302K Virginians could lose health insurance under Trump's One Big Beautiful Bill

More than 302,000 Virginians could lose their health benefits under pending and proposed changes to Medicaid and health insurance purchased under the Affordable Care Act, according to a new report by Democrats on a joint congressional committee.

The minority members of the Joint Economic Committee issued the report last Tuesday. It is based on estimates by the Congressional Budget Office, or CBO, of the potential effect of a budget reconciliation bill passed by the House of Representatives and now pending in the Senate, as well as the likely loss of enhanced federal subsidies for monthly insurance premiums and other proposed changes for people who depend on health benefit exchanges for coverage.

The joint committee, led by U.S. Sen. Maggie Hassan, a New Hampshire Democrat, estimates that the proposed and pending changes would push 166,025 Virginians off of Medicaid and cause 136,583 to lose insurance coverage under the Virginia Health Benefits Exchange, leaving a total of 302,608 more state residents without health insurance coverage.

The report echoes the findings of the CBO report, which estimated that 16 million Americans would lose health coverage under the One Big Beautiful Bill now in the Senate, as well as pending and proposed changes to the insurance market under the Affordable Care Act.

"Our initial assessment is they're pretty accurate," said Keven Patchett, director of the Virginia exchange, in an interview on Wednesday.

Patchett estimates that more than one-third of the people who buy insurance through the exchange would lose coverage if all of the proposed changes become law. Currently, 375,000 to 400,000 Virginians buy their health insurance through the exchange.

"That's huge!" said U.S. Rep. Don Beyer, D-8th, the highest-ranking House Democrat on the joint committee and its former chairman.

The joint committee went further in its analysis to estimate loss of Medicaid and health insurance coverage by congressional district. The estimated losses fall in more rural districts in Southwest and Southside Virginia, which traditionally vote heavily Republican in congressional elections.

For example, an estimated 36,717 people would lose health insurance coverage in the 9th Congressional District, in far Southwest Virginia, followed by the 5th Congressional District, which runs from Charlottesville to the North Carolina border, from Lynchburg to the Richmond suburbs. The report estimates that 35,963 would lose coverage: 18,463 under Medicaid and 17,000 under the health insurance exchange.

An estimated 31,040 would lose coverage in the 6th Congressional District, which includes the Shenandoah Valley and Roanoke area, with 17,340 dropping out of Medicaid and 13,700 losing insurance coverage.

President Donald Trump is the primary force behind the One Big Beautiful Bill, part of a push with Republican majorities in both chambers of Congress to cut federal spending to partly offset the cost of proposed tax cuts, which the CBO said would still increase the federal budget deficit by $2.4 trillion over the next decade.

He and Republican allies say they are saving the Medicaid program by making it more efficient and less wasteful, while refraining from triggering a reversal of Medicaid expansion that would have caused more than 640,000 Virginians to lose coverage.

Congressional districts that generally vote Democratic would not be spared from coverage losses under the joint committee analysis. An estimated 33,787 people would lose coverage in the 4th Congressional District, including Richmond and much of its adjoining suburbs: 20,387 under Medicaid and 13,400 under the health insurance exchange.

The 1st Congressional District, a Republican-leaning political battleground that includes parts of Chesterfield, Henrico and Hanover counties, would be less affected, with an estimated 11,467 people losing coverage under Medicaid and 13,000 under the exchange, for a total of 24,467.

U.S. Rep. Rob Wittman, R-1st, defended his vote for the budget reconciliation bill and emphasized his efforts to protect Virginians who rely on Medicaid.

"With the House passage of the Big Beautiful Bill, I voted to deliver once-in-a-generation investments that will strengthen Medicaid for Americans who need it most, invest in rural schools, bolster our national defense, and lower energy costs — all while delivering historic tax relief and preventing the largest tax hike in American history," Wittman said in a statement. "Throughout the reconciliation process, I fought to protect and preserve Medicaid for Virginia's most vulnerable, and this legislation does just that."

Most of the estimated losses would come under the provisions of the proposed budget reconciliation bill, now in the Senate but likely to return to the House with proposed changes.

The CBO, in a report issued earlier this month, said that the bill's provisions account for 10.9 million Americans losing health coverage. The remaining 5.1 million people would be affected by the expected loss of enhanced federal premium subsidies at the end of this year, which will make insurance less affordable for more people, and proposed new rules that would make it harder for them to enroll or qualify for premium tax credits.

House Republicans relied primarily on changes to Medicaid and the Affordable Care Act to find $800 billion in savings over the next 10 years from agencies overseen by the House Commerce and Energy Committee. Most of those savings would come from reducing enrollment in those programs.

In Medicaid, more people would have to work at least 80 hours a month, or show a comparable amount of "community engagement," and their eligibility would be subject to review and potential revocations twice a year instead of annually.

Patchett said proposed "technical and process changes" would make it much harder for people to apply and qualify for insurance and subsidies under the Affordable Care Act. He also said the changes could cost an additional $10 million a year for the exchange to administer.

For example, people would have to include proof of their identities and incomes — such as birth certificates, Social Security cards, tax returns and driver's licenses — instead of relying on electronic background checks through Social Security, the IRS and the Department of Homeland Security.

"It's going to feel much more like applying for a mortgage, and they're going to have to do it every year," Patchett said.