Congressional Budget Office Releases Updated Cost Estimates for H.R. 1

Federal Policy Update
Article Background

What’s happening

On June 4, 2025, the nonpartisan Congressional Budget Office (CBO) released updated cost estimates for H.R. 1, the comprehensive bill advancing the President’s top domestic legislative priorities. The bill passed the House of Representatives in May, and the Senate is currently considering it with the goal of sending it to the President for signature by July 4th. H.R. 1 contains policies important to hospitals, including changes to Medicaid work requirements, provider taxes, Affordable Care Act (ACA) Exchange enrollment processes and eligibility, Medicaid disproportionate share hospital payments, and more.

Of interest

CBO is charged with assessing the overall impact of legislation on the deficit, and in this instance has also been tasked with assessing the impact on insurance coverage for individuals enrolled through government funded programs.  CBO found that, if H.R. 1 was enacted as currently written:

  • As a result of this bill, 10.9 million more individuals would be uninsured in 2034. Of those, 7.8 million would lose Medicaid coverage, and 3 million would lose ACA marketplace coverage.
  • The federal deficit would increase by $2.4 trillion between 2025-2034.
  • Gross benchmark premiums for Marketplace plans would decrease by an average of 12% over a ten-year period, likely because there will be fewer subsidy-eligible enrollees.

 

Our partners at McDermott+, one of healthcare’s most trusted and respected policy and lobbying consulting firms, updated their summary of H.R. 1 to reflect the most recent cost estimates.

Why you should care

The updated CBO cost estimates show how, if implemented, H.R. 1 will impact insured rates and, ultimately, how hospitals will be paid. Hospital leaders should be informed about the potential policy changes and how they could impact your organization.

Looking to learn more?

McDermott+ offers valuable insights into what these updated cost estimates mean and how H.R. 1 could affect organizations. Read more to see what McDermott+ is saying about these proposals and how your organization could be impacted.

 

Click here to read the updated summary of the legislation’s healthcare provisions.