The NY State of Health, New York’s official health insurance marketplace, has issued an urgent alert, warning that a sweeping federal budget bill, which the Senate is preparing to vote on, could jeopardize health coverage for approximately 2 million New Yorkers.
With 6.7 million individuals currently enrolled in health insurance through the marketplace, the potential changes could lead to higher premiums, stricter enrollment requirements, and significant coverage losses starting in 2026. These changes would affect enrollees in the Essential Plan, Medicaid, and Qualified Health Plans (QHPs), potentially reshaping New York’s healthcare landscape.
The proposed federal budget bills could disrupt the affordability and accessibility of health insurance across New York, with impacts varying by region. NY State of Health has developed an NY Healthcare Impacts by Congressional District Map to illustrate how premium changes could affect residents based on their geographic location. The bills could introduce higher premiums, new bureaucratic hurdles such as additional paperwork or work requirements, and the outright loss of coverage for many. These changes could exacerbate healthcare disparities, particularly in rural and low-income communities, and place significant financial strain on hospitals and other healthcare providers statewide.
For those enrolled in the Essential Plan, a low-cost or no-cost health insurance option for lower-income New Yorkers who don’t qualify for Medicaid, the proposed changes are particularly severe. Over 730,000 individuals could lose their Essential Plan coverage entirely, forcing them to seek alternative options that may be unaffordable. Additionally, almost 50 percent of current Essential Plan enrollees may lose eligibility for premium tax credits, further limiting their ability to afford coverage. Hospitals could face losses exceeding $1.3 billion due to reduced coverage and increased demand for uncompensated care, which could make it harder for New Yorkers to access healthcare services, especially in underserved areas.
Medicaid enrollees, who rely on the program for low-income health coverage, face significant risks as well. Over 1 million Medicaid enrollees may lose their coverage due to stricter eligibility criteria or administrative barriers. The proposed federal changes could impose new paperwork or work requirements, potentially leaving nearly 1.5 million New Yorkers without insurance if they fail to comply. Additionally, enrollees may need to renew their coverage twice a year instead of annually, increasing the risk of coverage gaps due to missed deadlines or administrative errors. These requirements could disproportionately affect vulnerable populations, such as low-income workers or those with limited access to administrative resources.
Qualified Health Plan (QHP) enrollees, who purchase insurance through the NY State of Health marketplace, are also at risk. An estimated 65,000 to 80,000 New Yorkers may lose their QHP coverage due to changes in federal funding or eligibility rules. Approximately 140,000 enrollees who rely on tax credits to afford their QHPs could see their costs rise by 38 percent, making coverage unaffordable for many. Additionally, around 100,000 enrollees may face premium increases of at least 5 percent, further straining household budgets. These cost increases could force many to forgo insurance, exacerbating the coverage crisis.
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Kishor Panthi
View More PostsKishor Panthi is the founder and editor-in-chief of Khasokhas and NepYork. He is the author of three books, “Kampan,” "UNTRANSLATABLE" and “Zero Mile.” He writes about social issues, immigration, and politics.
