Health Care
~13,700
People lost health care today, on average
~7.0M
Total who've lost coverage so far
Why should I care?
In July 2025, Trump signed a Republican reconciliation law that cuts roughly $1 trillion from Medicaid over the next decade — the largest cut in the program's history. Separately, a set of enhanced Affordable Care Act ("Obamacare") subsidies expired at the end of 2025 after Trump and congressional Republicans declined to renew them. Both are already pulling people off their coverage: ACA marketplace premiums more than doubled on average overnight for people who lost that subsidy, and Medicaid is rolling out a new rule requiring most adults to prove they're working 80 hours a month just to keep their coverage. Independent research shows that even people who already meet that requirement will still lose coverage over paperwork alone — as many as a third of them, by some estimates. The Congressional Budget Office — Congress's own nonpartisan scorekeeper, currently led by a Republican-appointed economist — projects a combined 16 million more people will be uninsured by 2034 because of this law and the tax-credit expiration together.
"CBO estimates that the combined effects of those policies—two under current law and the others under H.R. 1—would increase the number of people without health insurance by 16.0 million in 2034."
— Congressional Budget Office, letter to Sens. Wyden, Pallone & Neal, June 4, 2025
What are "premium tax credits"? They're subsidies that lower the monthly cost of an ACA marketplace health plan, sized to your income. Congress temporarily expanded them in 2021, covering more people at a bigger discount. Those enhanced credits were set to expire at the end of 2025; Trump and congressional Republicans chose not to extend them, so premiums for marketplace plans roughly doubled for millions of people overnight — even though nothing about their income or health had changed.
What are the new Medicaid "work requirements"? Starting nationally by January 1, 2027 (some states sooner), most adults on Medicaid must document 80 hours a month of work, job training, or community service to keep their coverage — with exemptions for parents of young children, pregnant people, and those who are medically frail. In practice, the paperwork itself is the obstacle: research finds a large share of people who are already working, but can't reliably prove it every month, lose coverage anyway.
The two big cuts
Two separate policy changes are driving most of the coverage losses so far, and more provisions are still phasing in.
| Coverage Type | Time Period | People Affected |
|---|---|---|
| ACA marketplace plans (lost the enhanced premium tax credit) | Dec. 2025 – Feb. 2026 | 2.2M |
| Medicaid (work-requirement rollout, eligibility changes, redeterminations) | May 2025 – May 2026 | 4.8M |
From the Center on Budget and Policy Priorities' live coverage tracker (updated Sept. 2, 2026), built on official CMS and state enrollment data — the single source used for both the 7.0M stat card above and this breakdown, so the numbers stay consistent across the page and the homepage.
| Provision | Status | Effective |
|---|---|---|
| ACA enhanced premium tax credits expire | In effect | Jan. 1, 2026 |
| Medicaid work requirements — early states (e.g., Nebraska) | In effect | Aug. 2026 |
| Medicaid immigrant eligibility restrictions | Not yet in effect | Oct. 2026 |
| Medicaid work requirements — national deadline | Not yet in effect | Jan. 1, 2027 |
| ACA marketplace immigrant eligibility restrictions | Not yet in effect | 2027 (est. 1.2M affected) |
As the remaining provisions phase in through 2027, the losses above will keep climbing. CBO's longer-run estimate, combining the reconciliation law with the separate premium-tax-credit expiration: 16 million more people uninsured by 2034 — more than double the ~7 million already off the rolls today.
Sources
Updated September 2, 2026. Source for the 2.2M/4.8M breakdown and the 7.0M combined total, built on CMS and state enrollment data.
Source for the premium-doubling figure in "Why should I care?"
Source for the 80-hour/month requirement, exemptions, and the Jan. 1, 2027 national deadline.
March 2026. Source for the finding that a large share of people who already meet the work requirement will still lose coverage over paperwork, and for early state rollout dates.
CBO's own combined estimate — 16 million more uninsured by 2034 from the reconciliation bill and the premium-tax-credit expiration together. Source for the pull-quote and the 16-million figure used throughout this page. CBO is a nonpartisan legislative-branch agency (not part of the executive branch); its current director, Phillip Swagel, is a Republican economist appointed by Congress.