The Biggest Rollback in Federal Support for Health Coverage Ever

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The estimated Medicaid cuts in the One Big Beautiful Bill Act totaling $793 billion over a decade have gotten a fair amount of attention.

But, if you comb through the Congressional Budget Office’s spreadsheet of budgetary effects from the bill, you’ll find that there are also $268 billion in reductions related to the Affordable Care Act Marketplaces, which would have the effect of lowering tax credits to help people pay their premiums, hiking out-of-pocket premiums, and increasing the number of people who are uninsured.

Once you take indirect effects on federal revenues into account, Medicaid and ACA cuts total $1.04 trillion over a decade.

Republicans are not talking about repealing and replacing the ACA anymore, and the budget reconciliation bill doesn’t do that, at least not directly. However, the bill would restrict health insurance for many people who have been helped by the ACA, and it would be the biggest rollback in federal support for health coverage ever.