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Nearly 12 million Americans, including children, could lose their health insurance under a Republican-backed plan that dramatically reshapes federal health programs like Medicaid, the Affordable Care Act (ACA), and the Children’s Health Insurance Program (CHIP).
The sweeping proposal, officially named the “One Big, Beautiful Bill Act,” aims to strip nearly $1 trillion from government health care programs over the next decade — a move experts warn would reverse years of record coverage gains.
Currently, 78 million people rely on Medicaid, and another 24 million get their coverage through the ACA marketplaces. But under the GOP bill, that progress could unwind through a mix of eligibility crackdowns, benefit reductions, and new barriers to access — especially for low-income families, immigrants, and people with disabilities.
1. Medicaid & ACA Recertification Every 6 Months
States would be required to check income eligibility every six months, rather than annually. That means more paperwork, more frequent notices, and a higher chance people — especially the unhoused or those without stable internet access — could miss deadlines and be dropped from coverage.
“The life experience of these individuals is not necessarily one that allows them the luxury of working through onerous paperwork,” said Martha Santana-Chin, CEO of L.A. Care Health Plan.
When Texas piloted similar eligibility reviews between 2014 and 2019, thousands of children lost coverage, contributing to the state’s status as having the highest rate of uninsured kids in the U.S.
2. Work Requirements for Medicaid
The bill would mandate that adults aged 19–64 work, volunteer, or attend school for at least 80 hours per month to remain eligible for Medicaid — unless they are pregnant, disabled, or the parent of a young child.
While most Medicaid recipients already work or qualify for exemptions, the burden of proving compliance could still push many off the rolls. People without consistent access to phones or the internet — or who face bureaucratic delays — could lose coverage even if they meet the work requirement.
In Arkansas, where similar rules briefly took effect in 2018, 18,000 people lost coverage in just seven months before a federal judge struck the policy down.
3. New Hurdles for ACA and CHIP Enrollment
For those using Obamacare plans, income will be scrutinized more aggressively. People may face delays in coverage if income verification takes time — or penalties if they end up making more than expected during the year.
Children, meanwhile, may face longer waits to enroll in CHIP or be temporarily blocked from coverage if parents miss premium payments — up to $100/month in some states.
“This would roll back important protections that ensured children weren’t punished for their parents’ financial hardships,” said Jennifer Tolbert, Director of State Health Policy at KFF.
4. Immigrants and Refugees Targeted
The GOP bill narrows eligibility for legal immigrants, refugees, and asylum seekers. It slashes federal matching funds for states that cover immigrants — even legally present ones — prompting some states like California and Illinois to halt enrollment in Medicaid programs for undocumented residents.
The bill also reduces subsidies for immigrants buying ACA plans and limits access to coverage for thousands of refugees.
5. Medicare-Medicaid Enrollees Face Red Tape
Millions of Americans who qualify for both Medicare and Medicaid, often due to disabilities, would see simplified enrollment rules reversed. Biden-era policies that automatically enrolled these individuals would be scrapped, forcing more people to navigate complex paperwork to maintain their care.
Bottom Line
The Congressional Budget Office (CBO) projects that 11.8 million people would lose health insurance by 2034 under the GOP plan, with the biggest impacts falling on low-income families, children, immigrants, and people with disabilities.
Supporters say the changes will cut federal costs and curb program abuse. Critics warn they will devastate vulnerable populations, especially as bureaucratic and technological barriers result in eligible people losing coverage.
“It’s not just about encouraging work,” said Tolbert. “It’s about making it harder to get the care you need — even when you qualify.”
The bill still faces a narrow vote in the House, where Speaker Mike Johnson hopes to pass it before July 4 to hand President Trump a major legislative win.
But with slim GOP margins and rising public concern, the bill’s future remains uncertain — even as millions wait to learn what it could mean for their health care.
