Insurance Losses After the One Big Beautiful Bill Act

One year after President Donald Trump signed the One Big Beautiful Bill Act, a Protect Our Care report estimates that roughly five million Americans have lost health insurance. The legislation cut nearly $1 trillion from Medicaid and the Children’s Health Insurance Program (CHIP) over ten years and eliminated Affordable Care Act premium tax credits, prompting enrollment drops across public and marketplace plans.

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Medicaid and CHIP enrollment fell from 80.8 million to 76.9 million (-3.8 million). ACA marketplace enrollment dropped from 24.3 million to 23.1 million, and an estimated 1.2 million more lost coverage after premium spikes. The CBO projects that work-activity verification could add 5.3 million uninsured by 2034 and six-month eligibility checks another 700,000, for a total of about 15 million uninsured over the decade.

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Protect Our Care president Brad Woodhouse called the losses a “human toll” and warned of a broader affordability crisis. Democratic Rep. Greg Landsman said Republicans cut health care to fund tax breaks for the wealthy.

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A Kaiser Family Foundation poll showed 66 % of voters worried about health-care costs and 67 % disapproved of the Trump administration’s handling; 37 % trust Democrats versus 26 % trust Republicans on the issue. Critics say the cuts hit low-income families, seniors, veterans and small-business owners hardest.

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The CBO’s uninsured projections depend on future Medicaid verification rules not yet in place, so the 15 million estimate reflects policy scenarios, not observed enrollment. The five-million loss is drawn from CMS and state data; further losses remain uncertain until reforms are enacted.

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• “Five million and counting. That’s the human toll of the spiraling Republican healthcare affordability crisis,” — Brad Woodhouse, President, Protect Our Care

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• “cut healthcare by nearly a trillion to pay for tax cuts for the super wealthy... five million people no longer have healthcare.” — Rep. Greg Landsman, U.S. Representative, Ohio

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The report frames coverage losses as a key issue for the 2024 midterms, with Democrats using the cuts as a campaign focus. Pending Medicaid verification and ongoing premium-subsidy cuts will decide if projected uninsured numbers materialize. Stakeholders expect congressional turnover to influence future changes to Medicaid, CHIP and ACA subsidies.

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