Nearly 500,000 moderate-income New Yorkers will be dumped from their health insurance plans on 1 July – the first of major coverage losses expected as a result of HR 1, the Republican-led law signed almost exactly one year ago.
The law, sometimes called the “One Big Beautiful Bill Act,” slashed government health spending by $911bn nationally in favor of permanent tax breaks for higher-income families and border security.
“It’s an all hands on deck situation,” said Maia Dillane, senior director of strategy and implementation at the Arab-American Family Support Center (AAFSC), based in New York City, where the bulk of this summer’s coverage losses are expected.
The AAFSC is one of 20 community-based organizations working with the Community Service Society of New York to find people new health coverage.
But even as community organizations work against a deadline – people have to find new coverage within 60 days or wait until “open enrollment” in November – they expect many simply will not be able to afford the new costs.
“We’re seeing a lot of families still going back and forth on whether they can enroll in one of the qualified health plans – or whether they are just going to opt out of the coverage completely,” said Rahem Bader, director of the community health and well-being program at AAFSC.
“Families are having to choose how they’re going to split their costs when it comes to their healthcare, food, etc.”
The July coverage losses are related to the loss of New York’s “essential plan”, a provision of “Obamacare”. In 2023, the federal government approved a pilot program in New York to cover residents earning 200-250% of the federal poverty level, or up to $39,900 for a single person and $66,625 for a family of three.
For reference, both the National Employment Law Project and the Massachusetts Institute of Technology Living Wage calculator estimate a living wage for a single person in New York at about $73,000.
The pilot was meant to last until 2028 and, according to planning documents approved by the feds, be deficit neutral for the federal government. More people would be enrolled in very low-cost plan, without premiums or deductibles, and minimal co-pays, for the same amount as the federal government would have paid New York anyway.
But the program was thrown into upheaval soon after the passage of HR 1 in 2025, according to New York State of Health, the agency that administered the program.
In public announcements, the agency said essential plan funding was cut in half, and pointed to an HR 1 provision that ended health insurance tax credits to lawfully present immigrants. Despite calls for the state to step in, in June state lawmakers failed to find state funding for the essential plan, sealing its fate.
The loss of the essential plan is just one piece of a growing puzzle for New York state. As many as 1.1 million people could lose health insurance statewide through 2034 when taking other provisions of HR 1 into account, health policy analysts at Kaiser Family Foundation predict.
“This is just the tip of the iceberg, right – because come January all the other impacts of HR1 start to kick in,” said Dr Adam Aponte, chief executive at the East Harlem Council for Human Services, which operates the Boriken Neighborhood Health Center. New York City is expected to be hardest hit, with more than 250,000 city residents expected to lose their insurance, including 200 of Aponte’s own patients.
Nationally, the law could cause an additional 10 million people to become uninsured over the next decade. Those losses are largely a result of new work requirements for some Medicaid beneficiaries, which analysts predict will be very challenging to navigate and expensive to administer.
“What do these folks turn to?” said Aponte. “Federally qualified health centers like ours are going to be likely to absorb these individuals as uninsured patients into our organizations.”
In spite of the disinvestment in health, HR 1 is expected to add $3.4tn to the federal budget deficit by 2034, according to the Congressional Budget Office (CBO), largely due to reduced revenue from tax cuts.
“It’s very unlikely that these individuals will be able to afford a marketplace plan. So many of them are going to be caught with no insurance, at least for a period of time – who knows how long,” said Aponte, who expects most newly uninsured people will seek care in the emergency department.
People losing essential coverage will be forced to shop for health insurance through Obamacare marketplaces that require premiums and deductibles, and are experiencing historically expensive rate increases.
In addition to the cuts imposed by HR 1, the Republican-led Congress allowed special government subsidies to health insurers to lapse at the end of 2025, leading to record-high average deductibles of $3,786 per person according to KFF.
Those rate increases are expected to continue in 2027, with private health insurers already requesting double-digit increases, according to analysts at Georgetown University’s Center on Health Insurance Reforms found. In New York, insurers are asking regulators for an average 20.7% rate increase. UnitedHealthcare of New York proposed a 52.1% rate increase.
Analysts say most rate increases are the result of sicker people seeking insurance, and otherwise healthy people foregoing coverage they feel they can’t afford. Those dynamics tend to make insurance more expensive for everyone.
Analysts’ read on rate increases jibes with Bader’s experience helping people find insurance. When navigators work with struggling families who want to opt-in, “It’s because they are not looking for preventive care – they are looking for treatments for illnesses.”
