Senate GOP Budget Plan Projects 11.8 Million to Lose Coverage, Triggers $1.1 Trillion in Health Care Cuts
New analysis warns of sweeping Medicaid changes and rising uninsured rates under Republicans’ flagship tax-and-spending bill
In Washington on Saturday, Senate Republicans advanced a sweeping tax and budget overhaul that could lead to 11.8 million Americans losing health insurance by 2034, while slashing over $1.1 trillion in federal health care spending—primarily from Medicaid—according to a report by The Washington Post.
CBO Report Projects Sharp Medicaid Declines
The nonpartisan Congressional Budget Office (CBO) estimates that the Senate version of the “One Big Beautiful Bill” would increase the number of uninsured Americans by nearly 1 million more than the House-passed counterpart. This includes an estimated 1.4 million individuals without verified immigration or citizenship status who are expected to lose their state-sponsored health coverage, as noted by STAT News.
Most of the $1.1 trillion in projected savings would come from Medicaid alone, with smaller reductions proposed for Medicare and subsidies under the Affordable Care Act. According to The Washington Post, the scale of these reductions represents the most significant contraction of public health programs in decades.
Despite repeated assurances from President Donald Trump that only waste, fraud, and abuse would be targeted, the CBO concluded the legislation marks an “unprecedented” rollback of the Medicaid program, which currently covers over 70 million low-income Americans.
Work Mandates and Provider Tax Reforms Drive Savings
A core feature of the bill is the nationwide expansion of Medicaid work requirements. For the first time, Medicaid beneficiaries—including low-income parents of children over age 14—would be required to verify at least 80 hours per month of work, job training, or education to remain eligible. These new mandates, broader than those in the House version, are projected to reduce federal spending by $325 billion over ten years, according to the Center on Budget and Policy Priorities.
These requirements could lead to approximately 4.8 million people losing Medicaid coverage, Axios reported.
Additionally, the bill seeks to limit how states use taxes on health care providers to increase their federal Medicaid match. Currently, states impose provider taxes and return the funds to hospitals through higher reimbursements. The Senate bill would cap this practice, potentially cutting an additional $191 billion in federal spending over the next decade, as noted by AP News.
Resistance from Senators in Rural States
The proposed changes to provider tax rules have drawn opposition from Republican senators representing rural and medically underserved states. Lawmakers including Josh Hawley (R-Mo.), Susan Collins (R-Maine), Lisa Murkowski (R-Alaska), and Thom Tillis (R-N.C.) have raised concerns about disproportionate impacts on hospitals that serve low-income and rural populations, according to Newsweek.
While the House version would freeze provider tax rates, the Senate bill mandates reductions in several states. In response to intra-party pushback, the bill allocates $25 billion to a stabilization fund for rural hospitals. Still, the provision failed to win over Tillis, who voted with Democrats against a key procedural motion on Saturday. Hawley, despite voicing reservations, supported the motion and affirmed his support for the overall legislation, as reported by Agri-Pulse.
Legislative Clock Ticking Ahead of Holiday Deadline
As negotiations continue behind closed doors, several provisions in the bill remain subject to change pending review by the Senate parliamentarian. Key aspects must comply with budget reconciliation rules, which allow the bill to bypass a filibuster but impose strict procedural constraints.
With the White House setting a July 4 deadline, Senate leaders are aiming to secure final passage before the holiday. The bill would then return to the House for approval before being presented to President Trump for signing.
Medicaid Cuts Could Reshape U.S. Health Policy
The legislation’s sweeping Medicaid cuts and new eligibility restrictions could significantly alter how federal health programs function. If enacted, these Medicaid cuts would set a precedent for shifting coverage responsibilities away from the federal government and toward states, raising questions about long-term access for vulnerable populations.