Almost 10 million Americans will lose health insurance during the next decade under US President Donald Trump's newly signed tax and spending legislation, according to a Congressional Budget Office (CBO) report published on August 11. The CBO estimates 7.5 million individuals will lose Medicaid coverage as the law imposes tighter eligibility standards. Non-disabled adults with Medicaid will be expected to work, volunteer, or attend school to maintain their benefits. States will also need to make eligibility checks every six months, twice the current frequency.

Affordable Care Act Plans Also Impacted

Another 2.1 million Americans will lose Affordable Care Act (ACA) marketplace coverage, and about 400,000 more will lose coverage from other indirect impacts of "One Big Beautiful Bill."

Key Provisions of the Law

Signed into law by Trump on July 4, the law:

• Extends the 2017 tax cuts

• Stops federal imposition of taxes on tips and overtime payments

• Increases funding for border security

The CBO projects that the bill will increase the US federal deficit by USD 3.4 trillion over 10 years.

Families who make less than USD 23,750 a year — who now pay roughly USD 2,300 in federal taxes, will, on average, lose USD 1,200 annually because of changes in Medicaid and cuts in food assistance.

Middle-class families are estimated to receive between USD 800 and USD 1,200 a year, while the richest households, with incomes of more than USD 690,000 a year — will see their average tax reduction amount to USD 13,600 while still paying almost USD 200,000 a year in federal taxes.“This is one of the most regressive pieces of legislation I’ve seen, The rich will get richer and the poor will get poorer.” said Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms.

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The Senate approved the bill with Vice President JD Vance breaking a tie. Earlier estimates by the CBO indicated that the legislation would leave 11.8 million Americans without insurance in 2034, but the final bill was watered down after taking out a provision that would have charged states for expanding Medicaid to illegal residents.

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The CBO alerted that close to 5 million more individuals may lose their coverage if Congress doesn't renew pandemic-era tax credits, which have maintained ACA premiums low. Lacking the renewal, premiums for those individuals would increase by more than 75 per cent, estimates nonprofit health policy organization KFF. The triple hit of the tax law, the potential lapse of subsidies, and increasing healthcare costs will drive insurance premiums up for all. A Peterson-KFF Health System Tracker report is forecasting a median ACA premium growth of 18 per cent in 2026, the sharpest increase since 2018.