Yes, 13.7M in US may lose health insurance as Democrats claim — but GOP bill isn’t only culprit

Claim:

U.S. President Donald Trump’s One Big Beautiful Bill Act would end health insurance coverage for 13.7 million people.

Rating:

What’s True:

According to a Congressional Budget Office preliminary estimate, about 13.7 million people would lose health insurance by 2034 due to what it described as the “combined effects of certain actions.”

What’s False:

Of those 13.7 million, an estimated 8.6 million people would lose health insurance by 2034 as a direct result of Trump’s budget bill.

As U.S. President Donald Trump’s budget package known as the One Big Beautiful Bill Act made its way through Congress in mid-2025, Democrats claimed the legislation would cut nearly 14 million people from Medicaid, the government health insurance for low-income people.

“13.7 million people will lose health care because of their bill,” alleged Pennsylvania Democrat U.S. Rep. Brendan Boyle in a May 13 committee hearing (archived). A clip of his remarks received over 30,000 likes on X as of this writing (archived).

Many other Democrats, including New Yorkers Rep. Alexandria Ocasio-Cortez and Sen. Chuck Schumer, voiced similar claims; videos of their remarks spread on social media platforms like Bluesky (archived). Some Democrats also took to their own social media and accused Republicans of cutting health insurance for about 14 million Americans on platforms like Facebook.

However, Democrats were placing a disproportionate amount of blame on the GOP’s bill. While it is true that millions would lose access to health care should the budget legislation pass, the total would be closer to 8.6 million people, per a May 11, 2025, letter from the Congressional Budget Office (CBO).

CBO also estimated in the same letter how many people may lose health insurance coverage due to other policy decisions — including if lawmakers allow a policy written by Democrats to expire as scheduled. Those actions, taken together, resulted in the CBO estimating that 13.7 million people may lose access to health insurance. Thus, we rate the claim spread by Democratic lawmakers as a mixture of truth and falsehood.

The One Big Beautiful Bill Act passed the House of Representatives on May 22, 2025; it is not law as of this writing. It must pass the Senate and be signed by Trump in order to become law. 

CBO estimates for the GOP bill

On May 11, 2025, by request from Democratic lawmakers, the Congressional Budget Office estimated “the combined effects on health insurance coverage that would result from certain actions.”

(The letter is titled, “E&C Reconciliation Recommendations,” a reference to the U.S. House of Representatives’ Committee on Energy and Commerce’s budget reconciliation recommendations. Budget reconciliation is a Congressional process that expedites passage of funding-related legislation. The One Big Beautiful Bill Act includes these reconciliation recommendations.)

“In total, we estimate that the legislation would reduce the number of people with health insurance by at least 8.6 million in 2034,” CBO said of the GOP’s legislative proposal specifically.

That figure, per the letter, includes 7.7 million people who would lose coverage because of proposed changes to Medicaid in the legislation; see Subtitle D, Part 1 for those Medicaid changes.

Another estimated 900,000 beneficiaries would lose coverage due to new eligibility requirements for health insurance bought under the Affordable Care Act (ACA). Republicans included those ACA requirements in the bill, too — see section 44201, “ADDRESSING WASTE, FRAUD, AND ABUSE IN THE ACA EXCHANGES.”

Add 7.7 million and 900,000 together to get 8.6 million who would lose health insurance by 2034 as a direct result of the GOP’s bill, according to the CBO estimate.

(The letter actually estimates that 1.8 million in total would lose health insurance by 2034 due to the ACA rule changes, but half that number is already included in a separate estimate — the 4.2 million discussed in the paragraph below — because of how CBO handles proposed rules not yet finalized; hence, 900,000 instead of 1.8 million included in the 8.6 million total above.)

Where the 13.7 million figure comes from

Another 4.2 million would lose health insurance coverage in 2034 due to the “expiration of the expanded premium tax credits.” Democrats first established the “premium tax credit” through the Affordable Care Act in 2014, also known as Obamacare. These tax credits help eligible participants pay for health insurance.

While the original credit does not expire, Democrats expanded the subsidy program as part of COVID-19 relief legislation — but set an expiration date for the expanded offerings as Jan. 1, 2026. It is true that Republicans could extend that deadline — but it is not accurate to say that the “Big, Beautiful Bill” ends those tax credits.

Here is the summary CBO provided in its letter (emphasis ours):

In total, CBO estimates that these three actions would increase the number of people without health insurance by at least 13.7 million in 2034. Of that total effect, 5 million—stemming from the expiration of the expanded premium tax credits and half the estimated effect of the proposed marketplace rule—is already reflected in CBO’s baseline projections.

To summarize: Add up 4.2 million, 1.8 million and 7.7 million, and you get the 13.7 million number pushed by Democrats — but only 8.6 million would directly lose health insurance coverage because of the One Big Beautiful Bill Act.

That, however, is according to a preliminary estimate by CBO, not a final one — CBO hasn’t estimated how the interaction between these policy proposals may impact how many people might lose health care. “We anticipate that doing so will somewhat further increase the estimated number of people without health insurance,” CBO wrote in the letter.

The GOP’s bill has also undergone changes since the House passed it and is likely to undergo even more changes once it reaches debate in the Senate.

Sources:

“2025 Marketplace Integrity and Affordability Proposed Rule | CMS.” Cms.gov, 10 Mar. 2025, www.cms.gov/newsroom/fact-sheets/2025-marketplace-integrity-and-affordability-proposed-rule. Accessed 27 May 2025.

Arrington, Jodey. “Text – H.R.1 – 119th Congress (2025-2026): One Big Beautiful Bill Act.” Congress.gov, www.congress.gov/bill/119th-congress/house-bill/1/text. Accessed 27 May 2025.

Congressional Budget Office. Subject: E&c Reconciliation Recommendations. 11 May 2025, democrats-energycommerce.house.gov/sites/evo-subsites/democrats-energycommerce.house.gov/files/evo-media-document/cbo-emails-re-e%26c-reconcilation-scores-may-11%2C-2025.pdf. Accessed 27 May 2025.

“Enhanced Premium Tax Credit Expiration: Frequently Asked Questions.” Congress.gov, www.congress.gov/crs-product/R48290. Accessed 27 May 2025.

“Estimated Budgetary Effects of a Bill to Provide for Reconciliation pursuant to Title II of H. Con. Res. 14, the One Big Beautiful Bill Act.” Congressional Budget Office, 20 May 2025, www.cbo.gov/publication/61420. Accessed 27 May 2025.