House GOP Plan Could End Coverage for Millions by 2034

The House Republican reconciliation plan proposes significant cuts to Medicaid and the Affordable Care Act (ACA) subsidies, which are projected to leave millions of Americans without health insurance by 2034. According to a partial analysis by the Congressional Budget Office (CBO), approximately 9.5 million people could lose coverage, with the number possibly rising as further analyses are completed.

The plan aims to reduce eligibility and make enrollment processes more stringent, coupled with shifting greater Medicaid costs from the federal government to states. These changes would introduce more barriers for eligible individuals to maintain coverage, such as new work requirements for Medicaid and revoking certain Biden-era enrollment streamlining rules. Prior state experiences with similar work requirements indicate many enrollees failed to maintain coverage due to administrative hurdles rather than non-compliance. In addition to Medicaid, the plan would tighten ACA marketplace enrollment windows, increase documentation requirements, and restrict eligibility for certain legal immigrants.

The shift in Medicaid financing includes limiting provider tax arrangements, which states use to amplify federal matching funds, potentially reducing both program funding and provider payments. The cumulative impact of these policies, alongside the anticipated expiration of enhanced ACA subsidies, could result in nearly 15 million people losing coverage, reversing years of progress in reducing the uninsured rate.

This policy direction reflects a broader partisan debate over federal health priorities and fiscal strategy, with Republicans prioritizing federal budget savings and Democrats expressing concerns over coverage losses and public health implications. Policymakers considering this path face the challenge of balancing fiscal goals with the potential reduction in health coverage for vulnerable populations.