On July 4, 2025, President Donald Trump signed congressional Republicans’ regressive One Big Beautiful Bill Act (OBBBA) into law—enacting the largest-ever cuts to basic needs programs for vulnerable families to fund tax cuts for the ultrawealthy. One year later, the Trump administration’s policies are bleeding the revenue of the American tax system and have left millions of Americans without health coverage and food assistance, on top of the rising prices and economic uncertainty caused by the administration’s harmful economic, trade, and national security policies.
Millions of Americans are losing affordable health insurance
According to the Congressional Budget Office (CBO), the OBBBA’s health care provisions are expected to leave 10 million more Americans uninsured by 2034—a reality that’s already begun to unfold a year into the law’s implementation.
Average monthly net premium costs among marketplace enrollees increased by 58 percent—from $113 in 2025 to $178 in 2026.
While the Trump administration and congressional Republicans renewed many tax breaks that primarily benefit the wealthy and were set to expire at the end of 2025 in the OBBBA, they chose not to extend enhanced premium tax credits for Affordable Care Act (ACA) marketplace health plans that expired on the same timeline. As a result, average monthly net premium costs among marketplace enrollees increased by 58 percent—from $113 in 2025 to $178 in 2026. For many middle-income Americans, the financial hit is even greater than the national average suggests. Jill Kordick, an Iowa resident, saw a tenfold increase in her annual premium costs, from roughly $900 in 2025 to more than $9,000 in 2026. At the same time, average ACA marketplace deductibles increased by 37 percent to a “record high” of $3,786, up from $2,759 per person in 2025. Together, higher premiums and deductibles mean Americans are paying substantially more to maintain coverage and to access care when they need it.
ACA plan sign-ups fell by 5 percent, or 1.2 million people, during the 2026 enrollment period compared with 2025—the largest decline since the marketplace opened in 2014.
While marketplace enrollment reached an all-time high in 2025, higher costs are pushing people out of marketplace plans in 2026, particularly middle-income individuals who were unable to afford plans once the premium tax credits expired. ACA plan sign-ups fell by 5 percent, or 1.2 million people, during the 2026 enrollment period compared with 2025—the largest decline since the marketplace opened in 2014.* Forty-one states saw a decline in 2026 marketplace plan selections, with the largest decreases occurring in North Carolina (22 percent); Ohio (20 percent); West Virginia (17 percent); and Arizona, Delaware, and Indiana (all 16 percent).
Recent estimates indicate that 14 percent of people who signed up for a 2026 plan did not or were unable to pay their premium in January 2026. Marketplace enrollment data from six states through April 2026 show how people who signed up for coverage in 2026 either canceled their coverage or did not pay their premiums, a clear sign of financial strain. An analysis from KFF estimates that the average monthly effectuated enrollment in the individual marketplace is expected to decrease by 17 percent to 26 percent in 2026 compared with 2025, or a decline of 3.8 million to 5.8 million people. Early data from 17 state-based marketplaces already show that disenrollments are rising and were 24 percent higher in the January–March period in 2026 than they were in the same period in 2025.
The expiration of the enhanced tax credits is expected to have broader effects on the individual market. As higher costs drive many Americans out of coverage, insurers anticipate a smaller, less healthy risk pool. Reflecting those concerns, insurers in several states, including Rhode Island, Maine, Oregon, and Connecticut, have requested double-digit premium rate increases for 2027, which could further worsen affordability for marketplace consumers.
A recent RAND analysis projects that Medicaid provisions in the OBBBA will reduce states’ Medicaid budgets by nearly $679 billion and could result in 7.6 million Medicaid coverage losses nationally in 2034.
Americans are losing Medicaid coverage too. The OBBBA cuts federal Medicaid spending by more than $900 billion from 2025 to 2034, primarily stemming from Medicaid work reporting requirements that add more red tape for beneficiaries, restrictions on state provider tax arrangements, and limits on state-directed Medicaid payments. A recent RAND analysis projects that Medicaid provisions in the OBBBA will reduce states’ Medicaid budgets by nearly $679 billion and could result in 7.6 million Medicaid coverage losses nationally in 2034. Medicaid expansion states with significant utilization of state-directed payments and provider taxes, including Arizona, Iowa, and Nevada, are projected to see more than 15 percent reductions in their Medicaid budgets. As the number of uninsured Americans increases, the amount of uncompensated care also is likely to increase, forcing health care providers to absorb the costs.
Starting in January 2027, the OBBBA will impose new, burdensome work requirements and more frequent, six-month eligibility redeterminations for adults covered by the ACA Medicaid expansion. By 2028, both these provisions could cause between 4.9 million and 10.1 million people to lose Medicaid coverage, including between 3 million and 7 million enrollee coverage losses from work requirements alone. States including California and New York are expected to face some of the largest enrollment declines.
According to a Center on Budget and Policy Priorities analysis of U.S. Department of Agriculture (USDA) and state agency data, SNAP participation fell by 10 percent, or more than 4 million people, between the OBBBA’s enactment in July 2025 and March 2026.
