A sweeping tax and spending cuts package signed into law by President Donald Trump on July 4 is projected to result in 10 million additional uninsured Americans by 2034, according to an estimate released Monday by the Congressional Budget Office (CBO).
The updated forecast reflects last-minute changes to the Senate bill that reduced the initial projection of 11.8 million more uninsured individuals over the next decade. The final Senate version of the legislation became law.
Medicaid Provision Changes Reduce Estimated Coverage Loss
Shortly before passing its version of the bill, the Senate removed a provision that would have cut federal Medicaid funding for states providing undocumented residents and others with coverage similar to Medicaid using state funds. The previous CBO estimate included about 1.4 million people covered through such state programs.
The CBO also projects that 5.1 million more people will become uninsured by 2034 due to the expiration of enhanced Affordable Care Act (ACA) premium subsidies set to end at the close of this year, alongside a Centers for Medicare and Medicaid Services (CMS) rule affecting Obamacare enrollment and eligibility. While the rule has since been finalized with changes, the CBO has yet to update its estimates to reflect those adjustments.
Medicaid Changes Drive Most of the Coverage Loss
Though the recent CBO release does not break down the impacts of specific provisions in the new law, previous analysis of the House-passed version provides insight. Medicaid changes are expected to account for the largest share of coverage losses — around 7.8 million additional uninsured by 2034.
Notably, 4.8 million of those are expected to lose coverage due to newly added work requirements for many low-income adults who gained Medicaid under the expansion. The final law extends these work, volunteer, education, or job training requirements for at least 80 hours per month to parents of children aged 14 and older, a stricter standard than the House version which exempted parents of dependent children.
Other Medicaid-related changes contributing to coverage losses include more frequent eligibility reviews for Medicaid expansion enrollees, delays in implementing two Biden-era enrollment and eligibility rules, and restrictions on states imposing new or higher taxes on healthcare providers. The final law also lowers the cap on provider taxes in expansion states.
The CBO reaffirmed its earlier forecast that the legislation will increase the federal deficit by $3.4 trillion over the next decade compared with current law. Under the status quo, the individual income tax provisions of the 2017 tax cuts were scheduled to expire by the end of this year.
What The Author Thinks
This legislation demonstrates how budget savings often come at a steep human price. Increasing the number of uninsured by millions undermines the very fabric of public health and social stability. While fiscal responsibility is important, policymakers must consider the broader societal costs of reduced healthcare access. Cutting Medicaid and rolling back ACA subsidies risks driving vulnerable populations into financial hardship and poorer health outcomes — a cost that cannot be measured solely in dollars.
Featured image credit: Trump White House Archived via Flickr
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