This post contains excerpts of an article originally published by Truthout.
In a letter sent to Senate leaders on June 3, a team of health experts at Yale University and the University of Pennsylvania warn that funding cuts included in the budget Big Beautiful bill narrowly passed by House Republicans last month would lead to 51,000 more people dying across the United States each year.
The reconciliation package, labeled the “big beautiful bill” by President Donald Trump, includes deep cuts to Medicaid, which provides health insurance for lower-income and disabled people.
The Congressional Budget Office (CBO) estimates that a total of 10.9 million people will lose health insurance by 2034 if the current bill becomes law and Congress allows cuts to Medicaid and the Affordable Care Act Marketplace to go through.
An additional 5.1 million people would lose coverage because the bill fails to extend tax credits for ACA Marketplace plans, and Health and Human Services has proposed new rules limiting the program’s enrollment periods and making other changes, bringing the total to 16 million.
The estimate of 51,000 preventable deaths is based on details from a previous analysis from CBO, which initially found that 13.7 million people would lose their health care coverage by 2034. Since CBO has now revised that estimate to be higher in response to queries from Democrats, the estimate of 51,000 deaths could, in fact, be an undercount.
The legislation would also repeal federal safe staffing standards that require nursing homes and long-term care facilities to maintain a minimum ratio of nurses to patients in order to provide proper care, which the researchers estimate would result in 13,000 additional deaths annually.
The Senate is taking up the “big, beautiful bill” after House Republicans passed the budget package on a razor thin, one-vote margin, despite protests from Democrats and a handful of moderate Republicans from swing districts.
Sen. Ron Wyden (D-Oregon) and Sen. Bernie Sanders (I-Vermont) requested the analysis on mortality as ranking members on the Senate Budget Committee and the Health, Education, Labor, and Pensions (HELP) Committee, respectively.
“In other words, when you throw 13.7 million Americans off the health care they have … when you increase the cost of prescription drugs for low-income seniors, and when you make nursing homes throughout America less safe, not only will some of the most vulnerable people throughout our country suffer, but tens of thousands will die,” Sanders said in a statement on Tuesday.
The latest calculations from public health experts adds to a growing pile of research on the devastating potentialz impacts of budget cuts, which Trump and his fellow Republicans are pushing for to cover tax cuts that disproportionately benefit the wealthy. If the current bill becomes law, annual cuts to Medicaid would average over $70 billion over the coming years — the same amount millionaires and billionaires would gain in tax cuts each year, according to the Economic Policy Institute (EPI).
Even with those cuts to critical health care programs, the budget package is projected to increase the national debt by $3.1 trillion over the next decade, according to the nonpartisan Committee for a Responsible Federal Budget.
In an open letter to the Senate on Monday, EPI and six Nobel laureate economists said the nation’s structural deficits are already too high, and the bill would put upward pressure on inflation and interest rates while reducing incomes for the bottom 40 percent of earners. Taken together, the economists wrote, “the House budget constitutes an extremely large upward redistribution of income” while adding to the national debt.
“These steep cuts to the social safety net are being undertaken to defray the staggering cost of the tax cuts included in the House bill, including the hidden cost of preserving the large corporate income tax cut passed in the 2017 tax law,” the economists wrote. “But even these sharp spending cuts will pay for far less than half of the tax cuts (not even including the cost of maintaining the corporate income tax cuts of the 2017 law).”
The budget reconciliation package makes cuts to health care funding in multiple ways, although the proposal to impose work requirements on adult Medicaid enrollees has received the most media attention. The researchers at Yale and the University of Pennsylvania focused on three policies impacting three distinct groups: individuals who will lose all Medicaid coverage, lower-income seniors who will lose subsidies that help pay for prescription drugs, and people who are expected to die in nursing homes if the safe staffing requirements are removed.
According to their data, the researchers estimated an additional 51,000 preventable deaths annually, including:
11,300 deaths from the loss of Medicaid or Affordable Care Act Marketplace coverage, given that CBO first estimated 7.7 million people will lose coverage. That number has since been updated to 10.9 million.
18,200 deaths due to the loss of Medicaid coverage among 1.38 million low-income Medicare beneficiaries, causing loss of access to low-income prescription drug subsidies.
13,000 deaths among Medicaid enrollees in nursing homes due to the rollback of 2024 nursing home minimum staffing rule.
