Analysis of Key Medicaid and ACA Changes Under Recent U.S. Health Care Law

The recent congressional passage and presidential signing of the "One Big Beautiful Bill" brings significant changes to the U.S. healthcare landscape, primarily through cuts exceeding $1 trillion over the next decade. This legislation will impact Medicaid and ACA Marketplace enrollees, with the Congressional Budget Office projecting that approximately 10 million individuals will lose their health insurance coverage directly from these measures. Additionally, 5 million more are expected to lose access due to the expiration of enhanced ACA premium tax credits.

Key among these provisions is the Medicaid work reporting requirement slated for January 1, 2027, where adults in Medicaid expansion states must report at least 80 hours per month of work or community engagement. Failure to comply could lead to loss of Medicaid benefits and exclusion from ACA marketplace tax credits, representing a substantial administrative burden that may cause over 7 million disenrollments due to procedural issues rather than eligibility.

Moreover, Medicaid eligibility redeterminations will increase in frequency from annual to biannual for those in expansion programs, raising the likelihood of coverage loss from paperwork errors. The bill also restricts retroactive Medicaid coverage to shorter periods, which may affect access to care for newly enrolled individuals. Another provision restricts Medicaid reimbursements to clinics offering abortion services, notably targeting providers like Planned Parenthood, pending ongoing legal challenges.

The law also tightens eligibility for legal immigrants, narrowing Medicaid access to specific immigrant groups and limiting ACA plan enrollment and tax credit availability, thus potentially leaving many low-income lawful immigrants without affordable coverage options. Furthermore, federal Medicaid matching rates for emergency services for certain immigrants will be reduced.

As these measures roll out over the coming years, their regulatory and compliance implications are significant for payers, providers, and state agencies managing program implementation. Stakeholders should anticipate increased administrative complexity and shifts in enrollment dynamics that will influence healthcare coverage access across multiple populations. Advocacy groups continue to monitor and respond to these developments.