The bill, which narrowly advanced in the Senate with a 51-49 vote, would enact historic cuts to Medicaid and scale back key provisions of the Affordable Care Act (ACA), marking the most dramatic rollback of federal health coverage in modern U.S. history.
The CBO estimates that 11.8 million people would become uninsured by 2034 if the Senate’s version of the bill becomes law—nearly one million more than projected under the House’s version. The legislation calls for more than $1.1 trillion in cuts to Medicaid, Medicare, and Obamacare over the next decade, with Medicaid alone accounting for over $1 trillion of those reductions. These cuts would hit low-income families, children, seniors, and people with disabilities the hardest, as Medicaid currently covers over 71 million Americans.
The bill introduces strict new work requirements for many adults on Medicaid, including parents of children as young as 14, and imposes new co-payments for Medicaid services. It also reduces federal support for Medicaid expansion and alters tax credits that help millions afford ACA plans, changes that experts warn will disproportionately impact the South and West, where uninsured rates are already highest. According to Aaron Carroll, president and CEO of a major health policy group, “The effects could be catastrophic,” with many forced to pay out-of-pocket for care, delay treatment, or lose access to essential medications.
The proposed cuts have sparked deep divisions within the Republican Party. While fiscal conservatives push for deeper reductions, others—like Senator Thom Tillis of North Carolina, who announced he would not seek re-election after opposing the bill—have voiced concerns about the impact on their constituents and local hospitals. Democrats have uniformly opposed the measure, using Senate rules to delay a final vote and warning of the bill’s consequences for American families.
