Tens of thousands of Long Islanders would lose Affordable Care Act health insurance coverage or be required to pay much higher premiums under the budget bill that the House of Representatives passed, state estimates show.
The state would have to pick up the costs for another half million people statewide, including tens of thousands more on Long Island.
The legislation, which also includes what independent analysts say would be hundreds of billions of dollars of Medicaid cuts, would represent a massive contraction to health care coverage on Long Island and in the nation, experts say.
"In total, this would be the biggest rollback in federal support for health care ever," said Larry Levitt, executive vice president for health policy for KFF, a San Francisco-based health policy and news nonprofit, during a Wednesday conference call.
The cuts are part of a broader push by the Trump administration and congressional Republicans for major reductions in spending across much of the federal government, with the argument that much of it amounts to waste, fraud and abuse. Democrats rebut that contention and note that the bill's tax cuts would add $2.4 trillion to the federal deficit, according to a nonpartisan Congressional Budget Office analysis.
In addition to changes to tighten eligibility and add more conditions for ACA coverage, the bill, called "One Big Beautiful Act," does not fund an extension of federal tax credits enacted in 2021 and set to expire at the end of this year. The ACA, also known as Obamacare, has always offered income-based subsidies, but the 2021 legislation greatly expanded them.
"The enhanced premium tax credits were a response to the impact of the COVID-19 pandemic" and were not meant to be permanent, said Rep. Andrew Garbarino (R-Amityville).
The Republican-backed bill is now before the Senate and likely will face changes, though President Donald Trump strongly supports the measure.
Insurance purchased under the ACA provides coverage to more than 1.9 million New Yorkers, including 270,000 Long Islanders. Those with ACA insurance include self-employed people — such as freelancers and entrepreneurs — and workers in jobs that do not offer health insurance.
Consumers choose among insurance companies through ACA "marketplaces," with most receiving tax credits that reduce the cost of a premium.
New York’s system is more generous than almost all other states’ because it offers a federally subsidized $0 premium, with low co-payments, to residents not on Medicaid with annual incomes up to 250% of the federal poverty level, or $66,625 for a family of three. The state runs the program, called the Essential Plan, but insurance is through private companies.
There were 120,000 Suffolk and 105,000 Nassau residents, and nearly 1.7 million people statewide, in the Essential Plan as of May, state health department data shows.
Another 222,000 New Yorkers with incomes above the Essential Plan ceiling — including 22,800 in Suffolk and 22,200 in Nassau — are in an ACA marketplace.
In 2021, Congress increased the amount of tax credits and the number of people eligible for them, helping double ACA enrollment nationwide from 12 million in 2021 to 24.3 million in 2025, according to a KFF analysis. The bill does not extend them. If the enhanced credits were to be made permanent, they would cost the federal government $335 billion between 2025 and 2034, according to a 2024 estimate by the nonpartisan Congressional Budget Office.
The bill would remove hundreds of thousands of "lawfully present" New York immigrants and temporary residents from Essential Plan coverage. They include temporary workers, student exchange visitors, adults brought to the country illegally as children but with a deportation reprieve, refugees and others, according to a Congressional Budget Office analysis.
In the four congressional districts that cover Long Island more than 35,000 immigrants of 224,000 statewide would lose all coverage, state estimates show.
"These are people, families that have been here legally, done everything right, paid taxes, followed all the rules, and now suddenly they're not going to have coverage?" said Elisabeth Benjamin, vice president of health initiatives for the Manhattan-based nonprofit Community Service Society, which provides assistance for people signing up for the ACA.
With earnings that are low but not low enough to qualify for Medicaid, "we expect at these income levels they will not be [able] to afford coverage and will become uninsured," health department spokeswoman Danielle DeSouza said in an email.
An even larger group of these types of immigrants — more than a half million people, including nearly 80,000 in the four congressional districts — would become ineligible for Essential Plan coverage, but a court order requires the state to provide them Medicaid coverage.
Medicaid typically is funded by a combination of federal and state money, but federal law prohibits paying for Medicaid for the types of immigrants who would be newly ineligible for ACA coverage, so the state would have to pay all costs, an estimated $2.7 billion.
In addition, subsidies would be significantly decreased for about 960,000 other Essential Plan members. The plan's promise of a $0 premium would mean a $7.5 billion cost to the state to make up for the loss of the tax credits, Danielle Holahan, executive director of NY State of Health, which is the state's health insurance marketplace, told Newsday on Thursday.
