At Least 17 Million Americans Face Loss of Health Insurance Under Trump-Backed GOP Plan

Sweeping Senate legislation would roll back Affordable Care Act gains, slash Medicaid, and upend coverage for millions, experts and nonpartisan projections find

At least 17 million Americans stand to lose their health insurance if the Senate passes President Donald Trump’s flagship tax and immigration legislation, according to impartial analyses and Congressional Budget Office (CBO) projections released this week. The bill, which advanced through the Senate in a narrow, party-line vote, would unwind much of the Affordable Care Act (ACA) and enact historic cuts to Medicaid, marking the most significant rollback of federal health coverage in modern U.S. history.

Senate Bill Threatens Years of Health Coverage Gains

The Senate’s version of the “One Big Beautiful Bill Act” is projected to erase years of progress in expanding health care coverage, particularly among low-income, disabled, and working-class Americans. The CBO and independent health policy groups estimate that the legislation would leave at least 17 million more Americans uninsured over the next decade, a figure that surpasses even the coverage losses seen in previous GOP attempts to repeal the ACA.

“This could lead to a minimum of 17 million Americans losing their health coverage, as indicated by impartial assessments and specialists,” The Washington Post reported, underscoring the scale of the potential impact.

Medicaid Cuts at the Center of Controversy

The legislation’s most sweeping changes target Medicaid, the federal-state health insurance program that covers more than 71 million Americans, including children, seniors, and people with disabilities. The Senate bill proposes $930 billion in cuts over a decade to Medicaid, Medicare, and the ACA, with Medicaid alone facing reductions of over $1 trillion, according to CBO estimates.

New work requirements would mandate that able-bodied adults aged 19 to 64, without dependents, work or participate in approved activities for at least 80 hours per month to maintain Medicaid eligibility. While exemptions exist for parents of children under 14 and those with disabilities, policy experts warn the requirements could still strip coverage from millions.

“The proposed legislation represents the most serious threat to Medicaid in its history. This bill acts as a backdoor repeal of Medicaid expansion,” said Mara Youdelman, Managing Director of Federal Advocacy at the National Health Law Program, citing CBO projections that 13.7 million people could lose coverage due to Medicaid cuts and eligibility restrictions.

ACA Rollbacks and Loss of Subsidies

The bill also unwinds key provisions of the ACA, including the rollback of enhanced premium tax credits that have helped millions afford coverage through the health insurance marketplaces. The expiration of these subsidies, combined with stricter eligibility requirements, is expected to increase the uninsured rate, particularly in states with high ACA enrollment.

The CBO estimates that nearly 11 million people would lose insurance coverage directly due to the tax bill’s Medicaid and ACA changes. At the same time, another 5.1 million would become uninsured as a result of expiring ACA subsidies and new rules proposed by the Trump administration’s health department. Altogether, the CBO projects that 16 million people could become uninsured over a decade, matching the coverage losses anticipated during the 2017 GOP repeal effort.

Disproportionate Impact on Vulnerable Populations

The coverage losses would hit low-income families, children, seniors, and people with disabilities the hardest. Medicaid currently covers more than 71 million Americans, and the bill’s cuts would disproportionately affect those in the South and West, where uninsured rates are already highest.

“Sharp Medicaid cuts could result in vulnerable Americans no longer being able to receive care, either by losing coverage or by closing the centers that provide such care,” ABC News reported, highlighting the risk to rural hospitals and community clinics.

Jamila Michener, a professor of government and public policy at Cornell University, told Newsweek that more than half of Medicaid enrollees are Black or Latino, and that the coverage losses would be concentrated in states such as California, Louisiana, Florida, and New York—states with large communities of color and higher unemployment rates.

Geographic Breakdown: States Most at Risk

A state-by-state analysis by KFF, cited by Newsweek, shows that several states could see their uninsured populations rise by 5 percent or more if the bill becomes law. California is projected to see 1.7 million more uninsured residents, while Florida could see an additional 990,000. Louisiana, Washington, and Oregon are also expected to experience steep increases in uninsured rates, relative to their current populations.

