The Republican so-called One Big Beautiful Bill (OBBB), enacted on July 4, will take medical care coverage away from millions of people and dramatically raise health care costs for millions more. All to give inordinate tax breaks to billionaires.
According to CBO estimates, over the next 10 years, the OBBB will cut $1.1 trillion from Medicaid and ACA marketplaces and cause approximately 15 million people to become uninsured. Most of the cuts impact federal funding for Medicaid, the public insurance program that helps cover medical costs for low-income families, older adults, and people with disabilities.
The Congressional Budget Office (CBO) estimated that the OBBB would cut federal spending on Medicaid and Children’s Health Insurance Program (CHIP) benefits, due in part to eliminating over 10 million people from the programs by 2034.
The Patient Protection and Affordable Care Act (ACA or Obamacare) made changes to Medicaid. Among other things, it expanded eligibility to include adults with incomes up to 133 percent of the federal poverty level and provided premium tax credits for the purchase of private health insurance.
At the end of this year, Americans who buy their health insurance on the Affordable Care Act (ACA) marketplaces will no longer have access to enhanced premium tax credits (established in the Biden administration) to help defray the cost of their coverage. If Congress takes no action to extend them, nearly five million people are estimated to become uninsured in 2026, and insurance premium costs will soar for millions more.
Also, there will be cuts to Medicare. Without future congressional action, OBBB will trigger $490 billion in cuts to Medicare from 2027 to 2034.
But it doesn’t end with just Medicaid, ACA, and Medicare participants being adversely affected. Everyone will pay more for health care if the ACA tax credits disappear. Combined with the Medicaid cuts that Republicans in Washington passed this year, ending the Affordable Care Act tax credits would raise health care costs as much as $485 per person a year for the 179 million people with employment-based insurance. That’s nearly $2,000 more a year in health care costs for a family of four.
Democrats say they will not vote to approve the current funding bill – which would end the government shutdown – unless Congress extends the existing ACA subsidies that are set to expire at the end of this year.
The OBBB will cause many lives to be lost. In a June 18 virtual seminar hosted by the University of Pennsylvania’s Leonard Davis Institute of Health Economics and the nonprofit health policy newsroom Tradeoffs, researchers projected that the bill’s Medicaid cuts, shortened Affordable Care Act enrollment windows, and new administrative hurdles could increase the nation’s uninsured population by 60 percent and result in more than 51,000 additional deaths each year.
Extending the ACA subsidies would cost the federal government around $23 billion next year and about $350 billion over the next decade, according to estimates from the Congressional Budget Office. Without congressional action, the extra help will expire at the end of the year, effectively hiking insurance premiums by more than 100 percent for the average consumer in the market, according to an analysis from the health research group KFF.
The bottom line is that the OBBB cuts over $1 trillion in health care coverage over ten years, and at the same time provides tax cuts for the rich amounting to $5 trillion over ten years. After factoring in spending cuts and economic growth, the budget deficit will still increase by $3 trillion. And the Republicans so far are unwilling to restore the ACA subsidies by a “mere” $350 billion.
This is not just a political issue. This is a moral issue. OBBB is an immoral budget bill.
