Trump’s tax bill threatens to leave 10.9 million people without health insurance

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 it was approved by just a single vote.

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 pressuring 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.

The package would also raise the debt ceiling from $36 trillion to $40 trillion, the largest increase in history. The Treasury Department expects the current debt ceiling to be reached this summer.

“Republicans cry crocodile tears over the debt when Democrats are in charge — but explode it when they’re in power,” said Congressman Brendan Boyle of Pennsylvania, the top Democrat on the House Budget Committee. “In the words of Elon Musk, this bill is a ‘disgusting abomination.’”

Collection of tariffs

Meanwhile, the Congressional Budget Office also published on Wednesday an estimate of the impact of tariffs on revenue. The report is full of caveats, including possible changes and exemptions and the effect on the economy, but the initial calculation points to a deficit reduction of $3 trillion dollars over a decade. Based on this assumption, Trump’s numbers would add up, allowing him to reduce the deficit by cutting direct taxes and raising import tariffs.

“Before accounting for how the changes in tariffs would affect the size of the economy, CBO estimates that the increase in collections of tariffs would reduce primary deficits by $2.5 trillion,” the CBO report states.

It continues: “That estimate accounts for how flows of U.S. imports and exports would adjust in response to the tariffs imposed as of May 13, 2025. By lowering federal borrowing, those tariff collections would reduce federal outlays for interest by $0.5 trillion. As a result, in the absence of any effects on the U.S. economy, the changes in tariffs would reduce total deficits by $3.0 trillion altogether.”

In its preliminary analysis, the CBO concludes that the impact on the economy will not be very large and that, even taking this into account, the impact of the tariffs approved through May 13 on the deficit would be $2.8 trillion.

According to the agency, reductions in investment and productivity due to higher tariffs will be partially offset by increased resources available for private investment resulting from lower federal borrowing. In net terms, real economic output will decline due to tariffs compared to the estimated path, but not dramatically.

Meanwhile, inflation is expected to rise by an average of 0.4 percentage points annually in 2025 and 2026, according to CBO estimates, which will reduce the purchasing power of households and businesses.

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