The Congressional Budget Office (CBO) released new estimates for the One Big Beautiful Bill Act Wednesday, which show that the bill would reduce Medicaid spending by $793 billion. KFF’s latest Medicaid analysis considers what these federal cuts could mean for state Medicaid spending and enrollment by allocating the CBO’s estimates across states using KFF’s state-level data. Over 10 years, these proposed cuts would represent 12% of projected federal Medicaid spending, ranging from 5% in Wyoming and Alabama to 17% in Washington.
Previous CBO estimates show that 10.3 million fewer people would be enrolled in Medicaid in 2034, representing 12% of projected enrollment for that year. Washington and Virginia could see the largest percentage drops in Medicaid enrollment, with their rolls falling by 26% and 21%, respectively. The largest numbers would lose Medicaid in California (1.7M), New York (1.0M), Illinois (5104K), Washington (490K), and Pennsylvania (440K).
A second KFF analysis looks at how the bill would increase the number of people without health insurance by 10.9 million and 16 million more when the expected expiration of the ACA’s enhanced premium tax credits is included. About half (48%) of the 16 million more people who would be uninsured in this scenario live in Florida (2.3M), Texas (1.9M), California (1.8M), New York (920k), and Georgia (750k).
