If this happens, it would mean the ACA exchange market would drop by more than 1/3 from the ~24.2 million currently enrolled (myself & my own family included).
However, I've repeatedly stated that even this is likely a low estimate--the remaining ~16 million exchange enrollees would still be hit with MASSIVE (and in some cases eye-poppingly huge) premium hikes which would force them to drop to far worse plans (meaning much higher deductibles & co-pays; worse provider networks and so on).
More than 400,000 Washingtonians will lose health insurance if ‘Big Beautiful Bill’ passes
Washington Health Benefit Exchange warns of looming rise in uninsured Washingtonians if Senate passes Reconciliation Bill
OLYMPIA, Wash. - The Congressional Reconciliation bill and loss of enhanced federal tax credits would result in 16 million Americans losing coverage, according to the Congressional Budget Office, with more than 400,000 predicted to lose coverage in Washington state.
“The reconciliation bill now headed to the Senate would make it much harder for Washingtonians to get and stay covered,” said Ingrid Ulrey, CEO of Washington Health Benefit Exchange. “While there has been much attention on the bill’s effects on Medicaid — which will be devastating — it is important to understand that it would also create a massive new layer of red tape and higher costs for people who purchase private health insurance on the Exchange.”
Last month, in response to House Republicans passing their version of the budget resolution bill, I broke out total enrollment in Medicaid via ACA expansion, ACA exchange Qualified Health Plan (QHP) enrollment and ACA-based Basic Health Plan (BHP) enrollment by Congressional District in order to try and get a sense of just how many Americans healthcare coverage is at risk from the bill...and how that breaks out along partisan lines at the House District level.
As I noted at the time, Republicans seem to be under the impression that it will mostly be Democrats who get screwed by their bill, since 9 of the 10 non-expansion states are Republican strongholds...while some Democrats seem to be under the impression that it will mostly be rural MAGA republicans who get screwed.
BALTIMORE (June 3, 2025) – The federal budget reconciliation bill passed by the House earlier this month will have significant consequences for the Affordable Care Act in Maryland, if it becomes law as is. For the nearly 250,000 Marylanders who buy health insurance through Maryland Health Connection this bill will increase premium costs, and create unnecessary, inefficient barriers to enrollment.
“For many of those enrolled in Maryland Health Connection, this proposed bill will drive up prices and increase the barriers to quality health insurance,” said Michele Eberle, executive director of Maryland Health Benefit Exchange. “Maryland Health Connection has increased enrollment by 40% in the last four years, because people who know how important health insurance is have found it affordable.”
With the House Republican budget bill having made it past its second significant hurdle last night (the House Budget Committee vote), it's time tot ake a cold, hard look at just what the impact of the bill will be in pure partisan terms.
The logic Congressional Republicans (or at least Donald Trump, who pretty much has complete control over the Congressional Republican hivemind) seem to be going with is that targeting the Medicaid expansion population is good politics for them because:
