The Senate version of President Donald Trump’s latest tax and immigration plan could have severe repercussions for millions of Americans, with at least 17 million potentially losing their health insurance coverage.
The bill, which has narrowly passed the Senate and is heading back to the House, seeks to dismantle significant parts of the Affordable Care Act (ACA), undoing years of progress in expanding access to healthcare.
The proposed legislation would primarily target Medicaid and the ACA marketplaces, areas that have seen notable improvements since President Barack Obama’s administration. If enacted, this bill would mark the most significant rollback of health coverage in recent history, according to nonpartisan estimates.
Medicaid Cuts Could Wipe Out Key ACA Gains
According to the Congressional Budget Office (CBO), the Senate bill could result in an additional 11.8 million Americans becoming uninsured by 2034. A large portion of this increase stems from proposed cuts to Medicaid.
The bill would reduce federal funding for Medicaid by over $1 trillion, with detrimental effects on the health insurance coverage of approximately 20 million Americans. The cuts come at a time when Medicaid’s expansion has been integral to covering vulnerable populations, particularly in rural and low-income areas.
Experts, including Joan Alker, Executive Director of Georgetown University’s Center for Children and Families, warn that the bill will undermine the ACA’s vision of universal coverage.
“This bill — if passed, and if the enhanced subsidies expire — will be a very effective undermining of the vision of the Affordable Care Act to move the United States to a country where universal coverage is in sight. This was the 100-year fight to get to the passage of the Affordable Care Act.” she stated.
The cuts would particularly impact states that expanded Medicaid, making it harder for them to sustain the ACA’s Medicaid expansion at current levels.
Expiring Subsidies Will Further Complicate Healthcare Access
Another key aspect of the bill involves allowing pandemic-era enhanced subsidies for ACA health insurance marketplaces to expire. These subsidies have made healthcare more affordable for millions of Americans, particularly those who would otherwise struggle to pay premiums.
The expiration of these subsidies would lead to sharp increases in out-of-pocket healthcare costs for many, pushing an estimated 4.2 million people off insurance rolls.
This could further destabilise the insurance marketplace, leaving millions vulnerable to rising medical costs. The legislation also proposes new work and reporting requirements for Medicaid recipients, potentially disqualifying many low-income Americans who face difficulty meeting these new obligations.
The combination of cuts to Medicaid and the expiration of subsidies could push the U.S. healthcare system backward, with many returning to emergency care as their primary healthcare option.
The bill, which includes significant tax cuts benefiting the wealthy and increased spending on immigration enforcement and defence, could become a defining issue in the upcoming elections.
Despite objections from some Republicans about the Medicaid provisions, the proposed cuts would represent the largest reduction in federal support for Medicaid in nearly 60 years.
