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Sen. Bernie Sanders, I-Vt., speaks during a "Fighting Oligarchy" tour event at Arizona State University, March 20, 2025, in Tempe, Ariz. (AP)
The Congressional Budget Office said in 2025 that the One Big Beautiful Bill — signed into law by President Donald Trump in July 2025 — would increase the number of people without health insurance by 10 million through 2034.
Separately, an enhanced tax credit for people who purchase health insurance through the Affordable Care Act expired. About 4 million people were expected to lose insurance because of that change.
Although 15 million people are expected to eventually lose coverage, it hasn’t happened yet. Initial 2026 figures from January show a decline of about 1 million since 2025.
Democrats say Republicans have ignored voters’ concerns about affordability, including health insurance as they supported President Donald Trump’s 2025 tax and spending bill.
"As a result of the 'Big Beautiful Bill,' 15 million Americans have been thrown off the healthcare that they need," Sen. Bernie Sanders, I-Vt., said during a committee hearing that included testimony by Health and Human Services Secretary Robert F. Kennedy Jr.
The senator, who frequently talks about the high cost of health insurance or lack of access to it, has cited the 15 million number several times in recent months.
Millions of people are on track to lose Affordable Care Act coverage in the coming years, according to independent estimates. But only a fraction have likely occurred so far.
The One Big Beautiful Bill Act extended income tax cuts for a wide swath of individual taxpayers and businesses, added $75 billion in new funds for Immigration and Customs Enforcement, and made historic cuts to safety net programs, including Medicaid.
The Congressional Budget Office, Congress’ nonpartisan budget-analysis arm, predicted shortly after the legislation passed that the law would increase the number of people without health insurance by 10 million through 2034. That included people who had been covered by Medicaid or the Affordable Care Act.
Although Sanders’ statement targeted the legislation, Sanders’ spokesperson Patrick Barham told us the senator was also referring to the expiration of premium tax credits for people purchasing insurance through the ACA marketplaces, expected to affect about 4 million people. Barham said these two factors "will strip coverage from more than 15 million Americans and increase out-of-pocket health care costs for millions more." He cited an analysis by the left-leaning Center on Budget and Policy Priorities.
The Centers for Medicare & Medicaid Services reported in March that 23.1 million consumers were enrolled in ACA plans for 2026. That’s about 1 million less than in 2025.
So far, New Jersey and New York are among the states reporting decreased enrollment.
Community health centers that serve high volumes of ACA-enrolled patients have reported declines in insured patients, said Sara Rosenbaum, a George Washington University healthcare law and policy professor. Young people have disproportionately shed their insurance, leaving older, sicker people insured.
Medicaid work requirements under the 2025 law are set to take effect in January 2027, although some states are implementing the new rules this year, including Nebraska and Montana.
KFF Health News reported that most Medicaid beneficiaries affected by these provisions are expected to lose health insurance coverage not because they don’t work but because of paperwork errors, such as failing to document their hours worked.
Joe Antos, an American Enterprise Institute emeritus health policy specialist, said it’s not easy to assign the cause or causes of declining ACA enrollment, given the changes in the law and overall inflation that is squeezing many households.
Sanders said, "As a result of the 'Big Beautiful Bill,' 15 million Americans have been thrown off the healthcare that they need."
This is premature. ACA plan enrollment is down about 1 million people since 2025. The CBO projected that 10 million people would be newly uninsured by 2034 as a result of the 2025 bill. Separate from the legislation, in 2026 roughly 4 million people were expected to lose expiring tax credits that subsidized their coverage.
Although close to 15 million people are expected to lose coverage — not all of them because of the One Big Beautiful Bill — it hasn’t happened yet and we cannot know with certainty that it will.
The statement contains an element of truth but ignores critical facts that would give a different impression. We rate it Mostly False.
RELATED: Would rural residents get hit twice as hard by expiring ACA subsidies?
PBS News Hour, WATCH LIVE: Health Secretary Kennedy testifies on HHS budget before Senate HELP Committee, April 23, 2026
CNN, Shutdown America: A CNN Town Hall with Bernie Sanders and Alexandria Ocasio-Cortez, Oct. 14, 2025
Center on Budget and Policy Priorities, By the Numbers: Harmful Republican Megabill Will Take Health Coverage Away From Millions of People and Raise Families’ Costs, Aug. 27, 2025
Congressional Budget Office, Estimated Budgetary Effects of Public Law 119-21, to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14, Relative to CBO’s January 2025 Baseline, July 21, 2025
KFF, Marketplace Enrollment Snapshot for Open Enrollment 2026, Jan. 28, 2026
KFF, ACA Sign-Ups Are Down by Over a Million People, But It’s Still an Incomplete Picture, Jan. 29, 2026
KFF, Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees, March 19, 2026
KFF, How Will the 2025 Reconciliation Law Affect the Uninsured Rate in Each State? Aug. 20, 2025
Urban Institute, 4.8 Million People Will Lose Coverage in 2026 If Enhanced Premium Tax Credits Expire, Sept. 17, 2026
Kaiser Health News, Trump’s One Big Beautiful Bill Act Darkens Outlook for Government-Backed Clinics, April 1, 2026
NJ Spotlight News, About 14% drop discount health plans on loss of federal subsidy, April 24, 2026
Centers on Medicare and Medicaid Services, Exchange Coverage Remains Near Record High as 23.1 Million Enroll in 2026, Reflecting Continued Strength and Stability, March 27, 2026
Politico PRO, More New Yorkers are dropping ACA coverage, new data shows, April 21, 2026
PolitiFact, RFK Jr. said there's more than one way to calculate a percentage decrease. That doesn't add up, April 23, 2026
PolitiFact, How the Trump-backed policy bill rolls back Obamacare, June 5, 2025
PolitiFact, Does Trump’s new law make ICE the largest federal law enforcement agency? July 11, 2025
PolitiFact, Is it true that 5 million people at risk of losing Medicaid are already covered by other insurance? July 11, 2025
PolitiFact, Bernie Sanders says GOP bill would strip Medicaid, health care from 13.7 million. That’s too high. May 16, 2025
PolitiFact, Are US prescription drug prices 10 times higher than those in other nations? Only sometimes, May 18, 2023
PolitiFact, Bernie Sanders said 85 million Americans have no health insurance. That includes underinsured. Dec. 23, 2022
Centers for Medicare and Medicaid Services, Statement to PolitiFact, April 24, 2026
Email interview with Joseph Antos, senior fellow emeritus at the American Enterprise Institute, April 23, 2026
Email interview, Sara R. Collins, senior scholar, Expanding Coverage and Access & Tracking Health System Performance, Commonwealth Fund, April 24, 2026
Email interview, Sara Rosenbaum, George Washington University healthcare law and policy professor, April 24, 2026
Email interview, Larry Levitt, KFF’s executive vice president for health policy, April 24, 2026
Email interview, Patrick Barham, Sen. Bernie Sanders spokesperson, April 24, 2026
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