Hundreds of thousands of legal, taxpaying immigrants could lose access to Obamacare subsidies next year under a provision in the H.R.1 – One Big Beautiful Bill Act. According to experts, this could result in higher premiums, reduced coverage, and increased market instability. Families and local health systems may feel the effects.
Subsidy Removal Threatens Coverage for Lawful Immigrants
A provision in the One Big Beautiful Bill Act (OBBA) passed by Republicans in July would eliminate Affordable Care Act (ACA) subsidies for low-income lawfully present immigrants. These are individuals authorized to live and work in the U.S. but ineligible for Medicaid. Analysts project that 300,000 immigrants could lose coverage next year, with nearly 1 million affected by 2034.
Democrats, focused on extending enhanced ACA subsidies for citizens, acknowledge it may be challenging to reverse the provision. Immigration advocates warn that entire families could lose insurance, including U.S. citizen spouses and children. Experts caution that removing generally younger, healthier immigrants from coverage could drive up premiums for the broader market and destabilize local insurance programs.
Background on ACA Subsidies and Immigrant Coverage
The 2010 ACA provided tax credit subsidies to lawfully present immigrants earning under 100 percent of the federal poverty level. These included green card holders, refugees, and asylum seekers, many of whom are barred from Medicaid for at least five years after arrival.
Under the Republican bill, these tax credits will disappear starting next year. In 2027, lawfully present immigrants with incomes above the poverty line risk losing discounted ACA rates, which are currently available to citizens. Experts have argued that these changes could further exacerbate limited access to affordable health coverage, particularly among families that depend on benefits provided to multiple members.
State Responses and Advocacy Efforts
States and advocacy groups are increasing outreach to help immigrants navigate the changes. Connecticut, for instance, is expanding in-person enrollment assistance to make sure eligible immigrants understand tax credit options and income reporting rules.
Many states have taken advantage of the 2009 Immigrant Children’s Health Improvement Act to extend Medicaid and CHIP coverage to children and pregnant women. As of April 2025, the five-year waiting period is waived for children in 37 states and the District of Columbia, and for pregnant women in 31 states. Additional states, such as California, Minnesota, and Illinois, provide coverage for children regardless of their immigration status; however, these programs face reductions due to budget constraints.
Public Charge Rule Raises Additional Concerns
Lawfully present immigrants also face renewed uncertainty amid the possible revival of the Trump-era “public charge” rule, which could penalize individuals accessing public benefits, including health insurance, when applying for permanent resident status. Advocates argue that this rule could further discourage eligible immigrants from seeking care, thereby straining public health systems.
Studies have shown that past enforcement compelled many low-income immigrants to forgo routine medical services, resulting in gaps in preventive care and responses to emergencies. Experts say that the loss of ACA subsidies, combined with the public charge rule, could result in increased premiums, a strain on hospitals, and reduced access to healthcare for entire families.
Looking Ahead
Removing ACA subsidies for lawfully present immigrants and possibly reinstating the public charge rule marks a significant shift in federal health policy. It could have a ripple effect across families, insurance markets, and public health systems nationwide, analysts say.
For continued updates on ACA policy changes, immigrant health coverage, and U.S. immigration developments, visit ImmigrationQuestion.com.
Get answers to your immigration questions from licensed immigration attorneys. For attorneys, use our innovative 3-in-1 case management software to improve your practice. Download our free app on Google Play and the Apple App Store.
Resources:
**ImmigrationQuestion.com is a networking platform founded by Immigration Attorneys. It serves as a meeting ground for licensed immigration attorneys and people with immigration questions. It is not a law firm. It is not affiliated with or endorsed by USCIS or AILA. Attorneys on this platform are independent and have the discretion to offer a free consultation and/or set their fees under the law.
