President Donald Trump's Tax and Spending Act will add $3.4 trillion to the federal deficit through 2034, the Congressional Budget Office reported (CBO), which represents a slight increase in the projection that takes into account final adjustments Republicans made before getting the legislation across the finish line.

This would leave more than 10 million people uninsured in 2034. However, it would mark an improvement over an earlier CBO projection, which found that 11.8 million people would lose coverage over the decade.

The CBO said that more than $1 trillion in deficit savings are generated through the health parts of the bill, which includes new work requirements for certain Medicaid recipients in states that expanded the program through the Affordable Health Care, reports Associated Press (AP).

Consequences for Medicaid Recipients

The new tax law promoted by Trump introduces profound changes that directly affect Medicaid recipients, with significant consequences on several levels. Among the main ones are:

Work requirements and more bureaucracy: 1) Mandatory work requirement where Medicaid recipients between 19 and 64 years old must work, study or perform community service at least 80 hours a month to maintain their coverage; 2) Parents with children under 14 years old and people with disabilities are exempt; 3) The law requires income and address reviews every six months, increasing the administrative burden and the risk of losing coverage due to errors in documentation or lack of notification; and 4) Loss of health coverage for at least 10 million.

Access for vulnerable children and families: 1) Restrictions for minors. States have the power to temporarily prevent the enrollment of children whose parents are behind on premium payments; 2) Hardship for families in precarious situations.Those without a stable address or facing job instability could easily lose coverage for not meeting the new requirements or not receiving official notifications.

Impact on migrants

The law limits access to subsidized health insurance for refugees and asylum seekers, and reduces federal funding for states that cover undocumented immigrants (except children and pregnant women) from 90% to 80%, which will lead some states to stop new enrollments.

Beginning in October 2026, states will be able to disqualify beneficiaries whose immigration status is not verified, and will only be able to offer coverage with state, not federal, funds.

Demographic and social consequences

An increase in the uninsured population is coming. The CBO estimates that the number of uninsured people will increase by millions (between 10.9 and 16-17 million additional by 2034).

Widening inequality. The most affected groups will be low-income people, older adults, immigrants without legal status, and residents of rural areas.

In addition to a greater burden on older adults, who although exempt from the work requirement, the general cut in funding and the instability of the hospital network could make it difficult for them to access essential services, including long-stay care.