Medicaid Cuts in One Big Beautiful Bill Could Impact 7.7 Million Coverage Losses

The One Big Beautiful Bill Act proposes $625 billion in Medicaid cuts, which the Congressional Budget Office (CBO) estimates could lead to 7.7 million people losing health insurance coverage. Speaker of the House Mike Johnson denied these were cuts, describing the reductions as targeting Medicaid waste, fraud, and abuse, with specific emphasis on unauthorized immigrant coverage and able-bodied, non-working Medicaid recipients.

However, undocumented immigrants are not eligible for Medicaid under federal law, and the alleged numbers cited are from state-funded programs, not Medicaid itself. Furthermore, able-bodied individuals receiving Medicaid legally qualify under current eligibility rules, and there is no evidence that non-working recipients constitute fraud.

The proposal includes a requirement that Medicaid recipients work, volunteer or attend school for 80 hours monthly, a policy that has been criticized for potentially disqualifying eligible individuals due to administrative barriers and could negatively impact rural hospitals and low-income workers.

The CBO projects that restrictive changes in Medicaid and the Affordable Care Act within the bill will lead to almost 8 million people losing coverage, with other analyses suggesting even higher numbers at risk. The bill also omits renewal of expanded health coverage tax credits from the Inflation Reduction Act, which could cause an additional 4.2 million people, many working-class, to lose coverage.

These combined effects mark a significant shift in Medicaid and health coverage policy, with implications for coverage access and affordability among vulnerable populations including low-income and working-class Americans. The bill's framing as a measure to eliminate fraud and waste is contested, and expert analysis suggests it would reduce eligibility and access rather than solely improve program integrity.