17 Million Americans May Lose Health Coverage Under The One Big Beautiful Bill
About 17 million Americans could lose their health insurance coverage in 2026. That’s when the “One Big Beautiful Bill,” the flagship budget reconciliation package Trump signed on July 4, is expected to be fully implemented.
Twelve million of those at risk are Medicaid enrollees. An additional 5 million people stand to lose coverage due to changes in the Affordable Care Act marketplace coverage.
Overall, these changes will lead to significant increases in out-of-pocket healthcare costs, lapses in coverage, and total losses for the most vulnerable Americans. Here are five things you need to know about key health care coverage provisions in the bill.
Women Will Lose Access To Trusted Reproductive Health Care Providers
Due to a prohibition on Medicaid funds to nonprofit organizations and community health centers that offer family planning and reproductive health care services, including abortion care with private or non-federal funds, underserved and hard-to-reach communities are likely to see gaps in access to vital health care.
Planned Parenthood, a trusted and long-standing reproductive health care provider, is targeted through this provision of the bill. However, the effects will have far-reaching impacts on additional providers and millions of patients.
This is just the latest target by Congressional Republicans and President Trump of reproductive health care providers. In March, the Trump administration withheld tens of millions in funding from Planned Parenthood and other front-line family planning clinics. More than 1 million Americans seeking care from Planned Parenthood alone could lose access to essential services such as sexually transmitted infections testing, cancer screenings, and contraception. Some Planned Parenthood clinics also provide prenatal care to expectant parents. Due to a decades-old federal restriction on abortion coverage under the Hyde Amendment, Medicaid enrollees are already prohibited from using their health care coverage for abortion (except in the cases of rape, endangerment to the life of the mother, and incest). On July 7, a judge temporarily barred the Trump administration from withholding Medicaid funding to Planned Parenthood.
The Bill Imposes Stringent Work Requirements On Medicaid Enrollees
The bill enacts new conditions on Medicaid eligibility, requiring individuals between the ages of 19 and 64 to work at least 80 hours per month and undertake onerous reporting requirements. The final version, as signed by President Trump, does include exemptions for Medicaid enrollees who are the parents of children under the age of 13.
KFF estimates that 64% of adults on Medicaid already work full time or part time. The remainder simply cannot work due to caregiving responsibilities (12%), illness or disability (10%), or because they are pursuing education (7%). The work requirement could knock people out of much-needed insurance coverage, especially low-income, vulnerable individuals. The non-partisan Congressional Budget Office has estimated that while work requirements could result in federal savings over the long term, policies such as this would greatly increase the number of uninsured Americans and do nothing to spark increases in employment rates.
Out-of-pocket Health Care Costs Are Expected To Rise
Medicaid enrollees who maintain coverage given the new changes can expect to feel it in their pocketbooks. The bill will require states to impose cost sharing of up to $35 per service for adults with incomes between 100% to 138% of the federal poverty line. It includes exemptions for primary care, substance use disorder treatment, and mental health care, and maintains limits on cost sharing for prescription drugs from the previous law, along with prior exemptions (i.e., long-term care, family planning, etc.). Those managing chronic health conditions could see the greatest burden in out-of-pocket costs over a year. The average annual expense for all Medicaid enrollees is about $542, and up to $1,248 for those managing three or more chronic conditions. For people with limited incomes, an increase in expenses of this magnitude could completely derail household budgets and cause families to forgo necessities.
The Bill Cuts Biden-Era Incentive For State Medicaid Expansion
The budget reconciliation bill eliminates the American Rescue Plan’s temporary financial incentive for states opting to expand Medicaid. Forty-one states and the District of Columbia have expanded Medicaid, broadening the population of individuals and families with slightly higher household incomes eligible for Medicaid (up to 138% of the federal poverty line, or $21,597 for an individual, $44,367 for a family of four). Under the American Rescue Plan, 90% in federal matching funds had been awarded to state populations with Medicaid expansion.
Medicaid expansion has been key in increasing access to health coverage and essential care for millions of Americans, improving access to services such as long-term care, treatment of chronic conditions such as diabetes, behavioral health, pregnancy-related care (including in the vulnerable postpartum period), care for people with disabilities, and much more.
Certain Groups Of Immigrants Are No Longer Eligible For Subsidized Health Insurance Coverage
The bill eliminates subsidized health insurance coverage through the Affordable Care Act marketplace for all immigrants residing in the country lawfully with incomes under 100% of the federal poverty line. In 2025, this is just $15,650 annually for an individual and $32,150 annually for a family of four.
The new law places further limitations on subsidized coverage for immigrants with green cards, refugees, asylees, and people with Temporary Protected Status. It also severely or altogether limits Medicaid and State Children’s Health Insurance Program coverage for many of these groups of immigrants.
Undocumented immigrants are already ineligible for subsidized health insurance coverage. Uninsured rates among immigrants tend to be high, especially among the undocumented. These groups are also most likely to delay much-needed healthcare or forgo it altogether. Despite high rates of employment within the immigrant population, it’s uncommon for them to have access to employer-sponsored health insurance, making subsidized coverage critical to ensuring access to essential health care services.
Many of these provisions take effect in 2026, but the government is already beginning to implement them. In the meantime, the individuals and families affected by ensuing changes to their health care coverage must keep a close eye on not only their health plans but also their pocketbooks. While the health implications for the uninsured cannot be overstated, so too are the implications of those already experiencing economic hardship. The One Big Beautiful Bill will make it harder for already struggling individuals and families to make ends meet and stay healthy.