On August 11, 2025, the Congressional Budget Office (CBO) issued more detailed estimates of the impact of the budget reconciliation law (H.R. 1 or P.L. 119-21) on health coverage. Consistent with final cost estimates issued in July, CBO finds that the reconciliation law will increase the number of uninsured people by 10 million in 2034, relative to CBO’s January 2025 baseline.
- CBO estimates that the reconciliation law’s Medicaid, CHIP, Marketplace and Medicare cuts will increase the number of uninsured by 1.3 million in 2026, relative to CBO’s January 2025 baseline for that year. That increase in the number of uninsured people, relative to CBO’s baseline, will significantly rise to 5.2 million in 2027, jump to 6.8 million in 2028, jump again to 8.6 million in 2029 and then steadily grow to 10 million by 2034.
- The reconciliation law’s gross Medicaid and CHIP federal spending cuts of $990 billion over the next ten years — the largest Medicaid cuts in history — will result in three-quarters of the total coverage losses. According to CBO, the Medicaid and CHIP cuts will increase the number of uninsured by 7.5 million in 2034 (after accounting for interactions).
- Among the Medicaid and CHIP cuts, the largest contributor to these large coverage losses is the reconciliation law’s mandatory work reporting requirement for Medicaid expansion adults. That provision would increase the number of uninsured by 5.3 million in 2034 (before interactions). With the reconciliation law also requiring more frequent redeterminations for expansion adults — which would increase the number of uninsured by an additional 700,000 in 2034 (before interactions) — low-income adults, who would otherwise be eligible and enrolled in the Medicaid expansion, would face the brunt of the coverage losses under the law. Restrictions on states’ use of provider taxes to finance their share of Medicaid costs are also a major contributor, with the combined effect of such provisions increasing the number of uninsured by another 1.2 million in 2034 (before interactions).
- CBO estimates that the reconciliation law’s gross Marketplace federal spending cuts of $213 billion over ten years will increase the number of uninsured by 2.4 million in 2034 (after accounting for interactions). The cuts directly account for 2.1 million of that increase, with an additional 300,000 becoming uninsured apparently due to Marketplace interactions with the Medicaid cuts.
- The reconciliation law’s provision restricting Medicare eligibility for certain lawfully present immigrants would further increase the number of uninsured by 100,000 in 2034.
- Notably, CBO’s estimates of the overall 10 million net increase in the number of uninsured in 2034 do not include the impact of the law failing to extend the enhanced Marketplace premium tax credits which are scheduled to expire at the end of calendar year 2025. While expiration of the enhanced premium tax credits was already assumed in the CBO baseline, extension of the enhanced premium tax credits would prevent another 4.2 million people from becoming uninsured by 2034 according to earlier CBO estimates. Combined with other Marketplace changes already assumed in the CBO baseline, the total increase in the uninsured under the budget reconciliation law would likely equal about 15 million by 2034.