Medicaid and ACA Healthcare Cuts
Briefly, we have not gotten to the place where the impact of healthcare insurance cuts are going to occur. I suspect the impact will be devastating to many US citizens.
July 2025, Republicans led by Trump passed the One Big Beautiful Bill Act, otherwise known as the budget reconciliation bill. The law, H.R. 1, has made waves for its historic nearly $1 trillion cut to federal Medicaid spending over 10 years. Just to be clear, no Democrats supported this bill.
There have been estimates of what the impact would be to those insured by Medicaid. Combining the impact of the reconciliation law with the expected expiration of the ACA’s enhanced premium tax credits, CBO estimates suggest the number of uninsured people will increase by more than 14 million by 2034. Fierce Healthcare suggested the number of uninsured Americans is expected to grow by 10 million in 2034 as a result, and another 4 million may become uninsured if the Affordable Care Act subsidies expire. Well as we know the subsidies did disappear.
As Fierce Healthcare states, there is “a domino effect of Medicaid cuts and the hidden costs for healthcare.” Much of the impact will fall upon state Medicaid agencies which will have to adjust eligibility rules for Medicaid. A person denied or disenrolled due to work requirements, will have to file a new application reapplying for Medicaid. This will also trigger a compliance check of work status. As one expert (Karl Ulfer) said;
“You either pay for them proactively, or you pay for them through hospitalizations and ER visits. In the end, you’re going to end up paying for it either way as a taxpayer,”
“The Congressional Budget Office (CBO) estimates. Relative to its estimates of insurance coverage prior to the law being enacted, the law will increase the number of people without health insurance in 2034 by 10 million, because of changes to Medicaid (7.5 million), the ACA Marketplaces (2.1 million), and other policies and interactions among different provisions (0.4 million).
These legislative changes come at a time when enhanced premium tax credits for ACA Marketplace enrollees are set to expire later this year. When combining the impact of the reconciliation law with that of the expected expiration of the ACA’s enhanced premium tax credits, CBO estimates now show the number of uninsured people will increase by more than 14 million in 2034. That estimate does not account for the effects of the Trump administration’s ACA Marketplace Integrity and Affordability rule finalized earlier this year, so the overall change in the number of uninsured people could be even larger.”
Keep in mind this report by KFF is approximately 6 months old. There may have been other things taking place which may have added to the numbers.
The two maps below show different criteria. One shows the effects of the reconciliation law. The other shows those effects combined with expiration of the ACA enhanced premium tax credits. The ACA Marketplace Integrity and Affordability rule is expected to contribute to increases in the uninsured. The estimates of which have not been released been released by the CBO as of the writing of the KFF article.
I can not activate the map so as to show the numbers of uninsured by state. However, you can go to the original KFF article to capture each state’s numbers.
The analysis apportions the increase in the number of uninsured across the 50 states and the District of Columbia. It shows that number as a percentage of each state’s population. The number of additional uninsured people as a percent of the population is equivalent to the percentage point increase in the 2034 uninsured rate. Nationally, CBO projected an uninsured rate of under 10% in 2034 under current law, which assumed the enhanced ACA premium tax credits would expire.
The analysis here includes two maps: one showing the effects of the reconciliation law, and another showing those effects combined with expiration of the ACA enhanced premium tax credits. (The ACA Marketplace Integrity and Affordability rule is expected to contribute to increases in the uninsured, though estimates of the finalized rule have not been released by CBO.)
Anticipating how states will respond to changes in Medicaid policy is a major source of uncertainty in CBO’s cost estimates. Instead of making state-by-state predictions about policy responses, CBO estimates the percentage of the affected population living in each state having different types of policy responses.
For example, in the reconciliation law. Medicaid work requirements account for more than half of CBO’s estimated 2034 increase in the number of people without insurance. This is due to changes to Medicaid. However, different states might choose to implement a work requirement with reporting requirements that are easier or harder for enrollees. We just do not know what states will do. Potential state analysis reflects the uncertainty of state decisions. There will be variation showing a range of enrollment impact in each state. The variance may be plus or minus 25% from a midpoint estimate.
Besides being ~ 6 months old, I suspect the actual political environment and assumptions have changed. The count maybe different or in all likelihood, more aggressive in actual reduction. of insured in government programs. We should expect the worst to occur as Republicans are not responsive to constituent’s needs for healthcare.
Some References:
“How Will the 2025 Reconciliation Law Affect the Uninsured Rate in Each State?” | KFF
“2026 Outlook: The domino effect of Medicaid cuts, hidden costs,” Fierce Healthcare
“House passes healthcare bill without subsidy extension,” Fierce Healthcare