From CNBC: 2025-06-06 07:32:00

The House tax and spending bill would cut programs like Medicaid and the Affordable Care Act to fund priorities from President Donald Trump, including almost $4 trillion of tax cuts. The Congressional Budget Office projects about 11 million people would lose health coverage due to provisions in the House bill.

The legislation, known as the “One Big Beautiful Bill Act,” may change as Senate Republicans now consider it. Health care cuts have proven to be a thorny issue. The bill would add $2.4 trillion to the national debt over a decade, CBO estimates. The cuts are a sharp shift following incremental increases in the availability of health insurance.

Federal funding cuts to Medicaid will have broad implications, experts say. No population is safe from a bill that cuts more than $800 billion over 10 years from Medicaid. The provision in the House proposal that would lead most people to lose Medicaid and therefore become uninsured would be new work requirements that would apply to states that expanded Medicaid under the Affordable Care Act. House Speaker Mike Johnson, R-La., said “4.8 million people will not lose their Medicaid coverage unless they choose to do so,” while arguing the work requirements are not too cumbersome. The CBO estimates changes in Medicaid would lead to 4.8 million more uninsured. Exemptions could be missed due to underestimation. Medicaid will lose 10.3 million, resulting in 7.8 million without insurance. States may have to cut Medicaid coverage to balance their budgets due to reduced federal support.

The House proposal would create funding challenges for Medicaid. It would prevent states from using health care provider taxes as revenue for Medicaid. This would force states to either cut coverage or make cuts to other parts of their budget. Services like home and community-based care could face cuts.

More than 24 million people rely on ACA marketplaces for health insurance. The House legislation would significantly reduce ACA enrollment, impacting people who don’t have insurance through their jobs. Changes are technical but have significant consequences. The bill would have a combined effect on ACA enrollment.

ACA enrollment has doubled due to enhanced subsidies. The Inflation Reduction Act extended subsidies through 2025, lowering premiums by $705. The House Republican legislation doesn’t extend these subsidies post-2025, leading to 4.2 million uninsured people in 2034. Coverage will become more expensive for those who remain in a marketplace plan.

3 million people may lose ACA coverage due to House legislation provisions. Eligibility adjustments include a shortened open enrollment period and ending automatic re-enrollment. Administrative red tape will hinder households from receiving subsidies until eligibility details are verified. This may lead to a decline in coverage.

The House bill would eliminate repayment caps for premium subsidies. Households get subsidies based on estimated annual income, determining total premium tax credit. Eliminating caps would impact how households repay subsidies if their income changes. The House bill would require all premium tax credit recipients to repay any excess subsidies, regardless of income. This can be challenging for low-income individuals with unpredictable earnings. The bill also limits marketplace insurance eligibility for certain legal immigrants, including DACA recipients, starting in 2027.

Starting in 2027, some lawfully present immigrants, such as refugees and DACA recipients, may be ineligible for subsidized insurance on ACA exchanges. DACA recipients are currently eligible for coverage in 31 states and the District of Columbia. The bill would bar them from purchasing insurance on ACA exchanges in all states.

Read more: Health insurance coverage losses under House GOP tax, spending bill