The Congressional Budget Office estimates that 7.8 million Americans across the U.S. will lose their coverage through Medicaid – the public program that provides health insurance to low-income families and individuals – under the multitrillion-dollar domestic policy package that President Donald Trump signed into law on July 4, 2025.

That includes 247,000 to 412,000 of my fellow residents of Michigan.

Many of these people are working Americans who will lose Medicaid because of the onerous paperwork involved with the proposed work requirements.

They won’t be able to get coverage in the Affordable Care Act Marketplaces after losing Medicaid. Premiums and out-of-pocket costs are likely to be too high for those making less than 100% to 138% of the federal poverty level who do not qualify for health insurance marketplace subsidies. Funding for this program is also under threat.

And despite being employed, they also won’t be able to get health insurance through their employers because it is either too expensive or not offered to them. Researchers estimate that coverage losses will lead to thousands of medically preventable deaths across the country because people will be unable to access health care without insurance.

I am a physician, health economist and policy researcher who has cared for patients on Medicaid and written about health care in the U.S. for over eight years. I think it’s important to understand the role of Medicaid within the broader insurance landscape. Medicaid has become a crucial source of health coverage for low-wage workers.

A few years ago, Michigan was slated to institute Medicaid work requirements, but the courts blocked the implementation of that policy in 2020. It would have cost upward of

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