On May 22, House Republicans passed the One Big Beautiful Bill Act, a tax and budget reconciliation bill that imposes historic Medicaid cuts and drives up costs for Affordable Care Act (ACA) marketplace enrollees. The Center for American Progress previously released state-level estimates of uncompensated care costs for providers based on the nonpartisan Congressional Budget Office’s (CBO) preliminary projections of coverage losses.
Now, CBO projections released on June 4 show that the House-passed version of the bill would increase the number of people without health coverage by a staggering 10.9 million by 2034. When combined with the effects of other House Republican-backed policy decisions—including allowing the ACA marketplace enhanced premium tax credits to expire—the total increase in people uninsured rises to 16 million by 2034.
New CAP analysis provides updated state-level estimates of how these policies would increase uncompensated care costs and strain health care providers’ bottom lines, especially for rural hospitals and other providers reaching underserved populations.
The state that would experience the largest increase in uncompensated care costs is Florida, where an increase of 2.3 million people uninsured is projected to generate $5.2 billion in uncompensated care costs in 2034. Even smaller states would see sizable increases in uncompensated care. In Maine, for example, about 40,000 people would lose coverage, and providers could be saddled with $91 million in uncompensated care costs.
As House Republicans’ “big, beautiful bill” advances to the Senate, these estimates make clear the bill’s cuts would inflict serious harm on providers across the country. By taking health insurance away from 16 million Americans, the policies would shift $36 billion in costs onto health care providers, threatening the sustainability of crucial providers and access to care for the underserved populations that depend on them.
The authors would like to thank Kennedy Andara and Natalie Baker for their assistance with calculations and fact-checking.
Methodology
To estimate the increase in uncompensated care, the authors built on a 2021 KFF study that found post-ACA uncompensated care costs averaged $1,455 per full-year uninsured individual, applying a medical price inflation factor to estimate the impact by 2034. For the medical price inflation factor, the authors averaged the annual increase in the producer price index for health care services between 2017 and 2025, which was 2.6 percent. The authors then applied this inflation rate to the $1,455 baseline from 2017, estimating that uncompensated care costs would rise to $2,263 per full-year uninsured individual by 2034. This analysis assumes that the CBO and KFF estimates of coverage losses due to the reconciliation bill (10.9 million), as well as due to House Republicans allowing the enhanced ACA marketplace tax credits to expire (5.1 million), refer to full-year uninsured individuals. Finally, the authors multiplied the $2,263 estimate by the projected number of uninsured individuals in each state according to KFF data.