The nonpartisan Congressional Budget Office (CBO) estimates that about 10 million Americans will lose health insurance under President Donald Trump’s tax cut and spending law.
According to the CBO’s Aug. 11 analysis, changes in the law will cause 7.5 million people to lose Medicaid coverage over the next decade. Nondisabled adults on Medicaid must now work, volunteer, or enroll in school to keep their benefits, and states will need to conduct Medicaid eligibility checks twice a year instead of once.
The CBO also projects that 2.1 million people will lose Affordable Care Act coverage within the same period. An additional 400,000 will lose insurance due to the law — described as the “one big, beautiful bill” — which congressional Republicans supported.
The CBO previously reported that the legislation President Donald Trump signed on July 4 would add $3.4 trillion to the federal deficit. The law extends the 2017 tax cuts, eliminates taxes on tips and overtime pay, and increases funding for border security, among other provisions.
According to the CBO, lower-income Americans — those earning less than $23,750 a year and paying about $2,300 of that in federal taxes — will lose around $1,200 annually due to Medicaid changes and cuts to food assistance. Middle-income households are expected to gain between $800 and $1,200 a year. Wealthier Americans, earning more than $690,000 annually, will see an average tax benefit of about $13,600 a year, though they will still pay nearly $200,000 annually in federal taxes.
Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms, said the CBO report makes clear who gains and who loses under the legislation.
“This is one of the most regressive pieces of legislation I’ve seen,” Corlette said. “The rich will get richer and the poor will get poorer.”
Millions More Could Lose Their Health Insurance
When the bill passed the Senate, the CBO projected it would leave about 11.8 million Americans without health insurance by 2034. The version President Donald Trump signed will have a smaller impact because it dropped a provision that would have penalized states for extending Medicaid to undocumented residents.
However, nearly 5 million more people could lose coverage if Congress fails to renew the expiring COVID-19 pandemic-era tax credits that have made Affordable Care Act plans more affordable, earlier CBO estimates show.
According to KFF, a health policy nonprofit, consumers relying on those pandemic-era tax credits will face average payment increases of more than 75%.
The combined effects of the tax law, the expiration of tax credits, and rising medical costs will push insurance premiums higher for everyone. Insurers are planning a median premium increase of 18% for 2026 ACA plans — the largest price hike since 2018, according to a Peterson-KFF Health System Tracker report released on Aug. 6.
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