Americans are projected to lose Medicaid coverage by 2034 under the One Big Beautiful Bill Act, according to the Congressional Budget Office.
This page summarizes what nonpartisan federal scorekeepers and independent researchers have found about the law's effect on Medicaid, Medicare, and rural hospitals. It contains no estimates of our own. Every figure below links to its source.
Oct. 1: New York's members of Congress introduced the Restoring Essential Plan Coverage Act to let the state expand Essential Plan eligibility again for 2027 plans. Enrollment fell from 1.68 million in March to 1.34 million by July 5.
Oct. 5: New York State declared a disaster emergency over measles, with 108 cases this year. The order lets pharmacists, paramedics and midwives give the vaccine and lets nurses order tests.
Early voting runs Oct. 24 to Nov. 1. Election Day is Nov. 3.
What the official scorekeepers project
These are the Congressional Budget Office's central estimates for the law as enacted, compiled and cross-checked against the Kaiser Family Foundation's independent analysis. Figures are projections through 2034, the standard 10-year budget window. They do not mean this many people have already lost coverage.
People projected to lose Medicaid coverage nationwide by 2034, from the law's Medicaid provisions alone.
Congressional Budget Office estimate, compiled by the Center on Budget and Policy Priorities. View source →
New Yorkers lost eligibility for the free Essential Plan on July 1, 2026. This is a New York figure, separate from the national projections.
WAMC, June 30, 2026. View source →
Total Americans projected to become uninsured by 2034 from this law's Medicaid cuts, ACA marketplace changes, and immigrant-eligibility restrictions combined.
CBO, compiled by CBPP: 7.5M Medicaid + 4.2M marketplace + 0.9M ACA rule change + 1.3M eligibility restrictions. View source →
Cut from federal Medicaid spending nationwide over the next decade under the enacted law.
KFF analysis of CBO's federal Medicaid spending estimates. View source →
Broader estimate of additional uninsured Americans by 2034 when this law is combined with related federal policy changes, including expiring ACA premium tax credits.
KFF Quick Take, July 2025. View source →
A note on precision: CBO's 11.8M figure was scored against the Senate's draft text before final passage; the 7.5M / ~15M figures reflect later estimates for the law as actually enacted, which is why this page leads with those. Projections like these are periodically revised as CBO incorporates new data. We will update this page if that happens.
What about Medicare?
Medicare needs a more careful answer, because there are two parts to it.
The law restricts Medicare eligibility for some lawfully present immigrants.
This is a direct change in the bill's text, not a projection. It's part of the 1.3 million people CBO estimates will become uninsured due to the law's immigrant-eligibility restrictions, cited above.
Source: CBO, compiled by CBPP.
The bill's cost legally triggered a $536 billion automatic Medicare cut, which Congress later waived separately.
Because of how much the law added to the deficit, it tripped a federal budget rule called Statutory PAYGO, which requires automatic spending cuts when Congress doesn't pay for new deficit spending. CBO calculated that would have meant a roughly 4% cut to Medicare. That is about $45 billion in 2026 alone and up to $536 billion over nine years. The bill itself did not waive this. Congress avoided the cut afterward, in separate legislation, by erasing the PAYGO scorecard rather than offsetting the bill's cost some other way.
Sources: CBO PAYGO letter, May 2025 · Committee for a Responsible Federal Budget.
Bottom line: Medicare benefits have not been cut as of this writing. But the law came close enough that Congress had to take a separate, later action to stop it. Nothing prevents a future Medicare sequester if the same situation arises and is not addressed.
338 rural hospitals are on the list
Researchers at the University of North Carolina's Cecil G. Sheps Center for Health Services Research (an academic research center, not a political organization) identified 338 rural hospitals nationwide as being at elevated risk of closing, cutting services, or converting to a different type of facility because of the law's Medicaid and Medicare payment changes. The analysis was requested by Senate Democrats; the underlying methodology and hospital list come from the Sheps Center's own research.
Rural hospitals nationwide flagged as at risk. These are hospitals with three straight years of negative operating margin, a high share of Medicaid patients, or both.
Cecil G. Sheps Center for Health Services Research, UNC Chapel Hill. View source →
Of those 338 at-risk rural hospitals are located here in New York State.
Sheps Center state-by-state breakdown, via Penn State Center for Rural Health Practice. View source →
What "at risk" means locally
Projected federal healthcare funding loss to the North Country regional health system, putting coverage for an estimated 40,000 residents at risk.
North Country residents relies on Medicaid.
Hudson Valley residents are covered by Medicaid (24%) or Medicare (18.6%). Both programs are exposed to this law's changes.
New York isn't insulated from a national policy
Rural hospitals operate on thin margins in the best of years. When federal Medicaid payments drop, the hospitals that depend on them most are the first to cut services, convert to urgent-care-only facilities, or close. These are the hospitals that serve the highest share of Medicaid patients, often in places without a nearby alternative. Researchers used the same method to flag hospitals in all 50 states, and New York is not exempt.
What New York State did about health care
New York acted on coverage, hospitals and prescription costs. Each one is explained below for a family.
People with lower incomes kept their coverage after the federal budget law cut $7.5 billion a year from the program. New York won federal approval to switch it to a Basic Health Program, which took effect July 1, 2026.
NYS Department of Health, Mar. 23, 2026. View source →
Added this year for the Safety Net Transformation Program, plus $500 million for the Vital Access Provider Assistance Program, which supports struggling hospitals and nursing homes.
Governor's office, May 28, 2026. View source →
Copay for insulin since Jan. 1, 2025, with state-regulated insurance. The state says that saves people up to $1,200 a year. Self-funded employer plans follow federal rules and are not covered.
NYS Department of Financial Services. View source →
New Yorkers are in the state's Medicare Savings Program, up 20 percent. The state says people who qualify save $203 a month on Part B premiums.
Governor's office, Aug. 5, 2026. View source →
Early voting runs Oct. 24 to Nov. 1. Election Day is Nov. 3.
How this page was fact-checked
Every figure above links directly to its source. The full list follows.
Page last fact-checked: August 21, 2026. News and policy sections updated Oct. 15, 2026. Figures reflect the best available nonpartisan and academic estimates as of this date and are subject to revision as CBO and KFF update their projections.
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