House tax-and-spending bill and other Trump administration changes could make millions of people lose their health insurance coverage

President Donald Trump has promised not to cut Medicaid many times over the past decade, including in the tax-and-spending legislative package he has made a top priority in his second administration.
But several provisions in the bill, which the House of Representatives passed in a largely party-line 215-214 vote in May 2025, could cause millions of Americans enrolled in Medicaid to lose their health insurance coverage, according to the nonpartisan Congressional Budget Office. Medicaid is funded jointly by the federal government and the states. The program provides nearly 80 million Americans, most of whom are low-income or have disabilities, with health insurance.
The legislation, which advances Trump's agenda, faces a tough battle in the Senate despite the Republican Party majority in that chamber. Several GOP senators have either said they oppose it or have expressed strong reservations for a variety of reasons, including the trillions of dollars the package would add to the U.S. government's debt.
As a scholar who researches access to health care, I am concerned about the possibility that millions of people will lose their health insurance coverage should this bill become law. In many cases, that could occur due to new bureaucratic obstacles the bill would introduce.
About 25.3 million Americans lacked insurance in 2023, down sharply from 46.5 million in 2010. Most of this 46% decline occurred because of the Affordable Care Act of 2010.
The Congressional Budget Office, a nonpartisan agency that provides evidence-supported information to Congress, estimates that 10.9 million Americans would lose their health insurance by 2034 if the House of Representatives' version of that package were to become law.
Of these, as many as 7.8 million would lose access to Medicaid.
Another 2.1 million people who the CBO estimates would end up uninsured are Americans who today have coverage they bought in the marketplaces that the Affordable Care Act created.
In addition to the measures in the tax-and-spending bill, other changes are looming. These include the expiration of some ACA-related measures adopted in 2021 that Trump does not intend to renew, and new regulations. All told, the number of Americans losing their health insurance by 2034 could total 16 million, according to the CBO.
Other estimates suggest that the number of Americans losing their coverage could run even higher.
The House bill would reduce incentives the federal government provides states to expand their Medicaid programs as part of the ACA.
Eliminating these incentives would make it even less likely that Texas and the other nine states that still have not expanded Medicaid eligibility would do so in the future.
The bill would also make it harder for states to come up with their share of Medicaid funding by limiting 'provider taxes.' These taxes are charged to hospitals, doctors and other medical providers. The revenue they raise help pay for the state's share of Medicaid costs.
And the legislative package would also reduce federal funding to cover Medicaid costs in states that provide coverage to unauthorized immigrants using only their own funds. Threatened with billions in losses, the states that do this are unlikely to maintain these programs. In California alone, this would jeopardize the coverage of 1.6 million of its residents.
Losing Medicaid coverage may leave millions of low-income Americans without insurance coverage, with no affordable alternatives for health care.
Other proposed changes in the House bill would indirectly cut Medicaid coverage by forcing people to deal with more red tape to get or keep it.
This would happen primarily through the introduction of 'work requirements' for Medicaid coverage. When enrolled in the program, applicants who are between 19 and 64 years old would need to certify they are working at least 80 hours a month or spending that much time engaged in comparable activities, such as community service.
Work requirements specifically target people eligible for Medicaid through the Affordable Care Act's expansion of the program. They tend to have slightly higher incomes than the other people eligible for this benefit.
Arkansas gave Medicaid work requirements a try during the first Trump administration. Researchers who studied what happened found that 1 in 4 of the Arkansans enrolled in Medicaid affected by the policy lost their health insurance coverage. They also found that in most cases, this occurred because of bureaucratic obstacles, and that the policy didn't lead to more people getting jobs.
By some estimates, the work requirements provision alone would lead to close to 5 million people of the 7.8 million being denied Medicaid coverage.
At the same time, the bill would increase how often Medicaid beneficiaries have to reapply to the program to keep their coverage from once every 12 months to twice a year.
It also would delay or reverse several policies that made it easier for Americans to enroll in Medicaid and maintain their coverage. Many of those who aren't kicked out would also face either new or higher co-payments for appointments and procedures – restricting their access to health care, even if they don't wind up without insurance.
There is ample evidence that obstacles like these make it hard to remain enrolled in safety net programs. Historically, the people who are most likely to lose their benefits are low-income, people of color or immigrants who do not speak English well.
The bill would also affect the more than 24 million Americans who get health insurance through Affordable Care Act Marketplace plans.
Changes in the House version of the bill would make it harder to get this coverage. This includes reducing the time Americans have to enroll in plans and eliminating certain subsidies. It also makes the enrollment process more complicated.
Combined with other changes the Trump administration has made, experts expect Marketplace premiums to skyrocket.
The Congressional Budget Office expects more than 2 million beneficiaries to lose coverage due to these new policies.
Americans buying their own insurance on the ACA marketplaces may also face higher premiums.
Increased subsidies in place since 2021 are set to expire at the end of the year. Combined with Trump regulatory decisions, this may lead to more than 5 million Americans losing coverage – whether or not the GOP's tax-and-spending package is enacted.
The effects of the bill would also be compounded by further changes by individual states. This could include the introduction of monthly premiums that people with Medicaid coverage would have to pay, in Indiana and other states.
Some states may also reduce eligibility for certain groups or cover fewer services, as states seek to reduce their Medicaid costs.
And some states, including Iowa and Utah, are already pursuing work requirements on their own whether or not they become mandatory across the nation.
If fewer Americans have health insurance due to changes the Trump administration is making and the policies embedded in the pending tax-and-spending legislative package, the health of millions of people could get worse due to forgone care. And at the same time, their medical debts could grow larger.
This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Simon F. Haeder, Texas A&M University
Read more:
US health care is rife with high costs and deep inequities, and that's no accident – a public health historian explains how the system was shaped to serve profit and politicians
There's no evidence work requirements for Medicaid recipients will boost employment, but they are a key piece of Republican spending bill
Work requirements are better at blocking benefits for low-income people than they are at helping those folks find jobs
Dr. Simon F. Haeder has previously received funding from the Centers for Medicare and Medicaid Services, the Pennsylvania Insurance Department, and the Robert Wood Johnson Foundation for unrelated projects.

Try Our AI Features

Explore what Daily8 AI can do for you:

Learn with AIFact CheckingText to SpeechAI Summary

Related Articles

San Francisco Chronicle​

25 minutes ago

• San Francisco Chronicle​

S.F. ‘emergency protest' condemns ICE raids, U.S. support for Israel

Hundreds of people protested the prospect of a U.S. war with Iran and voiced support for immigrants in the U.S. and Palestinians in Gaza during a rally Friday evening outside the federal building in San Francisco's South of Market. The protest outside the Speaker Nancy Pelosi Federal Building, which drew about 200 people at its peak, was organized by a coalition of activist groups, including Bay Resistance, the Answer Coalition and the Bay Area chapter of the Council on American-Islamic Relations. The escalating tensions between Israel and Iran were a major focus of Friday's protest. President Trump said Thursday he will decide within two weeks whether the U.S. military will strike back at Tehran. Tensions initially soared last Friday with a surprise wave of Israeli airstrikes targeting Iran's nuclear and military sites, military leaders and nuclear scientists. 'As the U.S. escalates aggression on Iran — backing Israeli strikes and pushing for war — it exposes its imperialist playbook: defend Zionism, crush resistance. From Gaza to Tehran, the U.S. fuels war and genocide to maintain control,' organizers said in promoting the event, billed as an 'emergency protest.' The protest featured several speakers and closed the block around the federal building at Seventh and Mission streets, with many protesters chanting, 'Free, free Palestine.' Bay Area protests against Israel's war with Hamas have cooled in recent months, though activists have found new energy since Trump retook office in January. Last Saturday's No Kings Day protests drew tens of thousands of people to events in dozens of Bay Area cities decrying Immigration and Customs Enforcement raids nationwide. Weeks earlier, demonstrations against Tesla CEO Elon Musk drew huge crowds to the vehicle's showrooms across the Bay Area condemning the onetime Trump ally, whose relationship with the president has cooled in recent weeks. 'At home, the war continues through ICE raids, family separations, and repression of migrants — all part of the same violent system,' the organizers said. 'We reject this imperialist war machine and stand with all people resisting Zionism and U.S. domination.'

CNN

32 minutes ago

• CNN

Here's the latest look at US military assets in the Middle East amid Israel-Iran conflict

President Donald Trump says Iran has a "maximum" of two weeks for a diplomatic solution as he weighs whether or not to involve US military assets. CNN looks at where the fighting stands, and what shifting US military assets into the Middle East means for the conflict ahead.

Yahoo

37 minutes ago

• Yahoo

WSJ White House Reporter: How Trump Uses ‘Two Weeks' Deadline as a Tactic

President Trump said he will decide within 'two weeks' if the U.S. will get involved in the Israel-Iran conflict. WSJ's Alex Leary explains why the president resorts to the time-frame and how he uses it as a tactic. Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data