The Coming Health Care Apocalypse

One chart on the Big Ugly Bill

Still worn out from travel, so today’s post will basically consist of a single chart trying to illustrate the sheer ugliness of the One Big Beautiful Bill Act, in a way that I hope cuts through the blizzard of numbers and projections out there.

I hope most people following policy at all — which unfortunately misses a substantial part of the electorate — know that soon, maybe within a few days, Republicans appear highly likely to pass legislation that combines big tax cuts for the rich with savage cuts to programs that help lower-income Americans, including Medicaid and SNAP (food stamps). Loss of health insurance coverage won’t be the only source of mass misery from this legislation, but it’s the biggest and easiest to illustrate.

So let’s review what happened over the past 15 years. The Affordable Care Act, aka Obamacare, was enacted in 2010 but only went into full effect in 2014. It fell short of achieving universal health care, especially because many red states refused to expand Medicaid even when the federal government offered to pay for it. It is also somewhat complicated, because of the compromises made to limit disruption of the existing system.

Nonetheless, it led to a large decline in the number of Americans without health insurance. It also led to a large reduction in anxiety among Americans with preexisting conditions, who no longer had to fear being denied coverage or being trapped in jobs with health benefits for fear of losing coverage.

Essentially all these gains are about to be wiped out.

The Center on Budget and Policy Priorities has estimates based on Congressional Budget Office analysis of the House plan, plus refusal to retain enhancements that took place during the Biden years. Once the Senate gets done with it, the plan might be even worse. Also, some independent analysts believe the CBO is understating the likely coverage losses. But anyway, here are the CBPP numbers:

Source: Center on Budget and Policy Priorities

What I find, however, is that I need a way to put 16 million people losing insurance coverage in perspective. So here’s one way: 16 million people is about 6 percent of the population too young for Medicare, so if we add this to the current level of uninsurance we get this:

Source: KFF plus author’s estimate

Basically, we’re talking about undoing all the progress America has made in expanding health insurance. And as I said, many independent analysts believe it could be substantially worse.

Remember, this isn’t happening to save money: If Republicans cared about the deficit, they could forego those tax cuts. It isn’t happening by popular demand: the Big Beautiful Bill is extremely unpopular already, and will become even more unpopular once people see its effects.

It’s happening because our government has been taken over by fanatics who believe that, one way or another, they can escape the electoral consequences of making millions of Americans’ lives much, much worse.