According to a Center on Budget and Policy Priorities (CBPP) analysis of U.S. Department of Agriculture (USDA) and state agency data, SNAP participation fell by 10 percent, or more than 4 million people, between the OBBBA’s enactment in July 2025 and March 2026.** Participation rates have dropped in every state across the nation, including declines of 5 percent or more in 42 states and 10 percent or more in 21 states. The largest participation reductions during this period occurred in Arizona (53 percent), Florida (17 percent), Louisiana and Oklahoma (both 16 percent), and Delaware and Nevada (both 15 percent), with more recent state agency data showing even greater declines in these states and others. Based on emerging data, it’s likely that SNAP cuts will be significantly deeper than originally projected.
Additionally, from the OBBBA’s enactment in July 2025 to April 2026, the number of children receiving SNAP benefits dropped by more than 700,000 in the 12 states where child participation data were available. According to the Center on Budget and Policy Priorities, the most significant percentage declines in SNAP participation occurred in Arizona, where participation decreased by 55 percent, or more than 205,000 children, and in Louisiana, where participation declined by 22 percent, or nearly 80,000 children. SNAP cuts will have dire consequences: Not only will families bear higher grocery costs, but cuts also will exacerbate food insecurity and could worsen health outcomes and increase mortality for low-income families. A Center for American Progress analysis estimated that almost 70,000 deaths could result from the heightened work requirements by 2040. Cuts will also affect local economies, with more than 27,000 grocery stores and other SNAP retailers nationwide, particularly in rural counties, facing a higher risk of financial harm due to reduced business from SNAP recipients.
SNAP and health care cuts come amid growing pressures on household budgets, including higher costs for utilities. The OBBBA repealed the federal clean energy investment incentives in the Inflation Reduction Act, which cut in half the amount of energy that would have been added to the grid from 2025 to 2035. These changes will raise electricity rates for consumers by more than $110 per year in 2026 and nearly 18 percent by the end of the current presidential term.*** In 2025, electricity prices were among the fastest drivers of inflation and increased at more than twice the rate of overall inflation. This comes at a time when the Trump administration’s war on Iran has raised living expenses for families by driving up inflation, exacerbating fuel costs, and increasing grocery prices. These burdens fall heavily on the lowest-income families, who are already at risk of losing access to SNAP and health care programs.
The OBBBA’s tax provisions enrich the top 1 percent at the expense of the poorest Americans
Altogether, the OBBBA is the single-largest transfer of wealth from the poor to the rich in U.S. history—made possible by Senate Republicans breaking the legislative body’s reconciliation prohibitions to pass it. The law also weakens the nation’s long-term revenue collection and increases the federal deficit by $3.4 trillion from 2025 to 2034 while raising the fiscal gap to 2.4 percent of gross domestic product (GDP). The OBBBA also puts older adults’ Social Security benefits at risk by cutting revenues flowing into the Social Security trust funds, which increased Social Security’s financing shortfall by 0.16 percent of taxable payroll, contributing to an overall deficit roughly 4.42 percent larger.
From 2025 to 2034, the OBBBA will cut taxes on net by $4.5 trillion through provisions such as slashing marginal tax rates and the estate tax.
From 2025 to 2034, the OBBBA will cut taxes on net by $4.5 trillion through provisions such as slashing marginal tax rates and the estate tax. This includes $1 trillion in tax cuts to the top 1 percent offset by more than $1.2 trillion in cuts to SNAP, Medicaid, and other basic needs programs that support low-income families. From 2025 to 2034, the law will reduce taxes for the top 10 percent of richest households by more than $14,700 per year and by more than $50,000 per year for the top 1 percent of Americans by income, according to CBO and Joint Committee on Taxation estimates. In parallel, the OBBBA leaves low-income families worse off by raising taxes for Americans making less than $15,000 per year.
Conclusion
In its first year, the OBBBA has raised the incomes of the wealthiest households to the detriment of low-income Americans, while driving up the number of uninsured Americans and households without SNAP. Families, communities, and health care systems nationwide will be experiencing the harms of these policies for years to come.
The authors would like to thank Emily Gee, Colin Seeberger, Bobby Kogan, Corey Husak, Rachel Cotter Johnson, Madeline Shepherd, Michael Negron, and Leo Banks for their valuable contributions and review; Jiun Park and Aurelia Glass for their fact check; and the Data Visualization and Editorial team for preparing figures and supporting the review process.
* According to KFF and The Commonwealth Fund, the ACA sign-ups data do not provide a complete picture of the impact of these policies. The data released so far on initial sign-ups during open enrollment include people whose ACA coverage was automatically renewed at the end of 2025. Enrollment is incomplete until payment of the first month’s premium, also known as effectuated enrollment. The Commonwealth Fund reports that historic hikes in premium payments in 2026 have prompted some people who signed up for coverage to either cancel their policy or not pay their premium altogether. Federal regulators are expected to release the first look at nationwide paid enrollment data later this summer.
** The CBPP analysis includes data from the USDA and data from the Georgia Department of Human Services provided in an open records request. The nationwide SNAP participation estimate applies state data for Georgia because of anomalies in USDA data.
*** This estimate is based on preliminary modeling for nominal residential electricity rates for 2024 and 2028 from Rhodium Group, on file with CAP.