Dude it's well published - I used CBO numbers below where I could. Why do think reversing the cuts means adding back to the budget? Because people were getting something. So yes. Millions will lose their healthcare.
- Work requirements: "CBO estimates that 5.3 million people will lose Medicaid coverage due to new work or "community engagement" requirements, which take effect starting January 1, 2027." Many people, even those working will lose their coverage due to the onerous reporting requirements weeding them out. States that have this saw huge reductions in covered citizens. Fulltime home caregivers will lose their health coverage - mostly low income without the ability to pay for their parents/children care.
- Provider tax restrictions: An estimated 1.2 million people will lose Medicaid coverage due to new limits on states' ability to use taxes on health care providers to fund their Medicaid programs.
- Other provisions: Other changes, such as more frequent eligibility redeterminations and making it harder for dually eligible Medicare/Medicaid beneficiaries to retain Medicaid, are expected to cause further coverage losses around 1 million.
ACA premium tax credits
The OBBB did not extend the enhanced premium tax credits for ACA marketplace plans, which are set to expire at the end of 2025.
- Higher premiums: Without these enhancements, premiums are expected to rise significantly in 2026. KFF estimates that for subsidized enrollees, annual premium payments could more than double, increasing by 114% on average.
- Fewer insured people: Experts anticipate that millions of Americans will drop their marketplace coverage because they will no longer be able to afford it. The CBO estimates that 4.2 million people will become uninsured as a result of the cost increases to them.
Other factors affecting insurance coverage
Additional factors are expected to reduce insurance coverage, exacerbating the effects of the OBBB:
- Expiration of ACA rules: New CBO estimates from September 2025 predict that nullifying specific ACA marketplace rules, including automatic re-enrollment, will cause 900,000 additional people to lose health insurance.
- Higher costs for everyone: Insurers are citing increasing health care costs and the expiration of enhanced premium tax credits as key drivers for substantial rate hikes in 2026, which will affect even those not covered by subsidies. The median proposed premium increase for 2026 is 18% nationally.
https://www.cbpp.org/research/health/by-the-numbers-harmful-republican-megabill-will-take-health-coverage-away-from#:~:text=Roughly 15 million people will,not available at this time.)
