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Millions of Americans are losing their health insurance

The GOP’s Big, Beautiful Bill sought to roll back the Affordable Care Act. Now, the human costs are becoming clear.

One of the clearest success stories in US healthcare over the past 20 years has been the dramatic decline in the number of Americans without health insurance. In 2010, the year the Affordable Care Act was enacted, 16 percent of the population lacked coverage. By 2025, according to estimates from the US government, that figure was cut nearly in half, to 8.3 percent.

The increase in coverage hasn’t been a panacea; even people with an insurance card can struggle to afford their medical bills or to secure a doctor’s appointment. But with the US standing alone among its international peers in its failure to offer universal healthcare, it represented significant progress toward ensuring every American had a basic level of access to routine medical services.

Now, however, those gains are about to be reversed.

Last year, when drafting their One Big Beautiful Bill, Republicans had a chance to strike a blow against the ACA — a law they’d vilified for years — 15 years after its passage and eight years after failing to repeal the law in President Donald Trump’s first term. They established work requirements to target the people covered by the ACA’s Medicaid expansion and allowed subsidies that had helped millions of people to buy private coverage on the ACA marketplaces to lapse.

As a result, millions of Americans are dropping their health insurance this year, and millions more are expected to lose their coverage in the years to come.

The uninsured rate has spiked before, but it’s usually the byproduct of an economic crisis; people lose their jobs, and they lose their coverage. What makes the current turmoil different is that it is entirely a matter of policy choices.

Now, millions of Americans will pay the price.

“I don’t think there’s any historical precedent for the rollback in federal support for health coverage coming with the cuts in Medicaid plus the expiration of enhanced ACA premium subsidies,” Larry Levitt, executive vice president for health policy at the healthcare think tank KFF, told me. “The expected effects of OBBBA on coverage are self-inflicted and dwarf even the........

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