The One Big Beautiful Bill Act proposed by President Donald Trump has stirred controversy as it moves to the Senate after clearing the House. Critics argue that the legislation, which aims to reduce “waste, fraud, and abuse” in government health programs, would have severe consequences for millions of Americans. If passed, the bill could result in millions losing their Medicaid coverage and facing challenges in obtaining health insurance through the Affordable Care Act marketplaces.
Dubbed as Obamacare Repeal Lite by its opponents, the One Big Beautiful Bill Act represents the most significant rollback of the ACA since previous Republican efforts in 2017. While Republicans are avoiding the term “repeal” this time around, Democrats are quick to highlight the potential negative impact on the healthcare system. With nearly two-thirds of adults having a favorable view of the ACA, according to KFF polling, concerns about the proposed changes are mounting.
The House-passed bill includes provisions that could lead to approximately 9 million more people without health insurance by 2034, according to the Congressional Budget Office. This number could rise to nearly 14 million if enhanced subsidies for Obamacare plans are not extended. The potential expiration of these subsidies, coupled with changes in the bill such as shorter open enrollment periods and increased paperwork requirements, could have a devastating impact on the ACA marketplace.
While Republicans argue that the ACA subsidies are a separate issue from the One Big Beautiful Bill Act, critics warn of the potential consequences of the proposed changes. The new administrative hurdles and requirements, such as more frequent eligibility checks and copayments for Medicaid services, could result in people dropping or losing coverage. Studies show that such obstacles tend to affect healthier, younger, and lower-income individuals the most, leading to adverse effects on the insurance market.
Despite claims that the bill is not a full-on assault on the ACA, concerns remain about the potential loss of coverage and access to care for millions of Americans. While the projected number of people losing health insurance may be lower compared to previous estimates, the impact on the ACA’s coverage gains and the uninsured rate in the U.S. could still be significant. Critics argue that the bill, if passed, would represent a step backward in the progress made towards improving healthcare access and coverage for all Americans.
