1.4 Million Lawfully Present Immigrantsโ Face Loss of Health Coverage Under New Law
A recently enacted โคtax and budgetโข law is โprojected to result in โapproximately 1.4 million lawfully present immigrants losing health coverage, impacting access to bothโข Affordable Care act (ACA) Marketplaceโ plans and Medicare. The changes are being โขphased in over the next several years, beginning โขin late 2025.
The lawโค significantlyโ restricts eligibilityโค for subsidized ACA Marketplace coverage, limiting it โto Lawful Permanent Residents (LPRs), Cuban and Haitian entrants, and individuals residing in theโ U.S.โ under โคCompacts of freeโ Association (COFA).This change will exclude aโค broad range of lawfully present immigrants currently eligible for coverage, including refugees, asylees without green cards, those wiht temporary Protected Status (TPS), and individuals on work visas.
Initially, DACA recipients will once againโข becomeโ ineligibleโ to purchase ACA โฃMarketplace coverage, with most โขstates terminating coverage for currently enrolled individuals by September 30, 2025, following a Trump management rule finalized on June 25, 2025, that reinstates this โineligibility as of August 25, 2025.A โfurther restriction, taking effect January 1, 2027, will extend these limitations to the broaderโ group of lawfully presentโฃ immigrants mentioned above.
The Congressional Budget Office (CBO) estimates that these โACA Marketplace provisionsโค will lead to โฃan additional one million individuals becoming uninsured and reduce federal spending by $91.4 billion between 2026 and 2035. The CBOโ also projectsโฃ a $4.8โ billion increase in federalโฃ revenue by 2034. Additionally, โฃbeginning January 1, โ2026, lawfully present โimmigrants earning less than 100% of โฃthe Federal Poverty Level โฃ(FPL) who are ineligible for Medicaid due to their immigration status โwillโ also lose access to subsidized Marketplace โcoverage. Approximately 550,000 individuals with incomes under 100% FPL areโฃ currently enrolled in โขMarketplace plans and โare likely to be affected. The CBO estimates this provision will result in โขan additional 200,000 uninsuredโค individuals and a $27.3 billion reduction in federal โspending over theโ same period, alongside a โข$176 million increase in federal revenue โby 2034.
The lawโข also โขimpacts Medicareโค eligibility.Currently, lawfully present immigrantsโข can qualify for Medicare based on work history, disability, or age,โค and โthose without sufficient work history can purchase Medicare Part A โขafter five years of continuous legal residency. The new law will restrict Medicare eligibility to LPRs, Cuban and Haitian entrants, and those residing in the U.S.under COFA, โexcluding refugees, asylees without โgreen cards, individualsโ with TPS, and those on โขwork visas.Current Medicare beneficiaries subject to these new restrictions willโ lose coverage no later than 18 months after the law’s enactment (January 4,2027).โข The CBO estimates this will lead to โ100,000 fewer individuals withโ Medicare coverage, a $5.1 billion reduction in federal spending, and a $123 millionโ decrease in federalโค revenueโ by 2034.