A sweeping budget and tax package championed by former President Trump is projected to strip nearly 12 million Americans of health coverage by 2034, according to the nonpartisan Congressional Budget Office (CBO). Encompassing extensive tax cuts and sweeping spending reductions—especially to Medicaid and the Affordable Care Act (ACA)—the bill carries profound implications for low-income families, seniors, people with disabilities, and rural communities.

The Senate-backed version, dubbed the “One Big Beautiful Bill,” would extend Trump's 2017 tax cuts and introduce new exemptions (such as for tips and overtime pay), while enacting approximately $1 trillion in cuts to Medicaid and significant reductions to ACA subsidies. The CBO projects that around 11.8 million people could lose insurance, nearly 1 million more than under the House-passed version. Those most affected include working-age adults, children, and people with disabilities who rely heavily on Medicaid.

Key provisions include imposing work requirements and new co-payments on Medicaid recipients, while reducing eligibility thresholds and tightening access statewide. Key provisions include imposing work requirements and new co-payments on Medicaid recipients, while reducing eligibility thresholds and tightening access statewide. Medicaid-reliant rural hospitals warn these cuts could destabilize their operations, causing closures that hurt entire communities, even those who hold private insurance.

Health policy experts are sounding the alarm. A Washington Post–SYG interview highlighted that this bill could result in: 1.3 million Americans losing access to essential medications. 1.2 million are struggling with medical debt. 380,000 women are missing preventive screenings like mammograms. More than 16,500 annual deaths are tied to coverage loss. Critics argue that the package funnels wealth toward the highest earners—through trillions in tax breaks—while eroding the social safety net.

A study from The Guardian contended that it “benefits the wealthy at the expense of middle- and low-income Americans,” resulting in up to 13.7 million people losing health coverage when Medicaid and ACA losses are combined. Republican defenders affirm that the cuts are essential to rein in federal spending and promote work incentives, although some GOP senators, such as Thom Tillis and Susan Collins, caution that the economic and human costs—particularly in rural and vulnerable communities—are too great.

With a procedural vote already passed by a razor-thin 51–49 margin, the Senate continues its debate in this "vote-a-rama" phase, racing to meet a July 4 deadline. The bill may pass in a revised form, but not without fierce bipartisan contention and potential amendments aimed at easing the health provisions. In summary, Trump's budget proposal represents one of the most significant rollbacks of health coverage in modern U.S. history. While it delivers generous tax cuts to the wealthy, the CBO warns that the price could be catastrophic for millions who depend on Medicaid and ACA support, raising critical questions about the balance between deficit reduction and access to care.