Medicaid Enrollment Declines Amid Post-Pandemic Unwinding and Policy Changes

Approximately 1.6 million Americans were disenrolled from Medicaid during the first six months of 2025 amid the federal Medicaid "unwinding" process, which began after pandemic-era enrollment expansions ended in March 2023. Medicaid enrollment had expanded significantly during the COVID-19 public health emergency, rising from 64.5 million in February 2020 to 87 million by March 2023, due to federal allowances and state expansions aimed at supporting vulnerable populations. Following the expiration of these provisions, states have been mandated to begin re-evaluating and reducing Medicaid rolls, leading to a marked decrease in enrollment numbers. By July 2025, enrollment had fallen to approximately 70.4 million from over 72 million in January, indicating a substantive reduction. Concurrent policy changes, including $1 trillion in proposed Medicaid cuts alongside the cessation of enhanced Affordable Care Act (ACA) tax credits, contribute to projected healthcare coverage challenges. The Congressional Budget Office estimated these Medicaid cuts would result in millions losing coverage, exacerbated by new administrative work requirements likely to increase disenrollment. Experts warn of significant disruptions in coverage continuity, which may impair access to specialized medical care and continuity for vulnerable groups, particularly given the effects of insurance churn that forces changes in providers and medication formularies. Some states have experienced Medicaid enrollment drops exceeding 15% below pre-pandemic levels, raising concerns about increased uninsured rates in those regions. Analysts caution that administrative complexities, including work reporting mandates and immigration-related fears, may further reduce enrollment and elevate uninsured populations. The impending expiration of ACA enhanced subsidies is expected to increase plan premiums by an estimated 20%, impacting small business employees, retirees, and students especially. These combined factors suggest a challenging environment for Medicaid beneficiaries and ACA marketplace participants that could strain healthcare access and affordability. Without sufficient coverage, populations with lower incomes and chronic health conditions risk delayed or forgone care, potentially leading to worsened health outcomes and increased downstream medical costs.