On Saturday, a new survey from the White House suggested that between 8.2 and 9.2 million Americans could lose their health insurance if the significant budget plan proposed by President Donald Trump doesn’t pass, especially amid concerns about an impending economic downturn.
The survey stems from a memo titled “Opportunity costs for health insurance if the 2025 budget adjustment bill is not passed,” crafted by an economic advisor. It estimates that approximately 27 million people in the U.S. were uninsured in 2025. If the budget bill fails, that number could surge to around 50 million, echoing the level of uninsured individuals prior to the Affordable Care Act (ACA).
Trump has emphasized that “failure is not an option,” pointing out that the budget bill will greatly assist seniors, according to a key tax author in the House.
The memo bases its estimates on the assumption that states expanding Medicaid will need to fulfill balanced budget requirements and provide enhanced unemployment aid during severe economic challenges. It presents a scenario marked as a “very, very improbable but plausible bad case.”
Looking forward, the White House is forecasting a “medium to severe recession” triggered by Trump’s tax cuts set for 2026 and other economic shocks. Advisors indicate that a major recession could lead to a slump in consumer spending due to higher personal taxes and tighter credit conditions.
According to the advisor’s analysis, bypassing extensions of Trump’s tax cuts could lead to a drop of around 4% in U.S. GDP over two years, mirroring the 2008 recession. Unemployment could rise by 4 percentage points, translating to roughly 6.5 million job losses. Of these, an estimated 60% would impact those with employer-sponsored insurance, pushing approximately 3.9 million people into the ranks of the uninsured.
The memo also anticipates a decline in personal and marketplace coverage, as employer-supported individuals may no longer afford their plans. It predicts a 15% dip in coverage losses, amounting to around 3.3 million people affected from an original base of about 22 million in 2026.
Without the passage of the budget bill, enrollments for Medicaid and ACA plans may experience complications, resulting in 500,000 to 1 million individuals not receiving compensation, according to the memo. The loss of Trump’s 2017 tax cuts is expected to hit non-citizens, gig workers, and early retirees the hardest, leading to significant insurance losses in the working-class population.
House Speaker Mike Johnson is determined to push through this “one big beautiful act” despite the internal divisions among Republicans.
The proposed legislation, spanning 1,116 pages, includes over $5 trillion in tax cuts, some offset by spending reductions, and aims to deliver on many commitments from Trump’s campaign. This includes the introduction of a new tax-free “MAGA account,” eliminating certain temporary taxes on overtime for a number of workers, a new $10,000 tax cut on interest for loans on American-made vehicles, and a $1,000 contribution for children born during Trump’s second term.
