Trump Tax Bill Threatens 11.8 Millions With Medicaid Coverage Loss/ Newslooks/ WASHINGTON/ J. Mansour/ Morning Edition/ Nearly 12 million Americans risk losing health insurance under Trump’s tax bill, which imposes stricter rules on Medicaid and Obamacare programs. The GOP plan introduces work requirements, income checks, and limits immigrant coverage. Democrats warn millions could be pushed off vital health care.
Quick Look
Medicaid Work Rules → New 80-hour monthly work mandate
Frequent Checks → Twice-yearly income verification risks coverage gaps
Immigrant Coverage Cuts → Federal funding drops, states may drop programs
Kids Affected → CHIP access hurdles, premiums could block coverage
Dual Eligibility Impacted → Rollback of streamlined Medicare-Medicaid enrollment
Projected Losses → Up to 11.8 million people lose insurance
Political Divide → GOP touts savings; Dems warn of crisis
Vote Imminent → Bill headed for final House vote soon
Millions Face Loss of Health Insurance Under Trump’s Tax Bill, Analysis Finds
Deep Look
WASHINGTON (AP) — Nearly 12 million Americans could lose their health insurance if Republicans’ sweeping domestic policy package, dubbed the “One Big, Beautiful Bill Act,” becomes law.
The coverage losses wouldn’t happen overnight but would unfold gradually over the next decade, as the bill seeks to extract nearly $1 trillion in savings from Medicaid, the Affordable Care Act (ACA), and the Children’s Health Insurance Program (CHIP).
Such cuts would reverse a decade of gains that brought record highs in health insurance coverage across the U.S. Today, around 78 million adults and children are enrolled in Medicaid, while 24 million rely on ACA marketplace plans.
Medicaid — a federal-state program known by different names in some states, like Medi-Cal in California and MassHealth in Massachusetts — would be one of the biggest targets of change.
Here’s how the bill could cause millions to lose coverage:
More Frequent Income Checks Could Push People Off Medicaid
Under the GOP plan, states would have to verify Medicaid enrollees’ income every six months instead of annually.
That could be devastating for vulnerable populations such as homeless or transient individuals who may miss government notices and fail to submit paperwork on time, said Martha Santana-Chin, CEO of L.A. Care Health Plan, which serves millions in Los Angeles.
“The life experience of these individuals doesn’t necessarily allow them the luxury of dealing with constant paperwork,” she said.
Texas provides a cautionary example: Between 2014 and 2019, when the state increased income checks for children, thousands of kids lost Medicaid coverage, contributing to the highest child uninsured rate in the country at the time.
States would also be required to more frequently check addresses and death records of enrollees, and ACA enrollees would face stricter income verification and possible penalties if they underestimated their income when signing up for coverage. Unlike employer-sponsored health insurance, ACA enrollees could face lapses if their paperwork isn’t processed quickly.
CHIP Enrollment Could Get Harder for Kids
States would gain more power to block or delay children’s enrollment in CHIP.
Parents behind on premium payments — which can be as high as $100 a month in some states — could see their kids temporarily denied coverage. The bill would also allow states to impose waiting periods for children transitioning from private insurance to Medicaid.
These measures roll back Biden-era rules that banned states from denying coverage to kids because of missed payments or waiting periods.
Immigrants Face New Barriers to Coverage
The bill narrows eligibility for ACA subsidies, excluding many refugees and asylum seekers who currently qualify.
It would also reduce the federal funding match for states covering lawful immigrants under Medicaid from 90% to 80%. That financial hit could prompt states to eliminate coverage altogether for certain immigrant groups.
California has already announced it will freeze new enrollment in Medi-Cal for undocumented immigrants, while Illinois halted its immigrant coverage program earlier this month.
Work Requirements Threaten Millions of Adults
Perhaps the biggest impact would come from new work requirements for Medicaid enrollees ages 19 to 64, who would have to prove they work, volunteer, or attend school for at least 80 hours a month. Exceptions would exist for people who are disabled, pregnant, or parents of young children.
Michael F. Cannon of the libertarian Cato Institute argues that the policy might save money by deterring people who don’t value Medicaid enough to comply.
“It can encourage people who don’t value Medicaid coverage not to sign up for it,” he said.
However, most Medicaid enrollees already work, study, or care for family members. Only about 8% report not working or being unable to find employment.
Still, bureaucratic hurdles could push many off coverage even if they meet the requirements. Some may struggle to gather documentation or face technology barriers.
That’s what happened in Arkansas in 2018, when a similar policy led to roughly 18,000 people losing Medicaid in just seven months before a federal judge halted the rule.
Dual-Eligible Patients Could Face New Hurdles
Millions of Americans qualify for both Medicare and Medicaid, often due to disabilities.
Trump’s bill would roll back Biden-era policies designed to automatically enroll eligible individuals, potentially leaving more people trapped in administrative limbo.
“By rescinding these rules … it’s likely that some people will lose coverage because they get caught up in paperwork burdens,” said Jennifer Tolbert, director of state health policy at the health policy group KFF.
High Stakes for Health Coverage
These proposed changes, spread across the massive 887-page legislation, could fundamentally reshape the U.S. safety net and health coverage landscape for millions of Americans.
As debate rages on Capitol Hill, Democrats warn of devastating consequences for vulnerable families, while Republicans argue the reforms are necessary to reduce government spending and encourage self-sufficiency.
House Speaker Mike Johnson insists the bill is the best product the GOP can deliver, while critics like Rep. Nancy Pelosi argue it’s anything but “beautiful.”
Meanwhile, the fate of millions of Americans hangs in the balance as lawmakers race toward a possible final vote in the coming days.
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