GOP Reconciliation Law Projected to Cut Health Coverage for 15 Million by 2034

The upcoming Obamacare open enrollment faces significant uncertainty as enhanced Affordable Care Act (ACA) subsidies are set to expire at the end of the year, potentially causing premiums to spike and leading many to forgo coverage. The recently enacted Republican reconciliation law, known as the "Big Beautiful Bill," is projected to cut over $1 trillion from Medicaid and ACA marketplaces, resulting in an estimated 15 million people losing health coverage by 2034 due to Medicaid cuts, the failure to extend premium tax credits, and new enrollment restrictions. While Republicans tout policies like Individual Coverage Health Reimbursement Arrangements (ICHRAs) to promote individual choice and bolster the ACA market, changes in federal rules and subsidy expirations may make the ACA market less sustainable, threatening the viability of these arrangements. States like Virginia will feel the impact profoundly, with Medicaid program changes possibly causing coverage losses and economic strain on hospitals. Despite some Republican lawmakers expressing openness to extending ACA subsidies, there is little urgency, and ongoing political dynamics complicate timely action. These developments collectively risk destabilizing the health insurance marketplace and increasing the number of uninsured Americans.