Researchers forecast what Trump’s bill will mean for patients: Debt and
delayed care
[August 02, 2025]
By TOM MURPHY and NICKY FORSTER
Delayed treatments, canceled doctor visits, skipped prescriptions.
Losing insurance is bad for your health.
The Congressional Budget Office forecasts that the U.S. uninsured
population will grow by 10 million in 2034, due to the tax and spending
bill signed into law by President Donald Trump.
And, thanks to a natural experiment nearly two decades ago, researchers
can forecast what that will mean for patient care. Among the problems
they predict will develop as a direct result of these people losing
coverage:
— About 2.5 million people may no longer have a personal doctor.
— About 1.6 million patients will take on medical debt.
— The lack of care may cause nearly 22,000 deaths annually.
“There’s really no questioning the basic reality that you can’t take
health care away from 10 million people without causing many preventable
deaths,” said Dr. Adam Gaffney, lead researcher on a team that explored
the new law’s impact.
Here’s a deeper look at the research and challenges that could develop.
How the law may affect coverage
It will become harder for many people to enroll in Medicaid or
individual insurance plans and then stay covered. Medicaid is a state
and federally funded program that covers care for people with low
incomes.
States will have to verify every six months whether someone remains
eligible for Medicaid. That could cause coverage lapses for people with
incomes that fluctuate or for those who move and miss renewal paperwork.
Many also are expected to lose coverage as states require Medicaid
recipients to work, volunteer or go to school unless exempted.
Enrollment in Medicaid has swelled in recent years. Republicans are
cutting back in part to help fund tax breaks and pay for other
priorities like border security. They also say they are trying to root
out waste and fraud by rightsizing Medicaid for the population it was
initially designed to serve — mainly pregnant women, the disabled and
children.
People covered through the Affordable Care Act’s individual insurance
marketplaces also will see shorter enrollment windows and no more
automatic renewals.
About the research
Gaffney, of Harvard Medical School, and other researchers looked to past
studies to measure how many people would experience detrimental effects,
like going without prescriptions, from the upcoming changes. Gaffney
updated the published analysis, which was originally based on the House
version of the bill, at the AP’s request.
One study in particular was critical for their work: In 2008, Oregon
offered a rare opportunity to compare groups of people enrolled in
Medicaid with those who were not.
After a four-year period of frozen enrollment due to budget limitations,
the state determined it could enroll 10,000 more people in Medicaid. It
used a lottery system to make the selection amid high demand.
That gave researchers a chance to follow people who got coverage and
those who did not, similar to how scientists testing a new drug might
compare patients taking it to those given a placebo.
“This is a gold standard research design because it replicates a
randomized-controlled trial,” said Christine Eibner, a senior economist
at RAND Corp. who was not involved in the study.
Applying results from that study and other research to the recent CBO
estimate allowed Gaffney and other researchers to estimate specific
effects of losing coverage.
“By taking coverage away, we are putting patients in a terrible
position,” said Gaffney, a former president of Physicians for a National
Health Program.
Care could grow complicated
Amanda Schlesier went four days without her cancer treatment Calquence
this spring and wound up in a local emergency room, delirious with pain.
The leukemia patient worries about what might happen if she stops
treatment again for a longer stretch because she’s lost Medicaid.
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The price for a bottle of 60 tablets of Amanda Schlesier's
prescription chemotherapy pill, Calquence, is printed on a pharmacy
statement in Farmington Hills, Mich., Wednesday, July 23, 2025. (AP
Photo/Paul Sancya)
 “God forbid I forget to fill out a
page of documentation, and suddenly I lose access to my medication
or my doctors or any of the treatment that I’ve been going through,”
the 33-year-old Farmington Hills, Michigan, resident said.
People can still receive care when they don’t have coverage, but
important steps often are delayed, said Dr. Gwen Nichols, chief
medical officer of The Leukemia & Lymphoma Society.
Patients may be able to visit a doctor, but they would have to line
up coverage or help before they can receive expensive chemotherapy.
Diagnosis also may be delayed. Meanwhile, the patient’s cancer
continues to grow.
“It’s a ticking time bomb,” Nichols said.
Preventive care may lapse
The first thing patients often ditch when they lose coverage are
screenings designed to catch health problems before they become
serious, said Dr. Jen Brull, president of the American Academy of
Family Physicians.
That could mean patients skip tests for high cholesterol, which can
contribute to heart disease, or colonoscopies that detect cancer.
Researchers forecast that a half million fewer women will have
gotten a mammogram within the past year by 2034.
When patients struggle financially and lose coverage, they focus on
things like keeping a place to live and food on their table, said
Brull, a Fort Collins, Colorado, physician.
“Seeing a doctor because you don’t want to get sick feels like a
much lower priority,” Brull said.
Financial pressure can build
Patients start taking financial hits at all ends of care when they
lose coverage.
They may have to pay up front or start a payment plan before they
receive care, said Erin Bradshaw, an executive vice president with
the nonprofit Patient Advocate Foundation, which helps people with
medical bills.
Anyone with an outstanding balance will have to pay it before the
next appointment.
Financial assistance may be available, but patients don’t always
know about it. Getting help also may take time and require the
submission of tax returns, pay stubs or some validation that the
patient no longer has coverage.
Bradshaw said letters stating that a patient has lost Medicaid
sometimes arrive a couple months after the fact. That can contribute
to treatment delays or missed medication doses.
Some patients also try to avoid financial stress by skipping care.
Schlesier said she delayed seeing a doctor when she first felt
symptoms of her cancer returning because she had no coverage at the
time.
Staying on medications
If prescriptions are too expensive, patients may simply not get them
or split the doses to stretch the medicine.
For Thomas Harper, it’s a question of priorities.
“Sometimes you have to make a choice, how well do you want to eat
this week versus taking your medicine,” he said.
The West Monroe, Louisiana, truck driver has around $300 a month in
prescriptions as he deals with diabetes and recovers from
non-Hodgkin lymphoma, a type of blood cancer.
Harper, 57, recently returned to work. That meant he lost Medicaid,
which covered more of his prescription costs. He’s balancing buying
his meds with shopping for healthy food that keeps his blood sugar
in check and builds his immune system.
“I’ll survive, but I know there’s people out there that cannot
survive without Medicaid,” he said.
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AP video journalist Laura Bargfeld contributed to this report.
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