Analysis of sweeping GOP package raises stakes ahead of Fourth of July deadline
President Donald Trump’s “One Big Beautiful Bill” would add US$2.4 trillion to US federal deficits and leave 10.9 million more Americans without health insurance by 2034, according to a new analysis from the Congressional Budget Office (CBO). The sweeping Republican legislation, which includes tax cuts, immigration provisions, and large-scale spending reductions, passed the House narrowly last month and now faces mounting opposition in the Senate.
The nonpartisan CBO’s report, released Wednesday, estimates the legislation would cut spending by nearly US$1.3 trillion over 10 years but reduce revenues by a much larger US$3.7 trillion—resulting in a net deficit increase. It also projects major cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP), contributing to a significant rise in the number of uninsured and under-supported Americans.
Sharp cuts to healthcare and safety nets
At the heart of the projected coverage losses are changes to Medicaid, including new work requirements for able-bodied adults up to age 65. These are expected to push 7.8 million Americans off Medicaid rolls. An additional 1.4 million people—primarily undocumented immigrants currently covered by state-funded programs—would also lose coverage under a proposed ban on state Medicaid funding for non-citizens.
Further provisions affecting the Affordable Care Act (ACA) would eliminate automatic re-enrolment, shorten open enrolment periods, and require additional income verification, prompting another 1.7 million people to lose insurance. Healthcare experts, including Larry Levitt of KFF, have called the changes “the biggest rollback in federal support for healthcare ever.”
The CBO had previously estimated that 4 million fewer people would receive food stamps monthly due to tighter SNAP requirements, while benefits for others would be cut.
Republicans push back on CBO numbers
White House officials and GOP leaders have dismissed the CBO’s projections, arguing the bill will drive economic growth and ultimately be deficit-neutral—or even reduce the deficit. House Speaker Mike Johnson said the bill reflects “the mandate given to us by the American people,” and claimed the CBO’s assumptions are flawed, particularly its estimate of long-term GDP growth at 1.8%.
Others, including House Majority Leader Steve Scalise and Budget Director Russell Vought, accused the CBO of using an “artificial baseline” that doesn’t reflect continuation of current policies like the 2017 Trump tax cuts, which are set to expire.
Still, the CBO maintains its projections are consistent with standard scoring procedures used across administrations. Its director, Phillip Swagel, is a former Republican Treasury official reappointed to a second term in 2023.
Senate Republicans face internal divisions
Although the bill passed the House, Senate Republicans are divided. Some are calling for deeper spending cuts, while others, such as Senators Ron Johnson and Rand Paul, have expressed alarm over the bill’s impact on the national debt and healthcare access.
Johnson, speaking on ABC News, criticised the bill for failing to address long-term fiscal imbalances, saying, “I refuse to accept US$2 trillion-plus deficits as far as the eye can see as the new normal.”
Adding to the tension, former Trump administration official Elon Musk launched a scathing attack on the bill, calling it a “disgusting abomination” and warning that it would “bankrupt America.” Musk has threatened to target Republicans who support the package in the upcoming midterm elections.
What the bill includes
The 1,000-page-plus legislation seeks to:
- Make the 2017 tax cuts permanent
- Eliminate federal income tax on tips and overtime
- Increase defence and border security spending by US$350bn
- Raise the national debt ceiling by US$4tn
- Phase out green energy tax credits introduced under the Biden administration
- Impose work requirements on Medicaid and SNAP recipients
Republicans argue the bill targets waste and abuse, while Democrats claim it is an ideological attempt to dismantle the ACA and gut the safety net.
What comes next
Trump has urged Republicans to pass the package “in one big, beautiful bill” using budget reconciliation, which would bypass the need for Democratic support. But with July 4 approaching, Senate leaders are under pressure to reconcile internal disagreements and present a revised version that can clear both chambers.
Meanwhile, Democrats and healthcare advocates are using the CBO’s analysis to bolster opposition, warning of devastating impacts on millions of Americans.
“The more you look at the bill, the worse it gets,” said Senate Majority Leader Chuck Schumer. “People will fall through the cracks and get phased out of coverage in the coming years. Death by a thousand paper cuts—that’s the intention of the Republican bill.”
