Alliance Alert: A new analysis from the Congressional Budget Office confirms what we’ve feared: the House-passed federal budget bill could strip 16 million people of their health coverage if enacted without changes. This devastating impact would fall primarily on low-income individuals and families, disproportionately affecting people with mental health and substance use challenges, those living in poverty, and communities of color.
Among the most damaging provisions:
- Medicaid Work Requirements: Over 4.8 million people could lose health insurance under new, restrictive work-reporting mandates that make staying enrolled burdensome—even for those who qualify.
- Cuts to ACA Subsidies: Another 5.1 million could lose coverage if enhanced premium tax credits under the Affordable Care Act are allowed to expire.
- Attacks on Immigrants: The bill bars key immigrant populations from ACA subsidies and Medicaid coverage, potentially forcing 1 million people off insurance.
- Housing and SNAP Threats: These cuts follow a broader Trump-era budget agenda that slashes housing and food assistance programs, worsening instability for people already struggling to survive.
The Alliance for Rights and Recovery joins national and statewide advocates in demanding the Senate amend this harmful legislation. Senators must reject Medicaid cuts, protect ACA subsidies, defend immigrant access to care, and ensure housing and food assistance programs remain strong. We urge our partners, allies, and communities to raise their voices now—because people’s lives and recovery depend on it.
Our Call to Action
The Senate must protect Medicaid as a lifeline for millions—especially as the mental health and substance use crises continue to grow. We urge the Senate to:
- Strip Medicaid cuts from the budget bill
- Reject work requirements and punitive measures that harm the most vulnerable
- Prioritize health equity, community services, and the right to access health services without discrimination
This is a critical moment. If we don’t act, New York could lose billions in Medicaid funding, leaving more than 1.5 million people without access to health services. We urge all allies to contact your Senators now—let them know that protecting Medicaid is non-negotiable.
Take action today by visiting: Take Action Now!
You can also call 1-855-245-3682 to talk to your senators and tell them to vote NO on the reconciliation bill if there are no significant changes.
We will continue to fight for a federal budget that centers dignity, access, and support—not exclusion.
16 Million Could Lose Health Insurance Under GOP Policies, CBO Finds
By Ben Leonard and Robert King | Politico | May 4, 2025
Sixteen million people could lose health insurance if a House-passed budget bill becomes law, according to new estimates from the Congressional Budget Office.
Capitol Hill’s nonpartisan scorekeeper said that would be the likely result if the House-passed megabill becomes law, the Affordable Care Act’s enhanced subsidies expire as scheduled, and the Trump administration implements new health care rules.
Democrats asked the CBO to produce the study. They oppose the megabill and Trump’s rules and want to extend the subsidies a Democratic Congress and then-President Joe Biden expanded in a 2021 law. Democrats want to draw attention to the depth of health insurance losses that could result from Republicans’ efforts to extract major savings from Medicaid and other health programs. Democrats say the coverage losses would be devastating.
Republicans have accused Democrats of fearmongering about the extent of Medicaid coverage losses under their proposals.
“I’m not buying it,” House Speaker Mike Johnson told reporters Wednesday when asked about a separate CBO analysis released Wednesday that found nearly 11 million people would lose coverage under the House GOP megabill. “These assumptions are wrong. We are not cutting Medicaid.”
A major share of the coverage losses would be from Medicaid, the state-federal insurance program for low-income people. The House bill would require most recipients to certify twice a year that they are working, in school, or volunteering for at least 80 hours a month. The rule would exempt children, pregnant women and new mothers.
The Senate has not yet taken up the megabill and Republicans there plan to make changes.
On the ACA subsidies, Republicans are tasked with a difficult choice at the end of the year: Let the subsidies expire and see premiums rise heading into an election year, or greenlight significant new spending to continue the subsidies in some fashion. Some Republicans, including Sens. Lisa Murkowski (R-Alaska) and Thom Tillis (R-N.C.) and Rep. David Valadao (R-Calif.) have signaled support for an extension, but key GOP leaders have been skeptical.
Democrats expanded subsidies to middle-income people in 2021’s American Rescue Plan Act and then extended them through this year in 2022’s Inflation Reduction Act.
The CBO estimates letting those enhanced premium tax credits expire would lead to 5.1 million people losing health coverage in 2034.
The new CBO analysis also gave new details on the specific impacts of Medicaid policies in Republicans’ megabill.
Requirements that recipients work, volunteer or go to school, the largest source of savings in the bill at $344 billion, would lead to 4.8 million people losing health insurance. Policies reducing the federal share of payment to states who use their own funding to offer coverage to undocumented people would lead to 1.4 million people losing health coverage, the CBO estimated, because many states would pull back on those policies.
Here are some of the other impacts of megabill policies that CBO analyzed:
- Provider tax moratorium: The bill would place a moratorium on any new taxes that states levy on their hospitals. States can use revenue from the taxes to draw down more federal money for Medicaid and make hospitals whole by charging higher payment rates. The moratorium would likely lead states to reduce available resources for their Medicaid programs and change enrollment policies to “make enrollment more challenging to navigate,” the report said. All told, 400,000 people would lose insurance through 2034.
- Return of ACA payments: A last-minute change to the bill returns payments to insurers to reimburse them for covering reduced cost-sharing for low-income customers. However, it would likely end a loophole that plans and states have used to recoup the cost of the cost-sharing reductions by inflating the value of income-based tax credits. CBO estimates that 300,000 people would lose their coverage by 2034.
Changes to ACA eligibility: The bill includes several other ACA changes such as ending a special enrollment period for people who earn 150 percent or less of the federal poverty level, erasing a 2024 rule that enabled them to enroll at any point in the year. This provision would lead to 200,000 losing insurance through 2034. The bill would also prohibit some immigrants, such as those with pending asylum applications, immigrants permitted to stay in the country under former President Barack Obama’s Deferred Action for Childhood Arrivals program and trafficking victims from getting income-based subsidies on the exchanges. This would lead to 1 million people losing coverage. Stricter verification requirements for ACA customers to qualify for subsidies would also cause 700,000 people to drop off coverage through 2034.