WASHINGTON — The Congressional Budget Office estimates an increase of 10.9 million people without health insurance under President Donald Trump‘s big bill, including 1.4 million who are in the country without legal status in state-funded programs. The package would reduce federal outlays, or spending, by $1.3 trillion over that period, the budget office said.
Republicans’ sweeping policy bill aimed at advancing President Trump’s second-term agenda would increase annual budget deficits by a total of $2.4 trillion over the next decade, according to a new estimate prepared by the nonpartisan Congressional Budget Office.
The CBO also estimates that 10.9 million more people would be without health insurance in 2034 as the result of the House-passed legislation, mostly due to cuts to Medicaid and the Affordable Care Act under the bill.
House Republicans are aiming to cut at least $1.5 trillion in spending to offset trillions in tax cuts, while also raising the debt ceiling by $4 trillion. The CBO projection puts the spending cuts at about $1.2 trillion over the next decade, with the tax cuts totaling just under $3.7 trillion. The national debt currently stands at roughly $36 trillion, according to the Treasury Department.
The package, which Mr. Trump and Republican lawmakers refer to as the “one big, beautiful bill,” is now in the hands of the Senate after making it out of the House before Memorial Day. The bill is expected to undergo changes in the Senate before heading back to the lower chamber.
Though Republicans vowed to protect Medicaid benefits and have framed cuts to the program as trimming “waste, fraud and abuse,” the analysis found that the portion of the bill dealing with Medicaid would mean 7.8 million fewer people being enrolled in the safety net program. Federal spending on Medicaid and the Affordable Care Act would be reduced by $902 billion over a decade.
Another 1.3 million people would be without insurance due to changes in the Affordable Care Act. The bill would also eliminate state-funded insurance for 1.4 million people “without verified citizenship, nationality, or satisfactory immigration status,” the CBO said.
Medicaid, a popular entitlement program, provides government-sponsored health care for more than 70 million low-income adults, children and people with disabilities. The House bill includes new work requirements that would apply to childless Medicaid recipients without disabilities between the ages of 19 and 64, more frequent eligibility checks and changes to how states can finance their share of the costs of the program.
Cuts to federal food assistance programs, which includes Supplemental Nutrition Assistance Program, would save more than $294 billion over 10 years, according to the analysis. House Republicans plan to achieve the savings by requiring states to cover a share of the costs to provide benefits that help low-income individuals and families pay for groceries and by expanding work requirements.
About 42 million people benefited from SNAP, also known as food stamps, in fiscal year 2023, with recipients receiving an average of $211 each month in benefits, according to the Department of Agriculture.
House Republican leadership dismissed the CBO’s findings Wednesday morning, arguing that it ignores economic growth that will stem from their policies.
“This bill will actually reduce the deficit if you recognize the historical economical growth that has always been there,” House Majority Leader Steve Scalise, a Louisiana Republican, said Wednesday.
House Speaker Mike Johnson, a Louisiana Republican, also pushed back on the uninsured estimate, telling reporters later Wednesday, “We’re not buying the CBO estimates.”
“The primary emphasis is on the work requirements,” he said. “That’s the largest pool of people that they claim will be affected, and the minimal work requirement is 20 hours a week. Volunteer in your community, get a job or do a job training.”
President Donald Trump’s big bill making its way through Congress will cut taxes by $3.75 trillion but also increase deficits by $2.4 trillion over the next decade, according to an analysis released Wednesday by the nonpartisan Congressional Budget Office.
The CBO also estimates an increase of 10.9 million people without health insurance under the bill by 2034, including 1.4 million who are in the United States without legal status in state-funded programs.
The package would reduce federal outlays, or spending, by nearly $1.3 trillion over that period, the budget office said.
“Republicans cry crocodile tears over the debt when Democrats are in charge — but explode it when they’re in power,” said Rep. Brendan Boyle of Pennsylvania, the top Democrat on the House Budget Committee.
“In the words of Elon Musk,” Boyle said, reviving the billionaire former Trump aide’s criticism of the package, “this bill is a ‘disgusting abomination.’”
Trump pushing Congress to act
The analysis comes at a crucial moment in the legislative process as Trump is pushing Congress to have the final product on his desk to sign into law by the Fourth of July. The work of the CBO, which for decades has served as the official scorekeeper of legislation in Congress, will be weighed by lawmakers and others seeking to understand the budgetary impacts of the sprawling 1,000-page-plus package.
Ahead of the CBO’s release, the White House and Republican leaders criticized the budget office in a preemptive campaign designed to sow doubt in its findings.
Republicans criticize the CBO
White House press secretary Karoline Leavitt said the CBO has been “historically wrong,” and Senate Majority Leader John Thune said the CBO was “flat wrong” because it underestimated the potential revenue growth from Trump’s first round of tax breaks in 2017. The CBO last year said receipts were $1.5 trillion, or 5.6% greater than predicted, in large part because of the “burst of inflation” during the COVID-19 pandemic in 2021.
Leavitt also suggested that the CBO’s employees are biased, even though certain budget office workers face strict ethical rules — including restrictions on campaign donations and political activity — to ensure objectivity and impartiality.
“When it comes time to make prognostications on economic growth, they’ve always been wrong,” House Majority Leader Steve Scalise, R-La., said at a press conference.
Asked later if it’s time to get rid of the CBO, Scalise did not dismiss the idea. “I think it’s very valid to raise these concerns that CBO has missed the problems that come with making false estimates,” Scalise said. “Economic growth has been their Achilles’ heel.”
Alongside the costs of the bill, the CBO had previously estimated that nearly 4 million fewer people would have food stamps each month due to the legislation’s proposed changes to the Supplemental Nutrition Assistance Program, known as SNAP.
What’s in the bill
The bill, called the One Big Beautiful Bill Act after the president’s own catch phrase, is grinding its way through Congress, as the top priority of Republicans, who control both the House and the Senate — and face stiff opposition from Democrats at every step in the process.
Democrats call it Trump’s “big, ugly bill.”
All told, the package seeks to extend the individual income tax breaks that had been approved in 2017 but that will expire in December if Congress fails to act, while adding new ones, including no taxes on tips. It also includes a massive buildup of $350 billion for border security, deportations and national security.
To help cover the lost revenue, Republicans want to slash some federal spending. They propose phasing out green energy tax breaks put in place during Democrat Joe Biden’s presidency. New work requirements for some adults up to age 65 on Medicaid and SNAP would begin in December 2026 and are expected to result in less spending on those programs.
The package also would provide a $4 trillion increase to the nation’s debt limit, which is now $36 trillion, to allow more borrowing. The Treasury Department projects the debt limit will need to be raised this summer to pay the nation’s already accrued bills.
CBO aims for impartiality
Now in its 50th year, the CBO was established by law after Congress sought to assert its control, as outlined in the Constitution, over the budget process, in part by setting up the new office as an alternative to the White House’s Office of Management and Budget.
Staffed by some 275 economists, analysts and other employees, the CBO says it seeks to provide Congress with objective, impartial information about budgetary and economic issues.
Its current director, Phillip Swagel, a former Treasury official in Republican President George W. Bush’s administration, was reappointed to a four-year term in 2023.
By LISA MASCARO/Associated Press
Associated Press writers Kevin Freking and Joey Cappelletti contributed to this report.
