The non-partisan office that scores the cost of legislation on Capitol Hill warned that more than 10.9 million people could lose their health coverage if President Donald Trump’s proposed “One Big, Beautiful Bill” act passes.
The Congressional Budget Office, the non-partisan office that evaluates the effects of bills being debated, released its comprehensive report on the overall impacts of the legislation, which the House of Representatives passed late last month.
The audit found that under the bill, 10.9 million people in the U.S. would lose their health insurance. Of that number, 7.8 million people would lose their Medicaid coverage.
Under the original legislation, Republicans required that states would have to determine whether someone is eligible for Medicaid every six months and that able-bodied adults without dependent children would have to work, participate in a community service or in an education program for a minimum of 80 hours per month.
But conservatives in the House Freedom Caucus objected to the fact that work requirements would not go into place until 2029. In a closed-door agreement, Republican leadership changed the bill so that the work requirements would go into place in late 2026.
Republican House Speaker Mike Johnson has said that nobody would be affected by losing their health care except for able-bodied men playing video games, and immigrants who came to the country illegally.
But the legislation said that only 1.4 million undocumented immigrants would lose their coverage.
In addition, the legislation would also slash the number of people who receive their coverage under the Affordable Care Act — also known as Obama Care for the law that former president Barack Obama signed in 2010 — by 1.3 million.
Republicans have pushed back on scoring from the CBO, saying in the past, the office has underestimated the net positive impacts of the 2017 Tax Cuts and Jobs Act, the tax legislation that Trump signed in his first term.
The changes in health care come as House Republicans tried to slash spending to pay for an extension of the tax cuts that expire at the end of the year. In addition, Republicans plan to increase spending to enforce immigration at the U.S.-Mexico border, oil drilling and the U.S. military.
But the CBO warned that the legislation would explode the debt. The analysis found that the bill would reduce tax revenue by about $3.7 trillion over the next 10 years. It would also increase the debt by $2.4 trillion between 2025 and 2034.
The Senate is now debating how much to change the legislation.
With only 53 seats, Republicans plan to pass the bill through a process called reconciliation, which would allow them to sidestep a filibuster from Democrats as long as the legislation relates to the budget. Republicans can afford to lose only three senators, which allow for Vice President JD Vance to break a tie.
But the legislation hit a snag after former Trump adviser and Tesla CEO Elon Musk slammed the bill on X, the social media platform he purchased in 2022, calling the ‘massive, outrageous, pork-filled Congressional spending bill’ a “digusting abomination.”
Johnson for his part pushed back on Musk’s words during his weekly press conference on Wednesday.
“I called Elon last night, he didn't answer,” he told reporters. “I’m not upset about this. I think he understands, and he's acknowledged to me before that this is so serious that we can't fool around with it.”
Democrats for their part have sought to make hay out of the cuts to Medicaid in their messaging ahead of the 2026 midterm elections, hoping that it can help them win back the House of Representatives. But Johnson said it would not hurt Republicans.
“But am I concerned about the effect of this on the midterms? I'm not,” he said. “ Let me tell you why, because when the big, beautiful bill is done and signed into law, every single American is going to do better.”
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