Significant Tax and Spending Legislation Signed by Trump
On July 4, 2025, President Donald Trump enacted a substantial tax and spending law projected to cut government healthcare spending by over $1 trillion in the next decade. The legislation, which progressed rapidly through Congress, raised concerns about the number of individuals who might lose their health insurance. While estimates were not definitive, it was approved by a narrow margin, and nearly 12 million Americans may face the loss of insurance coverage, according to the Congressional Budget Office. The law is expected to offer compensation until 2034.
Yet, projections could be more dire. By 2034, as many as 17 million individuals might find themselves without insurance. This is notably due to more than 5 million Americans, currently insured through the Affordable Care Act’s marketplace, likely losing coverage once the funding for those policies expires at the end of 2025. A minority of Republicans have indicated support for renewing the grants.
Apart from that, regulations introduced by the Trump administration earlier this year may further exacerbate the loss of ACA Marketplace coverage for many Americans.
According to a public health expert, these developments represent a gradual reversal of the healthcare access expansion initiated with the ACA in 2010. In 2023, 25.3 million Americans were uninsured, a drop from 40.6 million prior to the ACA. Overall, this law might undo a substantial portion of the progress made in reducing the uninsured rate in the U.S.
Millions Requiring Medicaid May Find Themselves Uninsured
The most affected cohort will likely be those registered with Medicaid, serving over 78 million individuals. An estimated 5 million people could ultimately lose their Medicaid coverage due to new work requirements that are set to be implemented nationwide by 2027.
These requirements target individuals eligible for Medicaid through the ACA expansion, who typically have slightly higher incomes than others in the program. Applicants aged 19-64 must demonstrate they are working a minimum of 80 hours or participating in similar activities such as community service.
As similar regulations have led to challenges in other safety net programs, many might lose assistance not due to a lack of hours worked but due to administrative complexities. If more documentation is needed to maintain Medicaid enrollment, the Congressional Budget Office estimates that an additional 2 million could find themselves uninsured. Furthermore, another 1.4 million may lose coverage due to new immigrant or citizenship requirements.
Altogether, these changes in Medicaid might result in over 8 million more people being uninsured by 2034.
For those who manage to retain their Medicaid coverage, they may face new out-of-pocket expenses, making them hesitant to seek necessary care. New policies could complicate state payments for Medicaid, and, faced with fiscal pressures, some states might reduce enrollments or benefits.
The potential loss of Medicaid might leave many low-income Americans without affordable healthcare options, disproportionately impacting low-income people of color and non-English speakers.
Increased Costs in ACA Marketplace Policies
The legislation will likely complicate access to insurance for over 24 million Americans currently utilizing affordable marketplace plans. For starters, it would become more challenging to qualify for 2026 grants associated with those plans.
Recent changes stemming from the Trump administration suggest that about 1 million could lose access to ACA marketplace insurance. This includes reduced funding for outreach and enrollment efforts.
Moreover, the increased subsidies that have been in effect since 2021 are set to expire at the year’s end, and given Republican sentiments, extending these subsidies appears unlikely.
This could result in premiums soaring by over 75% in 2026, which means that an additional 4.2 million Americans could lose coverage, according to CBO estimates.
With political uncertainty rising and enrollments declining, there’s a chance that more private insurers might withdraw from the ACA marketplace. Some major companies have already voiced concerns about the market’s sustainability.
If they do exit, fewer options and higher costs will be the new norm, possibly leaving certain counties without ACA plans altogether.
Effects of Uninsurance on Health and Hospitals
The repercussions of losing health insurance can have dire consequences on health outcomes. Individuals who are uninsured are more likely to face deteriorating health and escalating medical debt. Early diagnosis and effective treatment can significantly improve health trajectories, but those without coverage often experience poorer outcomes.
The burden of being without insurance doesn’t just impact individuals. It also strains families and healthcare providers, as they may provide care without receiving compensation. Many hospitals, particularly those in rural areas, are already struggling and may be forced to make hard decisions—some may even shutter their doors.
These existing pressures could intensify with the law’s implementation, with some estimates suggesting that over 300 hospitals are at risk of closure. Children’s hospitals in low-income urban areas, heavily reliant on Medicaid, also face challenges in maintaining operations.
Despite efforts to allocate funds to assist rural hospitals, the projected losses due to Medicaid cuts could create significant financial strain that overshadows any legislative relief.
Looking Ahead
Some Republicans are signaling that additional healthcare policy changes might be included in forthcoming legislative efforts. They may attempt to bring back clauses that were left out of the latest legislation—for instance, revisiting the ACA Medicaid expansion cuts.
Medicare spending could also be on the chopping block. The Congressional Budget Office has warned of potential reductions amounting to $500 billion from 2026 to 2034 if no action is taken to counter the debts created by the new law.
Although Trump has pledged to protect Medicare and Medicaid, it remains possible that executive actions could further limit federal healthcare spending and dismantle coverage improvements granted by the ACA.
