Millions at Risk of Losing Health Insurance if GOP Tax Bill Becomes Law
Washington, D.C. – Approximately 11.8 million adults and children in the United States could face losing their health insurance coverage if the Republicans’ proposed domestic policy package, known formally as the “One Big, Beautiful Bill Act,” is enacted into law. The legislation aims to reduce nearly $1 trillion in federal spending by cutting funds for key healthcare programs including Medicaid, the Affordable Care Act (ACA), and the Children’s Health Insurance Program (CHIP).
Gradual Impact on Coverage Over a Decade
The potential losses in coverage would occur gradually over the next ten years, as the bill introduces a series of changes that would tighten eligibility criteria and enrollment processes for federal health programs. Currently, roughly 78 million people are enrolled in Medicaid, while about 24 million obtain coverage through the ACA marketplaces.
Medicaid, a joint federal and state program, varies in administration and name across states, including programs like Medi-Cal in California, BadgerCare in Wisconsin, and MassHealth in Massachusetts. The proposed bill seeks to make enrollment and renewal more stringent, which critics warn could lead to substantial coverage losses.
Key Changes That Could Lead to Loss of Coverage
Income and Eligibility Verification
Under the GOP bill, states would be required to verify enrollees’ income every six months to maintain Medicaid eligibility. This frequent verification process risks disenrollment, particularly among vulnerable populations such as the homeless or those with unstable housing, who might miss critical notices or fail to complete paperwork on time.
Martha Santana-Chin, CEO of L.A. Care Health Plan—which provides Medicaid coverage to millions in Los Angeles—highlighted that frequent re-verifications do not account for the challenges faced by people with unstable living situations. Historical data from Texas shows that increased income checks from 2014 to 2019 coincided with thousands of children losing coverage and contributed to the state having one of the highest rates of uninsured children nationwide.
Similarly, people covered through the ACA marketplaces would face increased scrutiny of reported income and potential penalties if their earnings exceed estimates made at the time of enrollment. In contrast to employer-based plans, which automatically renew coverage annually, these federal programs would require ongoing government verification before continuing coverage.
Children’s Health Insurance Program (CHIP) Enrollment Restrictions
The bill would allow states to delay or block enrollment of children in CHIP if parents are behind on premium payments, which can sometimes be as high as $100 per month. States also could impose waiting periods for children transitioning from private insurance to Medicaid coverage. The Biden administration had previously prohibited such lockouts and waiting periods to ensure uninterrupted access to coverage for children.
Impact on Immigrants’ Access to Care
The proposed legislation narrows eligibility criteria for Obamacare subsidies, limiting access for refugees and asylum seekers entering the U.S. annually. Additionally, the bill threatens federal funding for state programs that cover immigrants who may not have legal status. Currently, some states fund Medicaid for these populations entirely through state funds; the bill proposes reducing the federal matching rate from 90% to 80% for all legal residents, which could prompt states to eliminate such programs to avoid financial losses.
California has already announced a freeze on new enrollments in its state-funded Medi-Cal program for immigrants, while Illinois recently halted its similar program.
New Work Requirements Introduced
One of the bill’s most consequential provisions would impose work requirements for Medicaid eligibility on able-bodied adults aged 19 to 64. Beneficiaries would need to work, volunteer, or attend school for at least 80 hours per month unless they are disabled, pregnant, or caregivers to children under the age of 14. While proponents argue that work requirements could reduce dependency and save government funds, critics emphasize that verifying employment can be challenging. Many Medicaid recipients who do work might lose coverage due to difficulties in documenting their hours, technological barriers, or bureaucratic errors. Arkansas’ attempt to implement work requirements in 2018 resulted in roughly 18,000 people losing Medicaid coverage within seven months before a federal judge blocked the policy.
Complications for Dual Medicare-Medicaid Enrollees
Millions who qualify for both Medicare and Medicaid—often due to disability—could face more complicated enrollment procedures. The bill would roll back Biden administration efforts that streamlined enrollment for this group, including automatic enrollment for those qualifying for supplemental income assistance. Without these simplifications, increased paperwork burdens could cause some people to lose coverage inadvertently.
Expert Perspectives
Jennifer Tolbert, director of state health policy at the Kaiser Family Foundation (KFF), noted, “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.”
The cumulative effect of these provisions is expected to erode the gains in health coverage witnessed over recent years, marking a reversal in the trend toward broader health insurance access in the United States.
Conclusion
If the GOP’s “One Big, Beautiful Bill Act” becomes law, millions of Americans could face substantial obstacles to maintaining health coverage through Medicaid, the ACA, and CHIP. Increased verification requirements, enrollment restrictions, reduced funding for immigrant coverage, and work mandates combine to threaten the security of coverage for vulnerable populations nationwide. Policymakers and advocates continue to debate the bill’s potential impacts as the legislative process unfolds.
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