In addition, the bill does not extend 2021’s enhanced premium tax credits for ACA Marketplace insurance plans. If lawmakers allow these tax credits to expire and the rule changes at the Department of Health and Human Services become effective, an estimated 5.1 million people will lose affordable health insurance, leading to an additional estimated 8,811 preventable deaths, bringing the total to at least 51,000.
“We know that when people are enrolled in Medicaid it saves lives compared to people not having health coverage, and we know the bill will increase churn and disenrollment in Medicaid,” said Rachel Werner, director of the University of Pennsylvania’s Leonard Davis Institute of Health Economics and co-author of the analysis, in an interview. “It’s estimated that millions will lose coverage, and that will translate to loss of life.”
Polling consistently shows that cuts to Medicaid and the health care safety net are deeply unpopular, and many rural and lower-income districts in red states depend on Medicaid to keep hospitals and clinics running. Perhaps this explains why Trump has made a show of publicly urging House Republicans not to “touch” Medicaid. Now that Medicaid is indeed on the chopping block, Trump and his allies in Congress are turning to lies and misinformation.
In a statement on Monday, the White House said the idea that “people will literally die” due to Medicaid cuts is a “hoax” and a “disgusting lie” told by Democrats. The bill would penalize states that used their own funds to expand Medicaid to cover some immigrants who would not qualify for federal funding; the White House claimed Medicaid would be “strengthened” by removing 1.4 million undocumented immigrants from the rolls. That coverage loss would also extend to documented children and pregnant women under the proposed policy, according to the Kaiser Family Foundation (KFF), a top health policy think tank.
Trump and his allies in Congress are also defending controversial Medicaid work requirements included in the House bill, which would require adult recipients to prove that they are working at least 80 hours per month to maintain their health coverage. People with disabilities would also likely be required to prove they qualify for exceptions, and all enrollees would face more paperwork and barriers to coverage. The policy would reduce federal spending by $280 billion over 10 years by kicking people off Medicaid rolls.
The White House said on Monday that “4.8 million able-bodied adults on Medicaid are choosing not to work,” a claim also made by Republican House Speaker Mike Johnson, who recently told NBC’s Meet the Press that the 4.8 million people are “refusing” to work and will not lose coverage “if they choose too.”
However, as the Washingtons Post points out, 4.8 million is the number of people estimated to become uninsured due to work requirements, not the number of young men “sitting around and playing video games” instead of getting a job, as Johnson has previously suggested. KFF analysis shows 92 percent of adults on Medicaid are either working or likely qualify for exceptions to work requirements, as most Medicaid enrollees who do not work are caregivers, parents, students, or have a disability.
Arkansas instituted Medicaid work requirements in 2018, which led to 18,000 adults losing health coverage over the four months before a court stepped in to halt further implementation. A study by Harvard University researchers found the work requirements were effective at cutting Medicaid rolls during that time period but had no effect on employment. Research on other states has found that few programs linked to Medicaid work requirements actually help enrollees find jobs.
Some Republicans have outright lied about the reconciliation bill, suggesting they are not pursuing Medicaid cuts when they are. Others are resorting to callous mockery. When constituents confronted Sen. Joni Ernst of Iowa at a recent town hall with questions about people dying without health coverage, she shrugged and told them: “Well, we all are going to die.”
After a video of the exchange went viral, Ernst doubled down with a bizarre video in what appears to be a graveyard, suggesting that those who are afraid of preventable deaths under the Medicaid cuts are like children who believe in the tooth fairy and should embrace “my lord and savior, Jesus Christ.”
“Sen. Ernst’s flippant comments over the weekend reveal a grim reality: Republicans in Congress know that their tax bill will rip away lifesaving health care from their constituents, jeopardizing lives just to pad billionaires’ pockets … and they just don’t care,” said Kobie Christian, a spokesperson for the economic justice campaign Unrig Our Economy, in a statement.
The “big, beautiful bill” will likely undergo changes in the Senate, where conservative fiscal hawks are anxious about increasing the federal deficit, and defenders of public health refuse to blow holes in a safety net that provides coverage for millions of people in order to pay for tax cuts.
“In the wealthiest country in the world, we should be guaranteeing health care to all as a human right, not taking health care away from millions of seniors and working families to pay for tax breaks for billionaires,” Sanders said.
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