H.R. 1 Medicaid Work Requirements, ACA Changes to Drive 14 Million Coverage Losses by 2036
The One Big Beautiful Bill Act (H.R. 1) and expiration of enhanced ACA premium tax credits will result in an estimated 14 million coverage losses over the next decade, according to CBO projections. Medicaid work reporting requirements and six-month redeterminations for expansion adults begin January 1, 2027, with retroactive coverage cuts and new cost-sharing starting October 2028. The law cuts $1 trillion in federal and state Medicaid spending over 10 years, 95% in expansion states, while creating a $50 billion Rural Health Transformation Program. Marketplace enrollment could drop 17-26% in 2026 with morbidity increasing up to 6.5%, as healthier members disenroll following ePTC expiration.
Medicaid MCOs face significant membership losses starting in 2027, risk pool deterioration driving higher medical costs, and new administrative requirements for work reporting verification and more frequent eligibility redeterminations that will strain operations and revenues.
Managed Care · Finance
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