Comparison to the Last Major Health Bill, the Affordable Care Act
While most think that the House-passed budget reconciliation bill is about tax cuts and the budget, it would also make the largest changes to health care since the Affordable Care Act (ACA). Unlike the effort to pass the ACA, President Trump has not held any public forums or sessions on the megabill, the Republican Congress has not adopted any bipartisan amendments to it, and the public has limited support for it.
The impact of the two bills stands in sharp contract as well. Just before the finals votes to approve the ACA, the Congressional Budget Office projected it would increase health coverage and reduce the nation’s budget deficit; meanwhile, the House-passed bill is currently projected to reduce the number of Americans with health coverage and increase the national deficit and debt, despite its claim of improving the budget outlook (see Table 1).
Health coverage can mean the difference between life and death for people—so their elected representatives and senators should ensure a full debate with input before voting on a bill that transforms American health care.
Table 1
Sources:
White House Forum on Health Reform (March 5, 2009); five Regional White House Forums on Health Reform (March 12, 2009; March 17, 2009; March 23, 2009; March 31, 2009; April 6, 2009); White House Summit (February 25, 2010).
“Overview of the Open, Transparent, Lengthy Process of Enacting the Affordable Care Act,” House Education & Workforce Committee Democrats, July 6, 2017.
Douglas W. Elmendorf, “Manager’s Amendment to Reconciliation Proposal,” Congressional Budget Office Letter, March 20, 2010. Estimated health coverage impact for 2019 and deficit impact for fiscal years 2010 through 2019.
Phillip L. Swagel, “Estimated Effects on the Number of Uninsured People in 2034 Resulting from Policies Incorporated Within CBO’s Baseline Projections and H.R. 1, the One Big Beautiful Bill Act,” Letter, June 4, 2025. Estimated health coverage impact for 2034.
“Estimated Budget Effects of H.R. 1, the One Big Beautiful Bill Act, As passed by the House of Representatives on May 22, 2025,” Congressional Budget Office, June 4, 2025. Estimated deficit impact for fiscal years 2025 through 2034.
Andrew Gelman, Daniel Lee, and Yair Ghitza, “Public Opinion on Health Care Reform,” The Forum: Vol. 8: Iss. 1, Article 8, 2010.
“Majority of Voters Oppose GOP Budget Bill, With Just 67% of Republicans in Support, Quinnipiac University National Poll Finds; Trump Job Approval: 38%, His Handling of Russia – Ukraine War Lowest Among List of Issues,” Quinnipiac University Poll, June 11, 2025. From June 5 to June 9, 2025.
Tags: affordable care act, donald trump, reconciliation
Republicans’ Megabill Would Transform American Health Care. So Why Is It Being Rushed, without Public Debate?
Comparison to the Last Major Health Bill, the Affordable Care Act
While most think that the House-passed budget reconciliation bill is about tax cuts and the budget, it would also make the largest changes to health care since the Affordable Care Act (ACA). Unlike the effort to pass the ACA, President Trump has not held any public forums or sessions on the megabill, the Republican Congress has not adopted any bipartisan amendments to it, and the public has limited support for it.
The impact of the two bills stands in sharp contract as well. Just before the finals votes to approve the ACA, the Congressional Budget Office projected it would increase health coverage and reduce the nation’s budget deficit; meanwhile, the House-passed bill is currently projected to reduce the number of Americans with health coverage and increase the national deficit and debt, despite its claim of improving the budget outlook (see Table 1).
Health coverage can mean the difference between life and death for people—so their elected representatives and senators should ensure a full debate with input before voting on a bill that transforms American health care.
Table 1
Sources:
White House Forum on Health Reform (March 5, 2009); five Regional White House Forums on Health Reform (March 12, 2009; March 17, 2009; March 23, 2009; March 31, 2009; April 6, 2009); White House Summit (February 25, 2010).
“Overview of the Open, Transparent, Lengthy Process of Enacting the Affordable Care Act,” House Education & Workforce Committee Democrats, July 6, 2017.
Douglas W. Elmendorf, “Manager’s Amendment to Reconciliation Proposal,” Congressional Budget Office Letter, March 20, 2010. Estimated health coverage impact for 2019 and deficit impact for fiscal years 2010 through 2019.
Phillip L. Swagel, “Estimated Effects on the Number of Uninsured People in 2034 Resulting from Policies Incorporated Within CBO’s Baseline Projections and H.R. 1, the One Big Beautiful Bill Act,” Letter, June 4, 2025. Estimated health coverage impact for 2034.
“Estimated Budget Effects of H.R. 1, the One Big Beautiful Bill Act, As passed by the House of Representatives on May 22, 2025,” Congressional Budget Office, June 4, 2025. Estimated deficit impact for fiscal years 2025 through 2034.
Andrew Gelman, Daniel Lee, and Yair Ghitza, “Public Opinion on Health Care Reform,” The Forum: Vol. 8: Iss. 1, Article 8, 2010.
“Majority of Voters Oppose GOP Budget Bill, With Just 67% of Republicans in Support, Quinnipiac University National Poll Finds; Trump Job Approval: 38%, His Handling of Russia – Ukraine War Lowest Among List of Issues,” Quinnipiac University Poll, June 11, 2025. From June 5 to June 9, 2025.
Tags: affordable care act, donald trump, reconciliation