Medicaid expansion expenses.
Provisions under Energy and Commerce jurisdiction related to the marketplaces would lead to 1.3 million more uninsured people.
The Ways and Means Committee’s health insurance provisions would contribute to 2.3 million individuals becoming uninsured in 2034. The estimates considered language that would limit premium tax credit eligibility for some immigrants and for those earning under 100 percent of the federal poverty level, as well as language that would tighten verification and enrollment periods related to the advanced premium tax credit.
But CBO also said that interactions between various provisions would reduce unemployment by 500,000 people.
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