The House budget reconciliation bill, dubbed the “One Big Beautiful Bill Act,” includes large cuts in Medicaid spending that could lead to millions of newly uninsured individuals if the legislation passes in the Senate. The proposed law also contains provisions that alter the Affordable Care Act exchange landscape, potentially leading to millions more uninsured. The Congressional Budget Office estimates that at least five million current marketplace enrollees would lose coverage by 2034. The nonpartisan and policy research firm KFF says the number of people with marketplace plans could shrink even more, by around eight million .

Changes in the ACA marketplace would make coverage more expensive, as enhanced tax credits expire, and harder to obtain as open enrollment windows shorten,

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