US Senate bill could strip health coverage from 11.8 million Americans, slash Medicaid by $1 trillion

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A new analysis by the US Congressional Budget Office shows that the Republican-led Senate’s flagship domestic policy bill would leave 11.8 million more Americans without health insurance by 2034 and slash more than $1 trillion from Medicaid — far exceeding the already steep cuts in the version passed by the House last month, the New York Times reported.

The CBO report, released late Saturday, underscores the dramatic scale of the health care changes embedded in the bill and has deepened divisions within the GOP over how far to go in reducing federal support for public health insurance programs. While fiscal conservatives back aggressive cost-cutting, others warn of severe consequences for vulnerable populations and health providers, especially in rural states.

Deeper Medicaid cuts raise concerns

The Senate bill proposes over $1.1 trillion in health care cuts over the next decade, with Medicaid accounting for more than 90% of that total. The CBO confirmed that this would constitute the most significant rollback of the program since its inception in 1965, reversing decades of expansion under both Republican and Democratic administrations.

The savings come primarily from two provisions: a new nationwide work requirement for some Medicaid recipients, and restrictions on the use of provider taxes that states leverage to draw more federal funds.

Under the Senate plan, Medicaid beneficiaries — including parents of teens over age 14 — would need to prove they worked at least 80 hours in the previous month or qualify for an exemption. This provision alone is projected to save over $325 billion.

Another $375 billion would be cut by curbing state strategies that involve taxing hospitals and other providers to unlock larger federal Medicaid contributions. Unlike the House bill, which freezes current tax rates, the Senate bill would require many states to reduce their taxes starting in 2027.

GOP split over rural health impact

The deep cuts to Medicaid are already drawing resistance from Senate Republicans representing states with rural and low-income populations. Senators Susan Collins of Maine, Josh Hawley of Missouri, and Thom Tillis of North Carolina have publicly raised concerns about the proposal’s impact on their constituents.

In a bid to assuage critics, Senate leaders added a $25 billion rural health care relief fund to the bill on Saturday. But Senator Tillis still voted against advancing the legislation, calling the Medicaid reductions “too extreme.”

Senator Hawley, while acknowledging the Medicaid cuts as “bad,” voted to move the bill forward and indicated he would ultimately support it. Senator Lisa Murkowski of Alaska, a critical swing vote, was the apparent target of a provision added to boost Medicaid and Medicare funding for Alaska and Hawaii — but that clause was struck down Sunday by the Senate parliamentarian for violating budget reconciliation rules.

Parliamentarian blocks key health provisions

The Senate’s nonpartisan parliamentarian is still reviewing elements of the bill to ensure compliance with Senate rules. On Sunday, she ruled that several key health provisions must be removed, including extra payments for Alaska and Hawaii and new administrative hurdles for Medicaid enrolees. A GOP effort to repeal staffing regulations for Medicaid-funded nursing homes also failed the rules test.

Despite these changes, Senator Ron Johnson of Wisconsin said he would introduce an amendment to cut Medicaid even further — specifically targeting the ACA’s Medicaid expansion population. If added, his proposal could increase the number of uninsured and intensify partisan opposition to the bill.

Trump’s no-cuts pledge undercut

The proposed cuts also clash with President Donald Trump’s repeated promises to protect Medicaid from reductions, except in cases of fraud or abuse. While Trump has not commented directly on the CBO’s findings, the magnitude of the Senate proposal could create political risks for Republicans in the 2026 midterm elections, particularly in swing states.

As the bill moves forward, the GOP faces a critical test: whether it can push through its sweeping health care overhaul without alienating moderate senators or provoking public backlash over millions potentially losing health coverage.