The non-partisan Congressional Budget Office (CBO) on June 4, 2025 released an updated score for the House-passed budget reconciliation package, the One Big Beautiful Bill Act (OBBB).

The score updates the total fiscal impact by adding analysis of some previously unscored provisions and amendments to the bill made immediately prior to its May 22 passage in the House. These changes include sooner implementation of work requirements and more frequent eligibility determinations. Overall, the CBO score estimates that 10.9 million people will lose their health insurance coverage because of the bill: almost eight million will lose Medicaid coverage and the remainder would lose ACA Marketplace coverage.

In addition to that 10.9 million, CBO provided a separate June 4 estimate on additional coverage loss changes in its baseline if the Trump administration’s Marketplace rule, which would be codified by the OBBB, is implemented and if the enhanced premium tax credits, which expire at the end of 2025, are not extended. In combination, the Marketplace rule and the loss of the enhanced premium tax credits would cause 5.1 million people to lose health insurance, CBO says.

Across the reconciliation bill and the expiration of the enhanced premium tax credits, the total coverage loss estimates add up to 16 million people.

As anticipated, CBO noted higher savings from changes made in the House Rules Committee before final passage that moved the implementation dates for community engagement / work requirements and enhanced eligibility checks.

Overall, CBO estimates that $1 trillion dollars will be cut from federal healthcare spending over the next 10 years, including over $800 billion from federal Medicaid funding. The full score can be downloaded here.

Follow all Budget Reconciliation 2025 developments in this serial post.