As Republicans push forward with their budget, it has become increasingly clear that their only goal is to rip health care away from millions of Americans in order to fund tax breaks for the wealthy and large corporations. And Republicans aren’t just gutting Medicaid to pass their billionaire tax breaks – They’re taking an axe to the Affordable Care Act and the health care that millions purchase on their own through ACA marketplaces. This Republican budget includes new rules designed to make it nearly impossible for middle-class families to access affordable coverage through the ACA. And when coupled with their plan to eliminate premium tax credits and slash nearly $700 billion from the ACA, Republicans will drive up costs and rip coverage away from millions of Americans.
Beyond their cuts to Medicaid, Republicans have included in this bill more than 30 provisions that raise premiums, limit eligibility, and heap red tape and bureaucracy on working Americans trying to access health care. These “savings” Republicans are using to fund tax breaks for the wealthy will come from increasing taxes, blocking eligible people from getting coverage, and forcing everyday Americans to pay more for health care. With this bill, Republicans will finally deliver on their long-standing goal of dismantling the ACA, ripping health care from millions of Americans in the process.
It’s Not Just Medicaid: This Republican Bill Quietly Dismantles the ACA:
KFF: The Spotlight Is on Medicaid Cuts, But the ACA Marketplaces Could See a One-Third Cut in Enrollment.
- “[T]he expiration of the enhanced ACA tax credits… will reduce Marketplace enrollment by 4.4 million, according to Trump Administration estimates. Then add provisions from the House reconciliation bill, which will adopt Trump administration regulations, reducing enrollment by another 2.2 million, according to CBO… Add all that up and it’s easy to see why many Marketplaces believe they are facing a one-third drop in enrollment (about 8 million of the 24 million currently covered, if extrapolated nationally), once all these changes would be in place.”
Center on Budget and Policy Priorities: House Republicans’ Shockingly Harmful Agenda Is Now Crystal Clear – the Country Deserves Better
- “At least 13.7 million people would lose health coverage and become uninsured under the House Republicans’ Medicaid and Affordable Care Act marketplace agenda that deeply cuts Medicaid, erects new barriers to coverage, and allows the enhanced premium tax credits (PTCs) that help low- and middle-income families and small business owners afford health coverage to expire, the Congressional Budget Office (CBO) estimates.”
CHIRBlog: Death by Slow Strangulation: New Tactics in Longstanding Efforts to Repeal the Affordable Care Act.
- “The massive reconciliation bill pending before Congress includes numerous provisions that will lead to millions losing ACA insurance coverage, and increased paperwork and higher costs for those who try to remain insured… The Congressional Budget Office (CBO) has broken down the coverage losses between 2025 and 2034 as follows: 7.7 million more people uninsured from the Medicaid cuts in the Energy & Commerce Committee’s reconciliation bill; 1.8 million more people uninsured from adoption of the Marketplace Integrity rule (also in the House reconciliation bill); 4.2 million more people uninsured if Congress fails to extend the enhanced premium tax credits… it is evident that the overall result will be an unprecedented loss of insurance coverage for millions of Americans, causing the nation’s uninsured rate to increase by an estimated 30 percent.”
KFF: Potential Impacts of 2025 Budget Reconciliation on Health Coverage for Immigrant Families.
- “Some states have established fully state-funded programs to fill these gaps in coverage for immigrants. A proposed provision in the Energy and Commerce bill would penalize states that offer this coverage by reducing their federal Medicaid match rate for the ACA expansion population from 90% to 80%…. [around] 1.4 million more people would become uninsured by 2034 and… [there would be an] $11 billion reduction in the federal deficit between 2025 and 2034 as a result of this provision.”
- “In May 2024, the Biden administration published new regulations that extended Marketplace eligibility to DACA recipients effective November 2024, which it estimated would extend coverage to about 100,000 uninsured DACA recipients, who are mostly working adults without access to an affordable health coverage option… [the bill would make] DACA recipients ineligible to purchase ACA Marketplace coverage and to receive premium tax credits or cost sharing reductions to help pay for coverage effective January 2026.”
Politico: Letting Affordable Care Act subsidies expire would lead to millions losing coverage.
- “Millions of people would lose health insurance if congressional Republicans let a policy expire intended to lower the out-of-pocket costs of Affordable Care Act plans, according to a Congressional Budget Office estimate released Friday… the CBO analysis [finds premium subsidy cuts]… would result in close to 4 million fewer people having health insurance.”
- “This latest CBO report follows Democrats’ release of another set of CBO findings from earlier in the week showing that a Trump administration proposal aimed at reducing improper Medicaid enrollments would decrease the federal deficit by $210 billion over a decade — and lead to 1.9 million more uninsured people.”
Targeting Kids, Seniors, People with Disabilities and More, This Bill Will Blow Up Uninsured Rates and Everyday Americans’ Health Insurance:
KFF: How Will the 2025 Reconciliation Bill Affect the Uninsured Rate in Each State?
- “The biggest increase in uninsured by percentage point is in DC (5 percentage points), which also has expanded Medicaid eligibility up to 215% of poverty. 10 states and DC would have increases in their uninsured rates of 3 percentage points or more (DC, Washington, Oregon, Kentucky, New York, Louisiana, New Mexico, Connecticut, Illinois, Rhode Island, and California). In terms of increases in the number of uninsured people, California and New York are the top two states (1.4M and 810k, respectively). Florida, Illinois, and Texas would follow at 520K, 430k, and 430k, respectively.”
