The 2025 Budget Reconciliation Bill — also known as the “One Big Beautiful Bill,” or H.R.1 — could lead to more than one million missed cancer screenings, according to a research letter published January 8 in JAMA Oncology.
The bill reduces federal Medicaid funding and includes “mandates for work requirements and more frequent recertification” — conditions that could “disproportionately impact young and socially vulnerable enrollees, likely leading to coverage loss,” wrote co-authors Sarah Shubeck, MD, and colleague Adrian Diaz, MD, both of the University of Chicago.
“Coupled with a shift toward younger patients being diagnosed with cancer (i.e., <65 years), these changes could meaningfully reduce cancer screening and early detection,” the two noted.
Shubeck and Diaz came to this conclusion via a decision analytic model they developed based on state-level Medicaid data of adult enrollees from the U.S. Centers for Medicare and Medicaid Services (CMS). The team defined each state’s baseline enrollment as the mean from November 2024 to February 2025 and identified adult expansion share under the Affordable Care Act, treating remaining adults as nonexpansion. (“Adult expansion share” refers to initiatives that expand healthcare coverage to younger adults.)
The authors paired coverage losses with state-level Behavioral Risk Factor Surveillance System (BRFSS) 2022 to 2024 screening prevalence and converted missed screenings to incident cancers using two-year risk models, translating these to cancer stage shifts and deaths using parameters drawn from Cancer Intervention and Surveillance Modeling Network (CISNET) modeling used by U.S. Preventive Services Task Force (USPSTF) and the Surveillance, Epidemiology, and End Results (SEER) program.
Shubeck and Diaz estimated that, over the first two years after implementation of the bill, 7.5 million Medicaid-enrolled adults eligible for cancer screening could lose coverage. They also estimated the following:
- 405,706 missed mammograms, 679,745 missed colorectal screening tests, and 67,213 missed lung cancer screenings.
- Missed screening could result in 1,055 undetected breast cancers, 748 undetected colorectal cancers, and 538 undetected lung cancers. Among these, 156 breast, 105 colon, and 65 lung cancers will likely be discovered at an advanced stage.
“Projected Medicaid coverage losses are expected to result in over one million missed cancer screenings and hundreds of avoidable deaths within two years,” the authors wrote.
They did list some limitations of their model, including the primary focus on breast, colorectal, and lung cancer, writing that “overall oncologic consequences are likely larger,” and explaining that their estimates “do not account for interruptions in ongoing cancer treatment,” which suggests that their results could be conservative.
But overall, the research highlights “the substantial and preventable morbidity and mortality that could result from coverage retrenchment and underscores how national policy may result in divergent and costly public health consequences across states,” Shubeck and Diaz concluded.
Access the full letter here.