A White House analysis released Saturday projects that 8.2 million to 9.2 million Americans could lose health insurance during a potential recession if Congress fails to pass former President Donald Trump’s proposed budget reconciliation bill. The findings, detailed in a memo by the White House Council of Economic Advisers, warn that the expiration of Trump-era tax cuts and other economic shocks could trigger a downturn with cascading effects on healthcare access.
The memo titled “Health Insurance Opportunity Cost if 2025 Proposed Budget Reconciliation Bill Does Not Pass,” estimates the U.S. uninsured population—projected at 27 million in 2025—could surge to 36 million without the legislation. This would be near pre-Affordable Care Act (ACA) levels, when roughly 50 million lacked coverage. The analysis assumes states might scale back Medicaid expansions and unemployment support during a severe recession, while no policy interventions are enacted to mitigate the crisis—a scenario the White House calls a “plausible worst case.”
Economic Risks and Coverage Gaps
The memo ties the potential recession to the 2026 expiration of Trump’s 2017 tax cuts, which it claims could reduce consumer spending, stifle small-business investment, and trigger global confidence declines. A “major recession” might shrink GDP by up to 4% over two years—comparable to the 2008 crisis—and raise unemployment by four percentage points, costing 6.5 million jobs. Of those job losses, approximately 3.9 million individuals could lose employer-sponsored insurance.
Additionally, the analysis forecasts a 15% drop in individual and ACA marketplace enrollment, leaving 3.3 million without coverage. Medicaid and ACA subsidized plans could see 500,000 to 1 million fewer enrollees due to administrative “enrollment frictions.” Vulnerable groups, including gig workers, non-citizens, and early retirees, are expected to bear disproportionate impacts.
Political Hurdles and Bill Details
The proposed legislation, dubbed the “One Big Beautiful Act” by Trump, faces steep challenges in the House, where Republican leaders are racing to pass it by Memorial Day amid internal divisions. House Speaker Mike Johnson (R-La.) has emphasized the bill’s urgency, declaring “failure’s not an option” for measures he claims will aid seniors and workers.
The 1,116-page bill includes over $5 trillion in tax cuts, partially offset by spending reductions and tax code adjustments. Key provisions would permanently extend Trump’s 2017 tax cuts, temporarily eliminate taxes on overtime pay and tips, create a $10,000 tax break for auto loan interest on U.S.-made vehicles, and establish tax-free “MAGA accounts” providing $1,000 to children born during a potential second Trump term.
Criticism and Context
While the White House frames the analysis as a cautionary projection, critics argue it overstates risks to pressure lawmakers. The report acknowledges its estimates rely on aggressive assumptions, including states retracting Medicaid and no federal countermeasures—a dynamic the memo admits is “very unlikely” but theoretically possible.
The bill’s path remains uncertain as GOP leaders navigate a narrowly divided House, where dissent within the party could derail its progress.
