New CBO Well being Protection Estimates of Budget Reconciliation Law – Middle For Youngsters and Households

On August 11, 2025, the Congressional Budget Office (CBO) issued extra detailed estimates of the influence of the finances reconciliation legislation (H.R. 1 or P.L. 119-21) on well being protection. Consistent with last cost estimates issued in July, CBO finds that the reconciliation legislation will enhance the variety of uninsured individuals by 10 million in 2034, relative to CBO’s January 2025 baseline.

• CBO estimates that the reconciliation legislation’s Medicaid, CHIP, Marketplace and Medicare cuts will enhance the variety of uninsured by 1.3 million in 2026, relative to CBO’s January 2025 baseline for that yr.  That enhance within the variety of uninsured individuals, relative to CBO’s baseline, will considerably rise to five.2 million in 2027, leap to six.8 million in 2028, leap once more to eight.6 million in 2029 after which steadily develop to 10 million by 2034.

• The reconciliation legislation’s gross Medicaid and CHIP federal spending cuts of $990 billion over the following ten years — the biggest Medicaid cuts in historical past — will lead to three-quarters of the whole protection losses.  According to CBO, the Medicaid and CHIP cuts will enhance the variety of uninsured by 7.5 million in 2034 (after accounting for interactions).

• Among the Medicaid and CHIP cuts, the biggest contributor to those massive protection losses is the reconciliation legislation’s necessary work reporting requirement for Medicaid enlargement adults.  That provision would enhance the variety of uninsured by 5.3 million in 2034 (earlier than interactions).  With the reconciliation legislation additionally requiring extra frequent redeterminations for enlargement adults — which might enhance the variety of uninsured by a further 700,000 in 2034 (earlier than interactions) — low-income adults, who would in any other case be eligible and enrolled within the Medicaid enlargement, would face the brunt of the protection losses beneath the legislation.  Restrictions on states’ use of supplier taxes to finance their share of Medicaid prices are additionally a significant contributor, with the mixed impact of such provisions growing the variety of uninsured by one other 1.2 million in 2034 (earlier than interactions).

• CBO estimates that the reconciliation legislation’s gross Marketplace federal spending cuts of $213 billion over ten years will enhance the variety of uninsured by 2.4 million in 2034 (after accounting for interactions).  The cuts straight account for two.1 million of that enhance, with a further 300,000 changing into uninsured apparently resulting from Marketplace interactions with the Medicaid cuts. 

• The reconciliation legislation’s provision limiting Medicare eligibility for sure lawfully current immigrants would additional enhance the variety of uninsured by 100,000 in 2034.

• Notably, CBO’s estimates of the general 10 million internet enhance within the variety of uninsured in 2034 don’t embrace the influence of the legislation failing to increase the improved Marketplace premium tax credit that are scheduled to run out on the finish of calendar yr 2025.  While expiration of the improved premium tax credit was already assumed within the CBO baseline, extension of the improved premium tax credit would stop one other 4.2 million individuals from changing into uninsured by 2034 based on earlier CBO estimates.  Combined with different Marketplace adjustments already assumed within the CBO baseline, the whole enhance within the uninsured beneath the finances reconciliation legislation would doubtless equal about 15 million by 2034.