How many will lose health insurance under the Republican bill? The CBO says 13.7 million.

House Republicans are quibbling over exactly how many millions of Americans would lose health insurance under the budget bill passed Thursday morning.

Democratic lawmakers assert that up to 13.7 million people could lose coverage—many of them Medicaid beneficiaries. House Republicans dispute this claim.

“The Budget Resolution passed today does not specify any cuts to federal programs,” Rep. Ken Calvert (R-CA) said in a statement. “I want to make it clear that I do not support cuts to Social Security, Medicare and the safety net programs our vulnerable Americans rely on.”

The nonpartisan Congressional Budget Office (CBO), which analyzes the economic impact of legislation, says otherwise.

The bill imposes stricter work requirements for Medicaid, requiring recipients to prove that they worked or attended school for at least 80 hours in the month prior to enrollment. States would have the power to extend this time frame up to a full year before enrollment.

The bill also aims to cut billions in discretionary spending from the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), the federal agencies responsible for administering the program.

The CBO estimates these combined changes will lead to at least 7.6 million people being removed from Medicaid.

The number of uninsured individuals rises when changes to the Affordable Care Act (ACA)—which is also administered by HHS and CMS—are factored in.

The 2022 Inflation Reduction Act, signed into law by President Joe Biden, created tax credits to help low- and middle-income Americans afford ACA plans. These credits are set to expire at the end of the year, and the current Republican bill does not renew them.

The CBO expects many ACA enrollees benefiting from the credits to drop health insurance instead of taking on the additional costs. This factor, combined with the changes to Medicaid, forms the basis for the estimate that 13.7 million people will lose health insurance.

“Thirteen point seven million Americans are the number of people in this country whose health care are going to be stripped in this bill,” said Rep. Alexandria Ocasio-Cortez (D-NY). “Now, Republicans are going to try to tell you every distraction in the book from that essential number.”

Changes to Medicaid and the ACA may also affect access to health care for individuals who remain insured.

More than 30% of rural hospitals in the United States are at risk of closure due to financial hardship, and many of these hospitals rely on Medicaid payments to provide care.

Rep. Mariannette Miller-Meeks (R-IA), who supported the legislation, could see four hospitals in her district close.

The Kaiser Family Foundation, which tracks public health polling, reports that 76% of Americans oppose major cuts to Medicaid, and 65% oppose cuts to ACA tax credits.