Millions of Americans are at risk of losing health insurance due to a combination of policy changes, expiring subsidies, and administrative hurdles. The largest recent wave already happened: 20.7 million people were dropped from Medicaid between April 2023 and June 2024 as states resumed eligibility reviews after the pandemic pause. But more disruptions are on the horizon, particularly for the roughly 20 million people whose Affordable Care Act marketplace premiums depend on enhanced subsidies set to expire at the end of 2025.
People Dropped From Medicaid
The single largest group to lose coverage in recent years is people who were disenrolled from Medicaid during what’s known as the “unwinding.” During the pandemic, states were required to keep everyone enrolled in Medicaid regardless of changes in income or circumstances. When that protection ended in April 2023, states began reviewing all 94.3 million people due for renewal.
Of the 20.7 million who lost coverage, the majority didn’t lose it because they were found ineligible. About 68.7% of all terminations were procedural, meaning people were dropped because they didn’t complete paperwork, didn’t return a form, or couldn’t be reached by mail. Many had moved and never received renewal notices. Others were confused by the process after years without needing to verify their eligibility. Only about 6.9% of people who went through renewal were actually determined to be ineligible for the program.
This is a critical distinction. A large share of the people dropped from Medicaid likely still qualified for coverage but lost it over a missed piece of mail. If you or someone you know was disenrolled, it’s worth reapplying, particularly if nothing about your income or household has changed.
People Who Depend on Enhanced ACA Subsidies
The next major wave of coverage loss could hit people who buy insurance through the ACA marketplace (HealthCare.gov or state exchanges). In 2021, Congress temporarily boosted the tax credits that reduce monthly premiums for marketplace plans, and the Inflation Reduction Act extended those enhanced subsidies through 2025. If Congress does not act to renew them, the subsidies revert to their pre-2021 levels starting in 2026.
The Congressional Budget Office estimates that letting the enhanced subsidies expire would significantly increase the number of uninsured Americans. The people hit hardest would be those earning between 100% and 400% of the federal poverty level, roughly $15,650 to $62,600 for a single person or $32,150 to $128,600 for a family of four. Many in that range currently pay very low premiums or nothing at all. Without the enhanced credits, their costs could jump by hundreds of dollars a month, pricing some out of coverage entirely.
People earning above 400% of the poverty level would also be affected. The enhanced subsidies removed the previous income cap on eligibility for premium tax credits, so higher earners who currently receive some help would lose it completely if the subsidies expire.
People in States That Haven’t Expanded Medicaid
A smaller but particularly vulnerable group lives in the handful of states that still haven’t fully adopted the ACA’s Medicaid expansion. In most states, adults can qualify for Medicaid if they earn up to 138% of the federal poverty level (about $21,597 per year for a single person in 2025). But in non-expansion states, eligibility for parents and childless adults can be far more restrictive.
This creates what’s called the coverage gap: people who earn too much to qualify for their state’s limited Medicaid program but too little to qualify for marketplace subsidies, which generally start at 100% of the poverty level. Georgia, for example, requires adults to meet work requirements to qualify for coverage, even at very low income levels. These residents are effectively locked out of both public and subsidized private insurance.
Young Adults Turning 26
Under the ACA, parents can keep adult children on their health plans until age 26. Coverage ends on the child’s 26th birthday, and roughly 2 million young adults age out each year. If you’re approaching 26, the timeline for finding new coverage is tight. You have 30 days to enroll in an employer plan if one is available, or 60 days to sign up for a marketplace plan through a Special Enrollment Period. Missing those windows means waiting until the next Open Enrollment, which could leave you uninsured for months.
People Going Through Divorce or Job Loss
Divorce and job loss are two of the most common reasons people unexpectedly find themselves without insurance. If you’re covered through a spouse’s employer plan and you get divorced, you lose that coverage. You qualify for a Special Enrollment Period, but only if the divorce actually results in losing your insurance, and you must act within 60 days. You’ll need to attest to the qualifying event and may be asked to provide documentation.
Job loss triggers a similar window. Your former employer is required to offer you the option to continue your coverage through COBRA, but the cost is steep: you pay up to 102% of the full premium, including the portion your employer used to cover. For many people, that means monthly bills of $600 to $700 for individual coverage or well over $1,500 for a family plan. COBRA keeps you on the same plan, but the price shock leads many people to drop it within a few months. A marketplace plan with subsidies is often significantly cheaper.
Who Is Most at Risk Right Now
The groups facing the most immediate risk fall into a few overlapping categories. Low-income adults in non-expansion states remain stuck in the coverage gap with few options. People who were procedurally dropped from Medicaid during the unwinding may still be uninsured without realizing they can reapply. And the largest looming risk sits with marketplace enrollees whose affordable premiums depend entirely on whether Congress extends enhanced subsidies before they expire at the end of 2025.
If you currently receive help paying for a marketplace plan, watch for news about the subsidy extension in late 2025. If the enhanced credits expire, you’ll likely see a significant premium increase when you go to renew your plan for 2026, and you’ll need to decide whether the new cost is manageable or whether other options, like Medicaid or an employer plan, make more sense for your situation.