Who is losing healthcare in 2026?

An estimated 4 to 5 million people are losing health coverage in 2026 due to the expiration of enhanced Affordable Care Act (ACA) tax credits and new federal Medicaid rules.

Affordable Care Act (ACA) Marketplace Enrollees

• Scale of Loss: Marketplace enrollment dropped from 22.3 million down to roughly 17 million, with about 4 to 5 million people losing or dropping coverage.
• Primary Cause: Congress allowed the pandemic-era enhanced premium tax credits to expire at the end of 2025, causing average net premiums and deductibles to spike significantly.
• Demographics Affected: Young adults (ages 18–34) make up nearly half of the drop-offs, alongside low- and middle-income families priced out of higher rates.

Medicaid and Medi-Cal Recipients

• Scale of Loss: Millions face disenrollment or risk losing access following the passage of H.R. 1 (the One Big Beautiful Bill Act).
• Primary Causes:
  • Work Requirements: New federal rules mandate that many low-income adults report at least 80 hours of work or volunteering per month.
  • Frequent Re-certifications: Mandatory 6-month eligibility checks and stricter documentation rules cause heavy administrative drop-offs, impacting self-employed workers, students, caregivers, and individuals with irregular schedules.
• Immigrant Restrictions: Federal funding and eligibility for lawful immigrants under Medicaid and ACA programs were restricted or stripped.

Medicare Advantage Enrollees

• Forced Disenrollment: Roughly 1 in 10 Medicare Advantage enrollees face forced plan changes or disenrollment in 2026, primarily affecting lower-rated plans (under 4 stars), PPO plans, and plans from smaller insurance carriers.

Approximately 4 million to 5 million Americans have already lost or are projected to lose Affordable Care Act (ACA) marketplace health insurance coverage in 2026, with broader estimates pointing to nearly 8 million total Americans losing coverage across public and private programs following legislative changes.

Key Drivers of Coverage Loss

• Expired Subsidies: Congress allowed the enhanced Affordable Care Act premium tax credits to expire at the end of 2025, causing insurance premiums to double or skyrocket for millions of families.
• Marketplace Declines: Department of Health and Human Services data cited by Families USA indicates that marketplace enrollment dropped by roughly 4 million people during the first half of 2026. Research groups like KFF projected total 2026 marketplace declines to reach around 5 million.
• Medicaid and Policy Reductions: Ongoing policy shifts, administrative barriers, and cuts tied to recent federal legislation have further reduced rolls, with groups like Protect Our Care tracking over 8 million cumulative coverage losses. Organizations such as the Center on Budget and Policy Priorities (CBPP) note that additional steep losses—particularly regarding immigrant eligibility and work requirements—will phase in through 2027 and 2028.

Medi-Cal is facing federal funding reductions of roughly $30 billion annually due to federal legislation (such as H.R. 1) and federal payment freezes targeting California's Medicaid program.

Major Funding and Policy Cuts

• Federal Revisions: Federal changes slash billions in support, restrict provider taxes, and impose new administrative and work rules.
• Federal Payment Freezes: The U.S. Department of Health and Human Services deferred over $1 billion in federal payments (including hundreds of millions for home health care programs like In-Home Supportive Services) pending compliance and fraud reviews.
• Provider and Clinic Cuts: State budget adjustments plan reductions and restrictions for Federally Qualified Health Centers (FQHCs) and rural health clinics.
• Benefit and Eligibility Reductions: Scheduled rollbacks include lowered asset limits, stricter 80-hour monthly work or volunteer requirements for adults aged 19–64, more frequent 6-month eligibility checks, and the elimination of full-scope dental benefits for specific immigrant groups.

You can review official timelines and updates directly on the Medi-Cal Changes Portal or read the summary of cuts from the California Budget & Policy Center.

No broad groups of people are losing traditional Medicare in 2026, but some Medicare Advantage enrollees face forced plan terminations, and roughly 100,000 lawfully present immigrants are projected to lose Medicare later due to recent federal legislation.

Medicare Advantage Changes

• Forced Disenrollment: According to Johns Hopkins Bloomberg School of Public Health, about 1 in 10 Medicare Advantage enrollees face forced plan disenrollment in 2026 as insurers scale back offerings.
• Network Drops: Major health systems nationwide have dropped specific Medicare Advantage plans due to disputes over prior authorization and reimbursements.

Immigrant Eligibility and Future Cuts

• Medicaid vs. Medicare: Recent changes from the federal spending law (such as the One Big Beautiful Bill Act) primarily target Medicaid eligibility for certain lawfully present immigrants starting October 1, 2026.
• Medicare Impact: While Medicaid changes took effect in late 2026, the Congressional Budget Office estimates that roughly 100,000 lawfully present immigrants could eventually lose Medicare coverage, with formal terminations anticipated around February 1, 2027.

Yes, millions of people are losing or will lose Medicaid coverage because of the One Big Beautiful Bill Act (H.R. 1), which enforces stricter noncitizen eligibility rules and new work requirements.

⚠️ Current Cuts (As of October 2026)

• Refugees and certain legal noncitizens lost federal Medicaid access.
• Green card holders and specific exempt groups keep coverage.
• States began removing people under new work rules.

📊 Future Losses Projected by 2028

According to analyses by the Urban Institute and the Robert Wood Johnson Foundation, broader changes will roll out over the next two years:

• 4.9 to 10.1 million people could lose coverage by 2028.
• Frequent checks: State redeterminations every six months instead of annually.
• Work mandates: Requirements to log 80 hours of work or school monthly.
• Paperwork barriers: Workers losing coverage due to documentation challenges.

📌 What You Should Do

• Watch your mail for state eligibility notices.
• Respond with requested immigration or income proofs.
• Report work hours, school, or caregiving exemptions immediately.
• Contact your local county assistance office if notified.