As the political landscape heats up ahead of 2026, health care is once again at the center of America’s policy battles. President Donald Trump and congressional Republicans are pushing their Big, Beautiful Bill, which includes deep cuts to Medicaid and SNAP. But as they tout fiscal discipline, a much larger storm brews on the horizon, one that could affect millions of Americans’ wallets.
At the end of this year, expanded subsidies for the Affordable Care Act (ACA), also known as Obamacare, are set to expire. These subsidies were originally introduced under the American Rescue Plan Act and extended through the Inflation Reduction Act. They allowed individuals earning up to 400% of the Federal Poverty Line, to afford health insurance through ACA marketplaces. Without congressional action, premiums could spike dramatically, leaving millions uninsured or financially strained.
Jonathan Oberlander, a professor of social medicine at UNC-Chapel Hill, warns of “sticker shock” for Americans who haven’t been following the debate. If subsidies disappear, the insurance pool could shrink and destabilize, especially if healthier individuals opt out. That could drive up costs for everyone else. The Congressional Budget Office estimates that 2.2 million people could lose coverage by 2026, and 3.7 million by 2027 if the subsidies aren’t renewed.
Some Republicans, like Sen. Thom Tillis, suggest a short-term extension might be possible in a year-end spending package. Others, like Sen. Ron Johnson, remain staunchly opposed, arguing that Obamacare has damaged the health care system and federal budget. Democrats, meanwhile, are scrambling to preserve the ACA’s gains. Sen. Tina Smith lamented, “Here we are trying to fix all the things that they broke.”
The proposed cuts are not just numbers; they represent real consequences for communities, hospitals, and families. In Oklahoma, over half of rural hospitals are at risk of closure due to $6.3 billion in Medicaid cuts. Nearly 25% of the population is enrolled in Medicaid, and more than half of those are children. With one of the largest maternity care deserts in the country, access to obstetrics could vanish in 15 counties.
Kentucky is bracing for $38 billion in federal Medicaid cuts over 10 years, with an estimated 149,000 residents losing coverage due to new work and eligibility requirements. Minnesota expects to lose $1.1 billion in health care funding, and over 62,000 residents may lose coverage due to rising premiums.
Family caregivers, especially in Hispanic communities, rely on Medicaid-funded programs like Home and Community-Based Services (HCBS). Nearly one-third of Latino caregivers report being in debt due to caregiving costs. Cuts to HCBS could force families to institutionalize loved ones or shoulder even more financial burden. Seniors and people with disabilities are particularly vulnerable.
For millions of disabled and elderly Americans, Medicaid isn’t just health insurance. It is the foundation for independence, dignity, and daily life. The proposed $1 trillion in cuts threatens to unravel decades of progress made under the Americans with Disabilities Act. Medicaid funds home and community-based services, residential programs, employment coaching, assistive technologies, and transportation services. These services are not covered by private insurance and are critical to fulfilling the ADA’s promise of inclusion.
If the cuts go through, waiting lists for services will grow. Over 700,000 people already wait for HCBS. Staff shortages will worsen as direct caregivers face layoffs. Many people could be forced into institutions, reversing decades of deinstitutionalization efforts. New work requirements may cause coverage loss even for exempt individuals due to bureaucratic hurdles.
In states like Massachusetts, proposed cuts to MassHealth could destabilize personal care assistance and community-based programs, especially as immigration policies threaten the caregiver workforce. As someone who relies on MassHealth’s PCA program, the thought of losing coverage scares me.
According to the Joint Economic Committee, the projected losses in coverage by 2034 are staggering. California could lose nearly 2 million insured residents, Florida over 1.4 million, and Texas more than 1.2 million. Even smaller states like Kentucky and Oklahoma face losses of over 150,000 people each.
States will face tough decisions. They may raise taxes, cut other programs, or reduce Medicaid coverage. Some are exploring emergency funds or temporary extensions.
The long-term solution will require federal action. This isn’t just a policy debate. It is a fight for the health, independence, and dignity of millions. Whether Congress acts in time may determine not only the future of American health care but also the political fortunes of those leading the charge.
Sources:
Bradley, Jordyn. “Medicaid Cuts Will Hurt the American Economy. Here’s Why.” Investopedia, Investopedia, 5 Aug. 2025, http://www.investopedia.com/medicaid-cuts-hurt-economy-11779578.
Garcia, Eric. “Trump Slashed Medicaid – Now He’s Got Another Health Care Crisis Looming.” The Independent, Independent Digital News and Media, 6 Aug. 2025, http://www.independent.co.uk/news/world/americas/us-politics/trump-medicaid-affordable-care-act-health-care-b2803232.html.
“Medicaid Spending Reductions Would Lead to Losses in Jobs, Economic Activity and Tax Revenue for States: AHA.” American Hospital Association, American Hospital Association, 5 June 2025, http://www.aha.org/fact-sheets/2025-06-05-medicaid-spending-reductions-would-lead-losses-jobs-economic-activity-and-tax-revenue-states.
Williams, Elizabeth, et al. “Allocating CBO’s Estimates of Federal Medicaid Spending Reductions across the States: Enacted Reconciliation Package.” KFF, KFF, 29 July 2025, http://www.kff.org/medicaid/issue-brief/allocating-cbos-estimates-of-federal-medicaid-spending-reductions-across-the-states-enacted-reconciliation-package/.