In a letter to ranking Senate leaders, public health and policy researchers at Yale University and the University of Pennsylvania warn that provisions in the House-passed federal budget reconciliation bill could lead to more than 51,000 deaths annually if enacted.

Addressed to the Senate Finance Committee Ranking Member Sen. Ron Wyden and Senate Health, Education, Labor, and Pensions Committee Ranking Member Sen. Bernie Sanders, the letter presents science-based projections of the human toll of eliminating key health protections. The findings point to catastrophic public health consequences from mass insurance losses and cuts to nursing home standards—provisions supported by the House bill.

The researchers estimate that 42,500 lives could be lost each year from disenrollments in Medicaid and Marketplace coverage and the rollback of nursing home staffing rules. An additional 8,811 deaths are projected from the expiration of the enhanced Affordable Care Act (ACA) Premium Tax Credits, bringing the total to more than 51,000.

Background

The science information presented in the letter was produced in response to a request for technical assistance from the Senate Finance Committee and the Senate Committee on Health, Education, Labor & and Pensions (HELP) regarding the potential mortality effects of several provisions in the House-passed reconciliation bill.

Key Findings

The authors of the letter modeled the mortality impacts of three major provisions in the House bill:

• Loss of coverage for 7.7 million people: This would result in an estimated 11,300 additional deaths annually due to lost access to Medicaid or ACA Marketplace coverage.

• Disenrollment of 1.38 million low-income Medicare beneficiaries: Ending Medicare Savings Program support would increase mortality by 18,200 per year due to reduced access to subsidized prescriptions.

• Elimination of Centers for Medicare & Medicaid Services (CMS) nursing home staffing rules: Repealing the 2024 minimum staffing standard would lead to 13,000 deaths annually among nursing home residents.

In addition, the bill’s failure to extend the ACA’s enhanced premium tax credits is expected to push another 5 million Americans into uninsurance, resulting in 8,811 more deaths each year.

What the Researchers Say

“These are not abstract numbers,” said Dr. Alison Galvani, PhD, Director of the Yale Center for Infectious Disease Modeling and Analysis at the Yale School of Public Health. “Every data point represents a human life. These cuts would disproportionately harm the most vulnerable communities in America, including older adults, low-income families, and people already at the margins of our health care system.”

Methodology

To generate their mortality estimates, the research team relied on peer-reviewed studies quantifying the relationship between insurance coverage, access to prescription drug subsidies, and nursing home staffing levels with all-cause mortality. These estimates were applied to population loss projections from the Congressional Budget Office, which were released in May 2025. The researchers emphasized that the effects are additive across distinct groups—uninsured adults, low-income seniors, and nursing home residents—resulting in a total projection of more than 51,000 deaths annually if the proposed policies take effect.

The research was conducted by experts from Yale School of Public Health and University of Pennsylvania Leonard Davis Institute of Health Economics.

The letter is signed by Drs. Rachel M. Werner, Norma B. Coe, and Eric T. Roberts from the University of Pennsylvania and Drs. Galvani, Abhishek Pandey, and Yang Ye from Yale University.