The Affordable Care Act faces major rollbacks if the president's big spending and tax cut bill is approved by the Senate.

The proposed changes could affect many of the 24 million Americans enrolled in that insurance marketplace

and could leave millions of people without coverage.

The House and Senate versions of the so-called one big, beautiful bill, differ, but they have key changes in common,

including shortening enrollment periods requiring additional verification and effectively

ending automatic renewals of insurance, making health premiums more expensive and higher cost

sharing, and blocking subsidies for many legal immigrants, refugees, and those on student visas.

For more, we're joined now by Sarah Cliff, health policy reporter for the New York Times.

Sarah, thanks so much for being here. So these changes we mentioned help us understand how significant

they would be for people who rely on the Affordable Care Act for insurance coverage.

They would be quite significant.

It's estimated by the Congressional Budget Office that about 4 million people would lose health coverage.

That's about one-sixth of the people who currently get Obamacare.

And it's not this big sweeping repeal that Republicans used to talk about.

It's really a suite of policy tweaks that kind of add up one source that we talked to about this, kind of described it as repeal by paper cut.

A lot of small tweaks that add up to millions of people likely losing their insurance under this legislation.

And Republicans make the case that these changes are necessary because they say there's so much fraud in the marketplace.

What have you found on that front in your reporting? Yeah, the marketplace has struggled a little bit

with certain kinds of fraudulent enrollment. A lot of this had to do with brokers kind of

enrolling people in ways that weren't quite okay. The Biden administration did on its way out

issues and regulations to crack down on that

behavior. And I think what worries, you know, advocates for the Affordable Care Act is that this

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