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Contrary to President Donald Trump’s claim that no one will die as a result of the Republican budget bill, an analysis from the University of Pennsylvania and Yale University estimated that the legislation’s changes to Medicaid and the Affordable Care Act will result in at least 42,500 preventable deaths each year. At the same time, independent Sen. Bernie Sanders has slightly overstated the estimate.
In the run-up to and in the wake of the passage of the One Big Beautiful Bill Act, which Trump signed into law on July 4, politicians of both parties have sparred over the budget reconciliation bill’s effects on mortality.
Democrats, including House Minority Leader Hakeem Jeffries and Senate Minority Leader Chuck Schumer, have said that “tens of thousands” of people will die as a result of losing health insurance.
“51,000 Americans will die each year so that the top 1% can get a $1 trillion tax break,” Sanders wrote in a July 3 post on X. “This bill is a death sentence.”
Sanders repeated the claim in a July 9 post, using a figure of “more than 50,000.”
Meanwhile, Trump has insisted that the Democratic talking point isn’t true.
“The Democrats have come up with a false narrative. … It’s death, death, everyone’s going to die,” he said in a July 8 Cabinet meeting. As he had before, Trump said that the bill was “just the opposite. Everyone’s going to live.”
“Somebody gave them a soundbite, ‘it’s going to cause death,’” Trump said in a July 12 interview on Fox News, referring to Democrats and the law. “It is not going to cause death. It’s going to keep people alive and it’s going to make our country successful.”
Sanders is using a higher estimate than he should, but researchers at Yale and Penn’s Leonard Davis Institute of Health Economics projected in June that the House-passed version of the bill would “result in more than 42,500 deaths annually.”
The tally includes 11,300 deaths as a result of people losing Medicaid or Affordable Care Act marketplace insurance, as well as 18,200 deaths from low-income Medicare patients losing prescription drug benefits and 13,000 deaths from rescinding a Biden-era rule that required a higher minimum staffing level in nursing homes.
The group, which performed its analysis in response to an inquiry from Sanders and Sen. Ron Wyden, a Democrat from Oregon, based its projections on a preliminary Congressional Budget Office estimate that 7.7 million people would lose insurance coverage as a result of the bill.
The CBO later projected that due to the House bill, 10.9 million people would be uninsured in 2034, a figure that includes 7.8 million becoming uninsured because of Medicaid changes in the bill and 3.1 million losing coverage due to changes to the Affordable Care Act. The CBO hasn’t yet provided an estimate for the final legislation, but said that a modified Senate version of that bill would increase the uninsured by 11.8 million people in 2034.
Dr. Rachel Werner, a co-author of the analysis and LDI’s executive director, told us in an email that it’s “incorrect to say that no one will die as a result” of the legislation. “There is strong evidence that Medicaid coverage saves lives,” she said.
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“Getting someone insurance allows them to get screened for diseases like cancer. It’s a major source of providing people with treatment for the opioid epidemic,” Werner explained in a conversation with the Tradeoffs podcast. “It allows people to get medications to manage their chronic conditions. And so if you suddenly pull back all those resources that have been allowing people to get the care they need, the evidence is very clear now that we will lose lives.”
Another projection, published in mid-June in the Annals of Internal Medicine by researchers at Harvard Medical School and the City University of New York, estimated that the House bill’s Medicaid spending cuts would lead to between 8,200 and 24,600 medically preventable deaths a year, with a mid-range estimate of 16,642.
The study’s estimate, Werner explained, is “comparable” to the single 11,300 component of deaths from loss of insurance in her group’s total estimate. As she said on the Tradeoffs podcast, “we’re at the low end of that range, which is reassuring to us.”
Both the Harvard-CUNY and Penn-Yale authors have noted that the CBO estimates themselves may be low. When doing its calculations, the CBO assumed that states, which will lose some federal Medicaid funding under the bill, would use state money to make up for half of those losses.
“I think that that is a long shot,” Werner told Tradeoffs. “States budgets are very tight right now. Some states may be able to make up half of what they lose from the federal government, but I think it’s not a stretch to say most states can’t. And so if the funding that’s available for Medicaid goes down more than the CBO estimated, more people are going to lose access to coverage. So I think that I’m pretty confident that we are at the low end of the right ballpark.”
Both projections capture only a portion of the possible mortality effects. Dr. Eric Roberts, a co-author of the Penn-Yale analysis, said that his estimate does not include any deaths that might result from potential hospital closures, for example.
We asked the White House if they were aware of the Penn-Yale analysis and for support for Trump’s claim that the budget law would not lead to preventable deaths. “Reporters ignoring the commonsense reforms of The One, Big, Beautiful Bill that protect and preserve Medicaid while raising wages and growth to instead push debunked Democrat talking points with these sort of pointless ‘fact checks’ that rely on mindless hairsplitting is exactly why public trust in the media is at a record low,” White House spokesman Kush Desai replied in an email.
As for Sanders’ 51,000 figure, the number appears in the Penn-Yale estimate, and a Sanders spokesperson confirmed the analysis was the source of his claim. But it reflects an additional 8,811 preventable deaths that come from not extending expanded ACA premium tax credits that are set to expire at the end of the year. That is not part of the One Big Beautiful Bill Act itself, as we’ve written before.
Werner told us that the correct figure to use from her estimate when speaking of the provisions of the law is 42,500.
The overstatement is similar to what Democrats have done before, when they exaggerated the number of people who would lose health insurance under the bill using the same logic.
A Sanders spokesperson pointed us to Sanders’ full statement when the Penn-Yale estimate was first released, which repeatedly highlights the 51,000 number, but also explains the source of each of the four added figures.
Sanders spokesperson Anna Bahr also argued that the lack of action to extend the premium tax credit could be viewed as part of the legislation. But whether those credits are extended remains to be seen.
“Whether it’s by making massive cuts to Medicaid that community health centers, nursing homes, hospitals, and health care providers rely on, whether it’s by using red tape to kick millions of people off of their ACA coverage, or whether it’s by failing to extend premium tax credits that made health coverage affordable for millions of working families throughout the country, the result is unacceptably the same: more people won’t go to the doctor on time because they don’t have insurance or they can’t afford it, more will get sicker, and this research shows just how many more people’s lives are at risk,” she said in a statement.
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