States that did not expand Medicaid under the ACA, such as Kansas, New Hampshire, South Dakota, Wisconsin, and Wyoming, are expected to see smaller increases in the uninsured rate. However, thousands in those states would still lose coverage.

Health System Strain and Economic Fallout

Healthcare leaders warn that the legislation would destabilize state Medicaid programs and local healthcare systems. Hospitals and clinics, particularly those serving rural and underserved communities, face the prospect of increased uncompensated care, service reductions, and even closures.

“This legislation will cause 11.8 million Americans to be displaced from their health care coverage as they move from insured to uninsured status. It will drive up uncompensated care for hospitals and health systems, which will affect their ability to serve all patients,” said Harold Pollack, a health policy expert, as quoted in Medical Economics.

The American Hospital Association and America’s Health Insurance Plans (AHIP) have both issued warnings about the bill’s destabilizing effects, noting that people losing Medicaid eligibility will face fewer choices and higher premiums in the individual market, with the expiration of ACA tax credits compounding the disruption.

Chronic Illness, Medical Debt, and Social Consequences

The loss of health coverage is expected to have far-reaching consequences for public health and household finances. Without insurance, more Americans with chronic conditions like diabetes, heart disease, and asthma are likely to forgo checkups and medications, leading to unmanaged illnesses, higher rates of emergency room visits, and increased medical debt.

“We are going back to a place of a lot of uncompensated care and a lot of patchwork systems for people to get care,” said Ellen Montz, managing director at Manatt Health and former ACA marketplace official, in an interview with Axios.

Uninsured patients are less likely to receive cancer screenings or prenatal care, and Medicaid is a major payer for behavioral health counseling and crisis intervention. The bill’s passage could worsen outcomes for some of the nation’s most vulnerable groups, including children, seniors, and those with mental health needs.

Political and Legislative Context

The Senate’s passage of the bill followed a marathon debate, with all Democrats and several Republicans opposing the measure due to its impact on health care coverage. The House and Senate versions differ in the scale of Medicaid cuts. Still, both would result in millions losing coverage—nearly 11 million under the House bill and almost 12 million under the Senate version, according to CBO estimates.

President Trump and GOP leaders have argued that the bill’s tax cuts and spending reductions will spur economic growth and reduce government spending. However, health policy organizations and nonpartisan analysts warn that the coverage losses and resulting strain on the health care system could have long-term negative effects.

Voices from the Field

Healthcare professionals, patient advocates, and policy experts have voiced strong opposition to the bill’s healthcare provisions.

“The combined impact of the policies in the bill will destabilize state Medicaid programs and undermine countless local health care systems,” AHIP stated, warning of new red tape and barriers to enrollment and re-enrollment.

Protect Our Care Chair Leslie Dach said, “This bill is horrendous for the American people… Not only will hardworking families lose their coverage, but rural hospitals will shut down, seniors will be forced to leave their nursing homes, and people fighting cancer or addiction will lose access to lifesaving treatment”.

Uncertain Future in the House

The fate of the bill now rests with the House of Representatives, where lawmakers face pressure to reconcile the differences with the Senate version and address mounting concerns from healthcare stakeholders and constituents. No Democrats are expected to support the bill, and some moderate Republicans have expressed reservations about the scale of Medicaid cuts and the potential for millions to lose coverage.

If enacted, the legislation would represent the most significant rollback of federal health coverage since the ACA’s passage in 2010, fundamentally altering the healthcare landscape for millions of Americans.

High Stakes for American Health Care

The Senate’s adaptation of President Trump’s tax and immigration bill stands to reverse years of progress in reducing the uninsured rate in the United States. With at least 17 million Americans projected to lose health coverage—primarily through Medicaid cuts and ACA rollbacks—the legislation has sparked urgent warnings from health care leaders, policy experts, and patient advocates.

As the House prepares to take up the measure, the debate over the future of American health care remains at the forefront of national politics. The outcome will determine whether the nation moves forward with expanded coverage or returns to a time when millions more Americans lacked access to affordable, comprehensive care.