Overview

• Senate debate centers on the “One Big Beautiful Bill Act,” a reconciliation package that would trim federal Medicaid outlays by roughly $700 billion over the next decade.
• Congressional Budget Office estimates show the plan could reduce ACA marketplace and Medicaid enrollment by about 10.7 million and end expanded premium tax credits, leaving an estimated 5 million uninsured.
• The proposal would halt automatic ACA plan re-enrollments, narrow open enrollment windows and delay Biden-era rules designed to streamline transitions between Medicaid, CHIP and private plans.
• Keep Americans Covered, a coalition of health advocates, is running a seven-figure ad campaign targeting swing-state senators to oppose the bill’s provisions.
• Health policy experts warn the package amounts to a backdoor repeal of key ACA protections and would disproportionately harm low-income families and people with pre-existing conditions.