Study details
Earlier this month, President Donald Trump signed the OBBBA into law, which includes almost $1 trillion in cuts to federal healthcare programs, according to an estimate from KFF, including at least $940 billion in Medicaid cuts.
Many of the Medicaid cuts will come through work requirements and reduced federal funding. Most changes aren't slated to take effect until 2027 or 2028.
In the study, researchers based their projections on an earlier estimate from the Congressional Budget Office that found changes to Medicaid could result in 7.6 million people in the United States losing their health insurance by 2034.
The study found that these cuts could result in over 1,000 additional deaths and nearly 100,000 additional hospitalizations each year, and that 1.6 million people could delay seeking care. A worst-case scenario in the study projects around 2,000 additional deaths each year and estimates that up to 2.5 million people could delay seeking care.
According to Sanjay Basu, the author of the study, an epidemiologist and physician at the University of California, San Francisco, and CMO at Waymark, a company that aims to improve access and care to Medicaid patients, the coverage losses are expected to lead people to delay seeking care because they can no longer afford it.
"People tend to worry about cost or coverage," Basu said, so they avoid care until "they end up hospitalized or found at home, dead, from an uncontrolled condition."
In addition, the study also projected that 1.9 million people each year will skip, delay, or not take their medication as prescribed. It also estimated that the Medicaid cuts in the OBBBA will lead to an additional $7.6 billion in medical debt in the United States.
The study also projected that by 2034, more than 100 rural hospitals could be at risk of closure, more than 300,000 jobs could be lost, and the economy could shrink by around $135 billion. In its worst-case scenario projection, 408,000 jobs were lost and the economy shrank by $182 billion.
Basu noted the report's projections are likely "an underestimate" and noted that it doesn't take into account OBBBA's changes to the Affordable Care Act.
The estimates also assume that states will be able to make the changes required of them to their Medicaid programs, like setting up systems to track work requirements, within the two- to three-year period, Basu said.
"This stuff is actually quite complicated for a state, and the deadlines are not too long from now," Basu said. "We're not sure how many people will be dropped, not because they're no longer eligible, but because they procedurally can't get through things."
Basu also noted that loss of health coverage will impact consumer spending, which will affect the broader economy.
"If people have better health insurance coverage, they tend to be able to spend on other things," he said. "So you might be able to spend on your rent or food or other expenditures, and not be saving as much for your medication copays or other health-related expenditures."
Basu added that it's still possible to mitigate some of the potential harm caused by the OBBBA through added private funding.
RELATED resources
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- How you can prepare for the financial impacts of Trump-era policies
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- CBO: House bill would cost $2.4T, cause nearly 11M to lose health insurance
- $1T in healthcare cuts: What 'One Big Beautiful Bill Act' means for the industry
Discussion
The study reached a similar conclusion to another study published in the Annals of Internal Medicine in June that found the Medicaid cuts in the OBBBA could lead to 7.6 million people losing their insurance and over 16,000 preventable deaths each year because people delay care and got sicker.
However, those projections are at odds with comments made by HHS Secretary Robert F. Kennedy Jr., who said during an interview that the OBBBA is "not going to cut Medicaid and there's nobody who is going to die from this."
Jennifer Tolbert, deputy director of the program on Medicaid and the uninsured at KFF, said other studies have shown repeatedly that uninsured people are less likely than insured people to get preventive care and treatments for major health conditions and chronic diseases.
Nearly a third of uninsured adults report delaying or skipping care because of cost, compared to 6% of insured adults, according to a report from KFF.
"The consequences [of delaying care] can be severe, particularly when preventable conditions or chronic diseases go undetected," Tolbert said.
Benjamin Sommers, a physician and health economist at Harvard T.H. Chan School of Public Health, said that people often don't know they've lost their insurance coverage until they see their doctor and can face large bills.
Sommers published a study in the New England Journal of Medicine in 2019 that examined the impact of Medicaid work requirements implemented in Arkansas. While the program ended 10 months before any clear data was available on hospitalizations or deaths, the study found that the uninsured rate among Arkansans ages 30-49 rose from 10.5% in 2016 to 14.5% in 2018.
Sommers' study also found that around a third of those surveyed in the study had not heard of the work requirements, but nearly half were unsure whether the policy applied to them, and among those required to report, only 49.3% did so regularly.
"There are a lot of different ways people can experience this type of bureaucracy," Sommers said. "The red tape, starting with just not even understanding what the policy means and how it applies to them."
(Lovelace Jr., NBC News, 7/16; Cara, Gizmodo, 7/16; Olsen, Healthcare Dive, 7/16; Russo, STAT+ [subscription required], 6/16)
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