The health care debate is heating up again, and this time, the stakes feel even higher. With former President Donald Trump backing a sweeping new budget proposal—what he once called his “one big, beautiful bill”—millions of Americans may soon find themselves without coverage. Experts, doctors, and everyday people are warning that this bill could undo years of slow but steady progress in expanding health care access.
How many Americans could lose insurance?
Let us start with the numbers. According to estimates from the nonpartisan Congressional Budget Office (CBO):
- 10.9 million Americans could lose their health insurance by 2034 if the House version of the bill becomes law.
- If certain provisions expire or change—such as the Affordable Care Act (ACA) tax credits—that number could climb to 16 million.
That is not just a statistic. That is someone’s father. Someone’s neighbor. Maybe even you.
Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured, put it bluntly: “The effects could be catastrophic.”
What is in trump’s health care bill?
While Trump’s “one big, beautiful bill” focuses on broad budget cuts and tax breaks, it carries major health care consequences:
- Medicaid work requirements: The bill proposes that some Medicaid recipients must work, volunteer, or train for 80 hours per month to stay covered.
- Reduced Medicaid funding: Billions in cuts to federal Medicaid support would shift costs to the states.
- Tougher eligibility checks: Recipients could be removed from the program if they fail to meet new, more frequent checks.
Supporters argue this will lower government spending and encourage work. But critics say these changes will create more barriers for people who are already struggling to stay afloat.
Who would be most affected by the cuts?
If you are living paycheck to paycheck, working a low-wage job, or in recovery from an illness, this bill could hit you hardest. Others include:
- People in non-expansion states: States like Georgia and Alabama that did not expand Medicaid under the ACA already have high uninsured rates.
- Low-income families: Many earn just enough to miss Medicaid eligibility but not enough to afford ACA premiums.
- People of color: Uninsured rates are disproportionately higher among Black and Latino communities.
Alton Fry from Clarkesville, Georgia, knows this story all too well. After being diagnosed with prostate cancer, Fry found himself without insurance, with treatment costs piling up. He said, “There is no help for middle-class America.”
Why work requirements are causing concern
The idea behind requiring Medicaid recipients to work sounds simple. But in real life, it is not that easy.
Labon McKenzie, a 45-year-old from rural Georgia, fell through a skylight three years ago while working. He broke multiple bones and was later fired. He has not been able to work since.
He has not been approved for disability benefits and cannot afford care.
“I just want my body fixed,” he said.
Under the new bill, people like McKenzie—who are physically unable to work but not officially classified as disabled—could lose Medicaid altogether.
How america’s patchwork system makes it worse
The United States has a very complex and divided health care system:
- Employer-based insurance
- Medicare for seniors
- Medicaid for low-income individuals
- ACA marketplace plans for others
But there is no single place to go. That means millions fall through the cracks.
Sherry Glied, dean at NYU’s Wagner School of Public Service, summed it up:
“The big bug is that people fall between the cracks.”
Over half of uninsured Americans today qualify for assistance—but many do not know, cannot navigate the system, or simply cannot afford even the “affordable” options.
What happens when people lose insurance?
The evidence is clear:
- People delay or skip treatment
- They avoid seeing doctors
- Chronic conditions worsen
- Medical debt piles up
Take Kiana George from Camden, Alabama. She was removed from Medicaid after taking a part-time job that pays $800 a month. She now owes nearly $7,000 from a hospital stay and has stopped treatment for ovarian cysts.
“It hurts,” she said, “but I am just gonna take my chances.”
This is what the future could look like for millions if the bill becomes law.
Is there a better way?
Experts say fixing the system would take bold changes—like decoupling insurance from employment, simplifying coverage, and ensuring more people can access care regardless of income or job status.
But this bill moves in the opposite direction.
Aaron Carroll, president of the nonprofit AcademyHealth, said it best:
“There is a ton of evidence that shows that if you make people pay more for health care, they get less health care.”
And when that happens, it is not just about losing coverage. It is about losing lives.
