U.S. — Enrollment in Medicaid and Affordable Care Act (ACA) plans decreased by over 5 million in the past 12 months, according to a report from Protect Our Care. The organization cited expiring subsidies and Medicaid cuts as primary factors in this decline.

Enrollment in Medicaid and the Children's Health Insurance Program fell by approximately 3.8 million people since last June. ACA plans experienced a decline of about 1.2 million enrollees during the same period. Enhanced ACA subsidies expired in December, and Republican legislators declined to extend them.

Brad Woodhouse, executive director of Protect Our Care, indicated the current enrollment figures are likely to worsen. "We're already at 5 million," Woodhouse said. "This is going to get worse." A law signed in July includes nearly $1 trillion in Medicaid cuts over 10 years.

Medicaid enrollment began to fall in 2023 after states started rolling back pandemic-era protections. All states except Alabama, Missouri, and Montana saw a decline in Medicaid and CHIP enrollment. Indiana, Louisiana, Arizona, Rhode Island, and Delaware experienced the largest declines in these programs. ACA plan enrollment fell by more than 10% in 12 states, with North Carolina, Ohio, West Virginia, Indiana, and Delaware seeing the largest drops.

Medicaid work requirements are scheduled to begin in most states in January. Nebraska implemented new Medicaid work rules in May, and Montana is expected to implement new rules next month. In June, the Centers for Medicare & Medicaid Services (CMS) issued guidance on these new work rules.

Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University, said, "This was an entirely predictable consequence of the multilayered cuts and restrictions on eligibility." He added, "It will cost Americans in lost lives and economic distress." Woodhouse stated, "People who lack coverage get sicker sooner and they die earlier."

The Congressional Budget Office estimated last year that 15 million more people would be uninsured by 2034 due to Medicaid cuts and expiring subsidies. Miranda Yaver, assistant professor of health policy and management at the University of Pittsburgh, said, "The CMS rules that have been proposed certainly go farther than HR.1 and will almost assuredly result in more dramatic coverage losses than the CBO projected." She added, "This is a glimpse of a lot more to come."