- “The combined effects of the House Reconciliation package with the expiration of the ACA enhanced tax credits, compared to a scenario where the enhanced subsidies are in place and the proposed integrity rule was not in effect, results in the greatest increases in Florida, Louisiana, Georgia, Mississippi, and Washington, where the uninsured rate is expected to increase by at least 5 percentage points. 30 states and the District of Columbia may see an increase in their uninsured rates of 3 percentage points or more. About half (46%) of the 13.7 million more people who would be uninsured in this scenario live in Florida (1.8M), Texas (1.6M), California (1.5M), New York (800k), and Georgia (610k). Texas (2.8M Marketplace growth), Florida (2.8M) and Georgia (1.0M) experienced the most ACA Marketplace growth since 2020, the year before the enhanced premium tax credits became available.”
Unidos: The Medicaid cuts proposed in budget reconciliation would be the largest in U.S. history.
- “The $70 billion average annual Medicaid cut under the current legislation would be more than 10 times the size of the largest previous cut, the Deficit Reduction Act of 2005’s average annual reduction of $5.8 billion in March 2025 dollars.”
- “The current bill’s 9.6% drop in projected Medicaid spending would be roughly twice the size of the largest previous percentage drop that resulted from two sequential budget reconciliation bills added together—namely, the 5.0% Medicaid spending reduction that resulted from the Omnibus Budget Reconciliation Acts (OBRA) of 1981 and 1982. According to the Reagan Administration’s official evaluation, the latter legislation caused a 13% drop in total Medicaid coverage. ”
Manatt Health: No Place to Hide: Children Will Be Hurt by Medicaid Cuts.
- “Ending the enhanced matching rate would have a pronounced impact on every state with Medicaid expansion. States would lose $836 billion of their federal funding for this group over the next ten years… States that are not able to replace the lost funding, or which have “trigger laws” that end the expansion in the event that the 90% match rate is repealed, would drop the expansion group. If all states eliminated their expansion groups, nationwide average annual enrollment would decline by 22 million…”
- “If all Medicaid expansion states eliminate coverage for expansion adults, annual child enrollment in expansion states could drop by an estimated 773,000 children.”
Georgetown University: Medicaid Work Requirements Could Threaten Parents’ and Children’s Coverage and Well-Being.
- “In Arkansas and New Hampshire, which briefly began implementing work requirements in 2018 and 2019, respectively, the vast majority of people who could maintain their enrollment were identified as exempt or compliant by the state using available data. But most people who were not automatically deemed exempt or compliant lost coverage or were at risk of losing coverage despite working or potentially qualifying for an exemption. Studies found that many people did not satisfy the work reporting requirement because of factors like lack of awareness, confusion about the policy, and difficulties navigating reporting systems. Under the House Energy and Commerce Committee proposal, states are only required, where possible, to automate verification processes for work or work activities, but they are not required to implement automatic exemptions, including for parents.”
- “Work requirements would not help families make ends meet amid other threats to their health and well-being: prior studies assessing the effects of Medicaid work requirements in Arkansas found that they increased uninsurance with no improvement in employment… The Medicaid work requirement provisions in the House Energy and Commerce Committee’s proposal also would not provide any new funding for job training or job search programs or ameliorate other barriers to work that parents face, such as lack of transportation or difficulties finding affordable and high-quality child care.”
Urban Institute: Expanding Federal Work Requirements for Medicaid Expansion Coverage to Age 64 Would Increase Coverage Losses.
- “About 1.8 million more adults would be subject to work requirements that apply up to age 64 compared with work requirements that apply up to age 55. We project that an additional 1 million adults would lose federally funded Medicaid coverage in 2026 under work requirements that extend up to age 64 (5.5 to 6.3 million under a policy that extends to age 64 versus 4.6 to 5.2 million under a policy that extends to age 55).”
- “Whether work requirements extend to age 55 or age 64, at least 10,000 adults in almost every Medicaid expansion state would lose coverage, with variation across states reflecting the number and composition of expansion enrollees. Under work requirements that apply up to age 64, 17 states would see coverage losses of more than 100,000—up from 13 states under a policy that extends to age 55.”
Center for American Progress: Federal Medicaid Cuts Would Force States To Eliminate Services for Disabled Adults, Older Adults, and Children.
- “states would be prohibited from creating new or increasing existing taxes on health care providers to help finance their share of Medicaid program costs, making it more difficult for states to sustain Medicaid. As a result, states would have to look at three different strategies: raising taxes, limiting coverage, or reducing or eliminating vital benefits that are not explicitly required by federal law. Services that could be cut include home- and community-based services (HCBS), physical therapy, and speech therapy. These services are often critical for people with disabilities and older adults, who would be among the first and hardest hit by such cuts.”
- “People in the United States pay an average of $1,564 for pharmaceutical drugs per year. Without Medicaid covering these medications, many people will have to pay for their drugs out of pocket or forgo potentially necessary medicines altogether, resulting in poorer health outcomes.”
- “Medicaid is required to cover [outpatient services such as physical therapy; occupational therapy; speech, hearing, and language disorder services; tuberculosis-related services services for children under age 21]. If states decide not to cover these services under Medicaid for adults, people may end up having worse health outcomes from significant injuries or illnesses.”
PNHP: GOP Medicaid Cuts: Multifaceted, Severe, Deadly, Machiavellian.
- “House Republicans’ radical new budget plan proposes requiring states to implement Medicaid work reporting requirements for adults enrolled through the Affordable Care Act’s (ACA) Medicaid expansion… Evidence from prior state-level implementations show that bureaucratic paperwork requirements do not increase employment but do result in large-scale coverage losses—even among those who are working or should be exempt from the requirements.”