WASHINGTON (AP) — Millions of Americans, including both adults and children, may face the loss of health insurance if the Republican-backed domestic policy package becomes law. The proposed legislation, known as the “One Big, Beautiful Bill Act,” aims to reduce federal spending by nearly $1 trillion over a decade, significantly impacting Medicaid, the Affordable Care Act (ACA), and the Children’s Health Insurance Program (CHIP).
The potential losses will not occur immediately but will gradually unfold as the bill implements changes to federal healthcare programs. Currently, approximately 78 million people are enrolled in Medicaid, while 24 million benefit from ACA marketplaces. The proposed changes could reverse years of progress in increasing health insurance coverage across the U.S.
Impact on Medicaid and ACA Enrollees
Under the new GOP plan, states will be required to conduct more frequent income and eligibility checks for Medicaid recipients, potentially every six months. This increased scrutiny could disproportionately affect vulnerable populations, such as the homeless or transient individuals, who may miss government notifications to update their paperwork.
Martha Santana-Chin, CEO of L.A. Care Health Plan, which provides Medicaid to millions in Los Angeles, expressed concern:
“The life experience of these individuals is not necessarily one that allows them the luxury of having to work through onerous paperwork,” Santana-Chin said.
Historical precedents, such as Texas’s increased eligibility checks between 2014 and 2019, resulted in thousands of children losing coverage, highlighting the potential risks of the proposed changes.
Children’s Health Insurance Program (CHIP) Adjustments
States may be allowed to delay enrollment in CHIP if parents are behind on premium payments. Premiums can reach up to $100 per month in some states, according to health policy research firm KFF. Additionally, states might introduce waiting periods for children transitioning from private insurance to Medicaid, a practice previously prohibited by the Biden administration.
Challenges for Immigrants and Work Requirements
The bill also aims to narrow the definition of eligibility for ACA subsidies, impacting thousands of refugees and asylum seekers. States that offer Medicaid to undocumented immigrants could see reduced federal funding, potentially leading to program cuts.
California has already announced a freeze on new Medi-Cal enrollments for immigrants, while Illinois has halted its program entirely. The bill proposes work requirements for Medicaid eligibility, mandating that individuals aged 19 to 64 work, volunteer, or attend school for at least 80 hours per month.
Michael F. Cannon, director of health policy studies at the Cato Institute, commented on the potential effects:
“It can encourage people who don’t value Medicaid coverage not to sign up for it,” Cannon said. “And that saves the government money.”
However, the work requirement could lead to coverage losses due to bureaucratic errors or difficulties in verifying employment, as seen in Arkansas in 2018 when 18,000 people lost Medicaid coverage before a federal judge intervened.
Implications for Dual Medicare and Medicaid Beneficiaries
The GOP bill also proposes rolling back streamlined enrollment processes for individuals eligible for both Medicare and Medicaid, often due to disabilities. This could increase paperwork burdens and result in coverage losses for some individuals.
Jennifer Tolbert, director of state health policy at KFF, highlighted the potential consequences:
“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,” Tolbert said.
As the legislative process unfolds, the potential impacts of the GOP’s tax bill on healthcare coverage remain a critical concern for millions of Americans. The debate continues as policymakers weigh the fiscal benefits against the societal costs of reduced healthcare access.