Roughly 23,000 people in North Dakota could become uninsured if the legislation President Donald Trump has dubbed the “big, beautiful bill” is passed and the expanded tax credits under the Affordable Care Act are allowed to expire, a report by a health policy research firm says.
When the effects of the massive tax bill are combined with the expiration of the enhanced Affordable Care Act tax credits, the Congressional Budget Office estimates 16 million more people nationwide will be uninsured by 2034 than would be otherwise, according to a KFF analysis published June 6. On its own, the tax bill is projected to increase North Dakota’s uninsured population by roughly 16,000 people.
The legislation was passed by a single vote in the House on May 22, with all Democrats and two Republicans voting against it. Senate Republicans released their version of the bill June 16. The CBO estimates, though, are based on the House version of the bill.
A poll by KFF found that 64% of U.S. adults have an unfavorable opinion of the bill, including large majorities of Democrats and independents. However, six in 10 Republicans had a favorable view of the legislation.
The uninsured rate among North Dakota residents less than 65 years old was 4.9% as of 2023, below the national rate of 9.5%.
The KFF analysis says the projected increase in the state’s uninsured population includes 13,000 due to changes in Medicaid and 9,900 due to changes in the Affordable Care Act.
Nearly half of the 16 million people nationwide who could become uninsured live in five states: Florida (2.3 million), Texas (1.9 million), California (1.8 million), New York (920,000) and Georgia (750,000).
Medicaid is a government health program for low-income and disabled residents that covers about 72 million people. Medicaid covers low-income pregnant women, two in five childbirths and nursing homes for some low-income seniors and others. Some low-income seniors are eligible for both Medicare and Medicaid.
The federal government funds the majority of Medicaid spending, but states also contribute varying levels, depending on the program. States administer Medicaid programs, handle sign-ups and check eligibility, and many states contract with health insurance companies to manage Medicaid programs.
The tax credit is designed to help low- to moderate-income individuals and families afford health insurance through the marketplace. It was enhanced during former President Joe Biden’s term to include people with incomes above 400% of the federal poverty line and offered a more generous subsidy for those below that level, USA TODAY reported. The Inflation Reduction Act set the expiration for the enhanced tax credit at the end of 2025.
USA TODAY’s Ken Alltucker contributed to this report.
