Map Shows How Many People Will Lose Healthcare in Each State Under Tax Bill

A number of states could see the population of Americans without health insurance increase by 5 percent if President Donald Trump’s tax and spending bill is passed, according to data collected by KFF.

Louisiana, Washington and Oregon are expected to see the biggest rises in the number of constituents without health insurance if the “Big Beautiful Bill” is implemented.

Newsweek has contacted the Department of Health and Human Services and the Center for Medicaid and Medicare Services via email for comment.

Why It Matters

There has been widespread concern about the impact Trump’s “Big Beautiful Bill” will have on many vulnerable Americans and their access to health care—particularly in relation to Medicaid and plans to change eligibility for the program.

For example, the bill will mandate that Medicaid recipients must carry out some kind of work for at least 80 hours a month, which has prompted many healthcare experts and lawmakers to warn that it will only push them off the program.

What To Know

The GOP tax bill currently includes measures that would result in significant changes to the Medicaid program and the Affordable Care Act (ACA) marketplaces—changes that the Congressional Budget Office (CBO) believes will lead to more than 10 million people losing health care coverage.

With the expected expiration of the ACA’s enhanced premium tax credits as well, as the Trump administration does not appear set to extend them, the CBO has predicted 16 million more people will be uninsured by 2034.

Of the forecasted 10 million people who will lose their health insurance, most will likely be in California, Florida, New York, and Texas, according to KFF’s data.

California is set to see its uninsured population rise by 1.7 million people, while Florida will see another 990,000 people uninsured.

However, while these states’ constituents will make up a significant proportion of the CBO’s 10 million uninsured prediction if the GOP tax bill is passed, Louisiana, Washington and Oregon will experience the steepest increase based on their current number of uninsured Americans.

This is because larger states, particularly those that have expanded Medicaid or have a lot of ACA Marketplace enrollees, “stand to lose more from the double whammy of Medicaid cuts and the ACA enhanced subsidies being allowed to expire,” Paul Shafer, a professor in health law, policy and management at Boston University, told Newsweek.

States seeing the smallest change to their uninsured population will be Alabama, Kansas, New Hampshire, South Dakota, Wisconsin and Wyoming, each expected to see an increase of 1 percent.

This is due to the fact that states without Medicaid expansion “generally have smaller Medicaid enrollment as a share of population and higher uninsured rates, so they have less to lose, but that doesn’t diminish the impact that losing coverage will have on thousands or more in those states,” Shafer said.

Jamila Michener, a professor of government and public policy at Cornell University, New York, also told Newsweek that “since more than half of Medicaid beneficiaries are Black or Latino, high coverage losses are projected in New Mexico, Louisiana, California, Texas, Florida, and New York,” as in these states, people of color are more concentrated among the Medicaid eligible population.

She added that it is likely more people could lose their Medicaid in states with high unemployment rates, like California, Kentucky, and Illinois, given the work requirements that will be brought in for Medicaid eligibility.

There is still a lot of uncertainty as to how different states will respond to the changes in Medicaid policy, as if the federal match rate—the amount the federal government contributes to fund the program in states—is potentially reduced as well, some states may struggle to sustain the program.

What People Are Saying

Paul Shafer, a professor in health law, policy and management at Boston University, told Newsweek: “We know that work requirements and more frequent eligibility redeterminations will cause a lot of eligible people to drop out of Medicaid. But we don’t know how states will choose to adapt their eligibility and benefits to the changes, so it is all an educated guess at this point. Whatever the exact numbers end up being, millions losing coverage will have major ramifications for their health and the financial stability of safety net and rural hospitals, in particular.”

He added: “Until the Senate passes their version and reconciles with House, there is potential for more changes. For example, Senator Rick Scott (R-FL) has proposed an amendment to end the enhanced match for Medicaid expansion after 2030, which could make the coverage losses larger and worsen the financial impact on states.”

Jamila Michener, a professor of government and public policy at Cornell University, New York, told Newsweek: “States that are racially and ethnically homogenous, have small, or nonexistent, Medicaid expansion enrollment, and have relatively low unemployment rates, like Kansas, Wyoming, Nebraska, have the lowest risk of Medicaid insurance losses. Diverse, populous states, with complex labor markets will sustain the most losses. This includes some of the states that are top contributors to the U.S. GDP like California, Texas, New York, Florida, Illinois. In essence, the reconciliation bill risks systematically destabilizing the health and well-being of our most economically critical state populations.

She added: “States’ choices in the wake of the reconciliation bill—especially how they decide to implement work reporting requirements—will make a big difference. States have a number of paths through which they can make the burdens imposed by the reconciliation bill lighter, decreasing coverage losses. Alternatively, states can make those burdens as heavy as possible, heightening coverage losses. No matter what happens with the reconciliation bill, it will only be the beginning.”

What Happens Next

The GOP tax bill will continue to be deliberated in the Senate this week, with the self-imposed deadline set for July 4, meaning that after Friday, it will become clearer how the new budget bill will impact Americans across the country.