Proposed Budget Bill Could Reshape Medicaid, CHIP, and ACA Marketplace Coverage

The proposed budget legislation dubbed the "One Big Beautiful Bill" presents significant potential changes to healthcare coverage for millions of Americans, targeting Medicaid and the Children's Health Insurance Program (CHIP). Experts project that over 10 million individuals could lose eligibility for these programs by 2034 due to stricter application requirements introduced by the bill. This could lead to increased uncompensated care burdens on healthcare providers, particularly hospitals, as uninsured individuals seek care without coverage.

The bill also impacts those purchasing insurance through the Affordable Care Act marketplace by restricting premium tax credit eligibility for plans acquired during income-based special enrollment periods, potentially raising premiums for self-employed individuals and workers at small companies without employer-sponsored insurance.

In Virginia specifically, experts estimate that more than 300,000 residents may lose health insurance coverage, and hospitals in the state could face funding losses nearing $26 billion. However, some state officials dispute these assessments, highlighting the variability of impact projections. These developments underscore significant regulatory and market uncertainties that healthcare providers, payers, and policymakers must monitor closely as the healthcare coverage landscape evolves.