In the late evening of Saturday, June 28th, the Congressional Budget Office (CBO) issued preliminary estimates of the current version of the Senate Republican budget reconciliation bill now being debated on the Senate floor. The CBO estimates confirm that the Senate Republican reconciliation bill as it now stands would cut Medicaid to an even harsher extent than the House-passed reconciliation bill would (the “One Big Beautiful Bill Act” or H.R. 1). Here are some quick takeaways:
- The Senate Republican reconciliation bill would cut gross federal Medicaid and Children’s Health Insurance Program (CHIP) spending by $1.02 trillion over the next ten years. That means the Senate bill’s Medicaid and CHIP cuts are $156.1 billion or 18 percent larger than even the House-passed bill’s draconian cuts of $863.4 billion over ten years.1
- These larger gross Medicaid and CHIP cuts are driven by changes to the House-passed bill that would further restrict state use of provider taxes to finance Medicaid, eliminate eligibility for many lawfully present immigrants, cut federal funding for payments to hospitals furnishing emergency Medicaid services, and further reduce certain supplemental payments to hospitals and other providers (known as state-directed payments). The spending effect of these additional cuts is modestly offset by increased Medicaid and CHIP spending from provisions not in the House-passed bill including a rural health transformation program, increased federal Medicaid funding for Alaska and Hawaii, and expanded waiver authority for home- and community-based services.
- Overall, the Senate Republican reconciliation bill’s Medicaid, CHIP, Affordable Care Act marketplace, and Medicare provisions would increase the number of uninsured by 11.8 million in 2034, relative to current law. In comparison, the House-passed bill would increase the number of uninsured by 10.9 million in 2034. (More detailed CBO estimates of the specific Medicaid health coverage effects under the Senate Republican reconciliation bill are not yet available. For example, CBO estimates the House-passed bill’s Medicaid and CHIP provisions would cut Medicaid enrollment by 10.5 million by 2034 and by themselves, increase the number of uninsured by 7.8 million by 2034.)
As noted, these CBO estimates are preliminary and do not include more detailed analysis of the impact on Medicaid enrollment and health coverage. In addition, the Senate Republicans are likely to make further amendments to the reconciliation bill’s Medicaid and CHIP provisions to avoid “Byrd Rule” violations and to try to ensure Senate passage in coming days.
- These gross figures do not account for interactions with provisions affecting the Affordable Care Act’s marketplaces and marketplace subsidies and also do not include related revenue effects. However, the CBO estimates of the current Senate Republican reconciliation bill imply that the Medicaid and CHIP estimates may already account for interactions among those provisions and the interactions (if any) between the Medicaid and CHIP provisions and the ACA marketplace provisions would not have the effect of reducing the gross Medicaid and CHIP spending cuts but would instead have the effect of increasing ACA marketplace subsidy spending by as much $78.9 billion over ten years and therefore reducing the net ACA marketplace spending cuts. (These interactions may also be due to interactions among the ACA marketplace provisions.) ↩︎