Here's how millions of people could lose health insurance if Trump's tax
bill becomes law
[July 03, 2025]
By AMANDA SEITZ
WASHINGTON (AP) — Roughly 11.8 million adults and children will be at
risk for losing health insurance if Republicans' domestic policy package
becomes a law.
The losses won't come all at once. The GOP's “ One Big, Beautiful Bill
Act ” makes changes that will whittle away at enrollment through federal
health care programs like Medicaid and Obamacare over a decade in order
to wrest nearly $1 trillion from Medicaid, the Affordable Care Act, and
the Children's Health Insurance Program.
The bill is likely to reverse years of escalating health insurance rates
in the U.S., gains that have also been marked by record spending on
federally-funded health care coverage. Roughly 78 million adults and
children are enrolled in Medicaid's programs while 24 million people are
enrolled in the ACA's marketplaces.
Medicaid is a joint federal-state venture that is administered by the
states. The program goes by different names in some states, like Medi-Cal
in California, BadgerCare in Wisconsin, or MassHealth in Massachusetts.
A look at some of the ways in which people may lose health care coverage
under the GOP's plan:
Medicaid or Obamacare enrollee? Your income and eligibility will be
checked closely and more often.
Under the GOP's plan, states will need to verify a person's income to
check Medicaid eligibility every six months.
People who are homeless or transient may miss notices from the
government to fill out paperwork more frequently, said Martha
Santana-Chin, the CEO of L.A. Care Health Plan, which provides Medicaid
for millions of Los Angelenos. They'll lose their coverage if they don't
respond.
“The life experience of these individuals is not necessarily one that
allows them the luxury of having to work through onerous paperwork,”
Santana-Chin said.
When Texas increased income eligibility checks between 2014 and 2019,
for example, thousands of kids lost coverage in the state. Critics
faulted the frequent checks, too, for the state having the highest rate
of uninsured children in the nation at the time.
States will also be required to check enrollees’ addresses and death
records more frequently.
People enrolled in the ACA's marketplace coverage will also be subject
to more scrutiny over their reported income and face penalties if they
end up earning more than they expected when signing up for the coverage.
They'll have to wait for the government to verify their information,
too, before getting coverage.
It will be a sharp contrast from employer-based coverage, where people
are re-enrolled every year unless they opt out.
Is your child enrolled in coverage?
States will be allowed to delay kids from enrolling in the Children’s
Health Insurance Program in some cases.
They will be allowed to temporarily block parents from enrolling their
children if they are behind on paying the premiums for the coverage.
Those premiums for kids’ coverage can run as much as $100 a month in
some states, according to health policy research firm KFF. States will
also be able to introduce a waiting period for kids who are being
transitioned from private health insurance plans to Medicaid.
The Biden administration prohibited states from locking out parents from
enrolling their kids in coverage over missed payments or a waiting
period when transitioning from private health insurance.
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Senate Majority Leader John Thune, R-S.D., is flanked by Sen. John
Barrasso, R-Wyo., the GOP whip, left, and Finance Committee Chairman
Mike Crapo, R-Idaho, speaks to reporters after passage of the budget
reconciliation package of President Donald Trump's signature bill of
big tax breaks and spending cuts, at the Capitol in Washington,
Tuesday, July 1, 2025. (AP Photo/J. Scott Applewhite)
 Are you an immigrant? Getting
coverage may get harder.
The bill narrows the definition of who qualifies for lower Obamacare,
restricting access for thousands of refugees and asylum seekers who
come to the U.S. every year.
States that offer Medicaid coverage to cover immigrants who may not
be here legally will also receive less money from the federal
government. Several states allow immigrants to enroll in Medicaid,
paid for only using state tax dollars. But the bill threatens that
coverage by lowering the rate the federal government pays for all
legal residents from 90% to 80%.
That will lead some states to drop their program for immigrants
entirely rather than lose federal funding. Already, California has
announced a freeze on any new enrollment for the state funded Medi-Cal
for all immigrants. Illinois, meanwhile, halted its program this
month.
Able-bodied? You’ll have to work, volunteer or go to school.
Most coverage losses are expected to come from the GOP's proposed
work requirement. People aged 19 through 64 will be required to
work, volunteer or go to school for 80 hours per month in order to
qualify for Medicaid under the new law. They'll be exempt if they're
disabled, pregnant or parent a child who is 14 or younger.
Ultimately, some people will decide they don't want to work and
don't need the coverage, said Michael F. Cannon, director of health
policy studies at the libertarian think tank Cato Institute.
“It can encourage people who don’t value Medicaid coverage not to
sign up for it,” Cannon said. “And that saves the government money.”
Most Medicaid enrollees already work, attend school, have a
disability or are caregivers, which should exempt them from the
requirement. Only about 8% of enrollees report not working or being
unable to find work.
In some cases, people will lose coverage even if they're working.
They will fall victim to bureaucratic errors, overlooked forms, or
trouble getting all of the documents — like proof of employment and
tax forms — together to prove to the government that they're
working. Verifying work will be especially difficult for people who
don't have access to the internet, a computer or phones.
That's how some people lost coverage in Arkansas, which tried to
enact work requirements in 2018. Roughly 18,000 people were pushed
off Medicaid within seven months. A federal judge later blocked the
requirement.
Enrolled in both Medicare and Medicaid? It will be harder to
apply
Millions of people qualify for both Medicare and Medicaid, often
because of a disability.
The GOP bill will roll back requirements of the ways the Biden
administration streamlined enrollment for those people, including a
rule that required states to automatically enroll people into
coverage if they qualify for supplemental income because of a
disability.
“By rescinding these rules and no longer requiring states to make
some of these simplifications, it’s likely that some people will
lose coverage because they get caught up in these paperwork
burdens,” said Jennifer Tolbert, director of state health policy at
KFF.
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