US Medicaid and ACA enrollment drops over 5 million

A new report by advocacy group Protect Our Care finds that more than 5 million Americans lost coverage in Medicaid, the Children’s Health Insurance Program (CHIP) and Affordable Care Act (ACA) exchange plans during the past year. The decline follows the enactment of the “big, beautiful” legislation signed by former President Donald Trump, which curtails Medicaid funding and allowed the expiration of enhanced ACA subsidies in December, causing premiums to rise sharply.

Data from the Centers for Medicare & Medicaid Services show Medicaid and CHIP enrollment fell by about 3.8 million people and ACA enrollment dropped by roughly 1.2 million. All but three states experienced declines, with the largest Medicaid drops in Indiana, Louisiana, Arizona, Rhode Island and Delaware, and the steepest ACA losses in North Carolina, Ohio, West Virginia, Indiana and Delaware. Experts warn the losses will deepen as many states implement new Medicaid work‑requirement rules in early 2025, potentially pushing more eligible residents off coverage.

The report cautions that loss of insurance leads to delayed care, higher disease severity and increased mortality, and it underscores the broader economic and health impacts of the policy changes.