Millions of Americans are projected to become uninsured over the next decade as major changes to Medicaid and Affordable Care Act coverage take effect this month. The Congressional Budget Office estimates that Medicaid changes enacted as part of President Donald Trump's 2025 tax and spending law will increase the number of uninsured Americans by 7.5 million in 2034. And when changes affecting Affordable Care Act Marketplace coverage and other provisions are included, the law is projected to increase the uninsured population by 10 million.
New Medicaid eligibility restrictions for certain lawfully present immigrants took effect on October 1, but broader Medicaid requirements will take effect in 2027. However, the exact impact will vary by state. Medicaid provides health care coverage to tens of millions of Americans.
The 2025 reconciliation law brought major restructuring to the program, including new work requirements and more frequent eligibility checks. New restrictions also affect certain immigrants. KFF estimates that 5.3 million of the 7.5 million people projected to become uninsured because of the Medicaid changes will be uninsured because of new work requirements affecting people in the ACA Medicaid expansion population and partial-expansion programs.
Those requirements are scheduled to begin January 1, 2027. The 2025 reconciliation law made several consequential changes to Medicaid. Beginning in 2027, certain adults covered under Medicaid expansion will generally have to satisfy new community-engagement requirements involving work, education or other qualifying activities.
States will also be restricted in how they use provider taxes and state-directed payments to health care providers. KFF estimated California could have 1.6 million additional uninsured residents by 2034, the largest numerical increase in the country. New York follows with 860,000, while Florida could see an additional 590,000 uninsured people, Texas 480,000 and Illinois 470,000.
Their medical needs don't magically disappear. Prescriptions get skipped, treatment gets delayed, and something manageable can turn into an emergency,” Ryan said. The patient, the hospital, or eventually everyone else?
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