The tax and spending bill that Republicans are pushing in the United States Congress, with the support of Donald Trump, will leave 10.9 million people without health coverage, according to calculations by the Congressional Budget Office (CBO), a technical and nonpartisan agency. The office has updated its figures to reflect the modifications included in the House of Representatives before just a single vote approved it.
Trump’s tax bill has come under fire from all fronts. Even Elon Musk — Trump’s former right-hand man — has criticized the measure. “I just can’t stand it anymore. This massive, outrageous, pork-filled Congressional spending bill is a disgusting abomination,” said the world’s richest man in a post on Tuesday.
The estimates, published by the CBO in a spreadsheet, indicate that the law will result in a loss of $3.67 trillion in revenue over 10 years, while spending cuts are estimated at $1.25 trillion. This leads to the calculation of a $2.42 trillion increase in the deficit over that period. The debt increase would be higher when accounting for interest payments to finance that deficit. The CBO has not yet completed its analysis of the macroeconomic impact of the more than 1,000-page law, dubbed by Trump as the “big, beautiful bill.”
After the additional cuts included during the parliamentary process, the CBO report indicates that the measures could leave 10.9 million people without health insurance by 2034. This includes 1.4 million people without verified citizenship, nationality, or satisfactory immigration status, who would lose coverage under programs funded exclusively by the states. The cuts would affect the two main public health insurance programs: Medicaid and Medicare.
The CBO had previously estimated that nearly four million fewer people would receive food stamps each month due to the proposed changes in the Supplemental Nutrition Assistance Program (SNAP) legislation.
The cuts are implemented through new work requirements to qualify for health coverage or food assistance. The new rules, affecting some adults up to 65 years old, would take effect in December 2026. At an event in Des Moines, Iowa, with voters, Republican Senator Joni Ernst tried to defend the cuts but was rebuked by the audience, who said that without healthcare, people will die. “People are not… Well, we’re all going to die,” she responded, to the outrage of those present.
Democrats have particularly criticized these cuts and those related to food aid programs. Trump has also proposed cuts to scholarships for low-income families and medical research programs, among many others.
The Republicans are struggling with a difficult balancing act. The fiscal hawks are demanding deeper cuts or fewer tax breaks to prevent a sharp rise in the deficit and debt. Moderates, on the other hand, fear the impact that social spending cuts could have on voters. Trump is pressing Congress members to pass the bill so he can sign it on July 4, Independence Day.
Elon Musk has sided with those calling for further cuts. “I’m sorry, but I just can’t stand it anymore. This massive, outrageous, pork-filled Congressional spending bill is a disgusting abomination. Shame on those who voted for it: you know you did wrong. You know it,” the mogul wrote Tuesday on his social media platform, X, threatening to target those who supported the bill in the midterm elections next November.
