The House has passed a reconciliation bill that would take health coverage away from millions of people and dramatically raise health care costs for millions more. Here are some of the impacts:

• Roughly 15 million people by 2034 would lose health coverage and become uninsured because of the Medicaid cuts, the bill’s failure to extend enhanced premium tax credits for Affordable Care Act (ACA) marketplace coverage, and other harmful ACA marketplace changes, according to estimates from the Congressional Budget Office (CBO). This figure could well rise to account for last-minute changes in the House that made the bill harsher.
   
  • CBO estimates project that 7.6 million people would become uninsured due to Medicaid policies passed by the Energy and Commerce Committee (E&C).
  • 1.8 million people would become uninsured due to codification of the Trump Administration marketplace rule provisions, which the E&C Committee also passed.
  • 2.1 million people would become uninsured because of marketplace policies passed by the Ways and Means Committee.
  • An additional 4.2 million people would lose marketplace coverage because the legislation fails to extend the premium tax credit enhancements.
• When people lose their health coverage, they lose access to preventive and primary care, care for life-threatening conditions, and treatments for chronic conditions. For example, a person with diabetes who loses health coverage would lose the ability to properly manage their condition so they can maintain their health as well as their employment.

• According to CBO, an earlier version of the bill would cut Medicaid by at least $716 billion, the largest cut in the program’s history.
• Between 9.7 million and 14.4 million people in the expansion population would be at risk of losing Medicaid under a provision that takes coverage away from people who don’t meet a harsh work requirement.
   
  • Estimates of how many of those at risk will lose coverage vary. We estimate that if coverage losses mirror those experienced in Arkansas when it implemented similar requirements, some 7 million people would lose coverage.
  • Two-thirds of people aged 19-64 receiving Medicaid in 2023 worked during the year, and many of those who didn’t were taking care of a family member or had an illness or disability.
  • This expansive work requirement will harm parents, people with disabilities, and those with other chronic illnesses because past experience shows that exemptions don’t work. Even people who are supposed to be protected — and those who are working — lose coverage when they get caught in bureaucratic red tape.
• One provision would take Medicaid coverage away from people, mostly seniors and those with disabilities who also have Medicare, due to provisions that make it harder to get and stay enrolled in Medicaid.
• Some people would also lose coverage due to new requirements that expansion enrollees re-prove their eligibility every six months (instead of annually). These requirements frequently end up pushing eligible people off Medicaid because they don’t receive or submit the necessary paperwork, or because the state fails to process the paperwork.
• Forcing states to implement the work requirement, along with all the other sludge this bill adds to the enrollment process, puts all Medicaid enrollees at risk of having their coverage held up and their questions left unanswered because of the burden on state agencies.
• At the same time that states need to implement all these changes and will have more uninsured people, some states would lose federal funds due to new restrictions on how they finance their Medicaid programs, and all states would be limited in how they can finance their programs in the future.
• The bill would require 38 states (plus the District of Columbia) that have adopted the ACA’s Medicaid expansion to low-income adults to modify their immigration-related eligibility requirements for health coverage or face severe penalties. These states would see their share of costs for covering the Medicaid expansion group double if they provide comprehensive health coverage to people who are not U.S. citizens or do not have the very narrow “qualified alien” statuses. This would put enormous pressure on these states to reduce or terminate comprehensive coverage programs now in place for people granted humanitarian parole for at least one year and for people who have given birth in the prior six months, as well as programs in 16 states and D.C. that are solely state funded and cover people who do not meet the extremely narrow eligibility requirements for Medicaid.
• The legislation would also raise costs for Medicaid expansion enrollees and will lead many of them to defer needed care. The bill requires states to charge working people with incomes just above the poverty line — $16,000 year for an individual — new cost-sharing charges when they go to the doctor.

• About 22 million people, including 3 million small business owners and self-employed workers, will see their health coverage costs skyrocket or lose coverage altogether in 2026 because, so far, the House bill does not extend the premium tax credit enhancements — even while extending huge tax cuts for millionaires — which are critical to making health coverage in the ACA marketplace more affordable.
   
  • Without an extension of this vital credit, an estimated 4.2 million people will be uninsured in 2034 because costs would rise to an unaffordable level.
  • Onerous marketplace changes in the House bill will make it harder for millions of working people to enroll in affordable health coverage.
• The legislation also would take premium tax credits and Medicare away entirely from many immigrants who live and work in the U.S. lawfully. (People without a documented status are already ineligible.)
   
  • Those who would be affected include people with immigration statuses designed to help people in humanitarian need, like those granted refugee or asylee status and victims of trafficking or domestic violence.