"A $7.5 billion reduction is more than the state is prepared to handle," she said. "So I don't know what the future of the Essential Plan is if this goes forward."
The measures would be phased in beginning in 2026 and 2027. The state’s seven Republican members of Congress signed letters urging a delay until 2029, to provide more time for the state, hospitals and others to prepare. But they said they support reducing the number of noncitizen residents eligible for coverage.
"Taxpayer-funded health benefits should go to American citizens and long-term legal residents, not recent arrivals or those here illegally," one of the signatories, Rep. Nick LaLota (R-Amityville), said in a statement to Newsday.
About 28,000 of the 45,000 Long Islanders with marketplace coverage receive subsidies, and they will on average face a 32% increase — or $219 a month more for a couple — in premiums, according to state estimates.
They are people who aren’t poor enough for Medicaid or the Essential Plan but don’t earn high salaries, many of them young people who won't pay for full-cost coverage because they view themselves as low-risk for health problems, said Vanessa Baird-Streeter, president and CEO of the nonprofit Health & Welfare Council of Long Island.
The exodus of younger, healthier people from the marketplace, and from the Essential Plan, would leave a pool of people with higher health care costs, Benjamin said.
That would lead insurance companies to increase premiums, causing potentially large increases even for ACA recipients without subsidies, Holahan said.
The large number of newly uninsured people would put a strain on hospitals, which are required to provide emergency care regardless of ability to pay, Baird-Streeter said.
LaLota, noting that the subsidies were timed to expire this year, said that, with a ballooning federal deficit, "we simply can’t afford to keep emergency-level spending in place indefinitely."
There are a number of other changes to the ACA in the bill that together would, according to the Congressional Budget Office, lead to hundreds of thousands more people nationwide losing coverage.
They include shortening the period for which people can enroll for ACA coverage — in New York, it would be cut from three months to a month and a half — and requiring additional documentation if reported income can’t be verified with tax records.
Provisions like those would further decrease the number of younger adults with coverage, because they typically wait longer to enroll in health plans and are less likely to search for documents, making the insurance pool even older, said Sara Collins, vice president for health care coverage at The Commonwealth Fund, a Manhattan-based nonprofit focusing on health care.
Bill Hammond, senior fellow for health policy at the fiscally conservative Empire Center for Public Policy, agreed that one reason for the verification provision is "to layer on levels of hassle and red tape with a view towards discouraging people from signing up."
But, he said, the government has a right to try to ensure only eligible people enroll.
"We’re talking about giving someone potentially thousands of dollars worth of tax credits," he said. "I think it makes sense to be careful about who we give that to."
DeSouza, the health department spokeswoman, said New York already has "robust verification requirements."
Tens of thousands of Long Islanders would lose Affordable Care Act health insurance coverage or be required to pay much higher premiums under the budget bill that the House of Representatives passed, state estimates show.
The state would have to pick up the costs for another half million people statewide, including tens of thousands more on Long Island.
The legislation, which also includes what independent analysts say would be hundreds of billions of dollars of Medicaid cuts, would represent a massive contraction to health care coverage on Long Island and in the nation, experts say.
"In total, this would be the biggest rollback in federal support for health care ever," said Larry Levitt, executive vice president for health policy for KFF, a San Francisco-based health policy and news nonprofit, during a Wednesday conference call.
The cuts are part of a broader push by the Trump administration and congressional Republicans for major reductions in spending across much of the federal government, with the argument that much of it amounts to waste, fraud and abuse. Democrats rebut that contention and note that the bill's tax cuts would add $2.4 trillion to the federal deficit, according to a nonpartisan Congressional Budget Office analysis.
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Senate Minority Leader Chuck Schumer speaks about the health care impacts of the Republican budget and policy bill, also known as the "One Big Beautiful Bill Act," during a news conference June 4. Credit: AFP via Getty Images/SAUL LOEB
In addition to changes to tighten eligibility and add more conditions for ACA coverage, the bill, called "One Big Beautiful Act," does not fund an extension of federal tax credits enacted in 2021 and set to expire at the end of this year. The ACA, also known as Obamacare, has always offered income-based subsidies, but the 2021 legislation greatly expanded them.
"The enhanced premium tax credits were a response to the impact of the COVID-19 pandemic" and were not meant to be permanent, said Rep. Andrew Garbarino (R-Amityville).
The Republican-backed bill is now before the Senate and likely will face changes, though President Donald Trump strongly supports the measure.
Insurance purchased under the ACA provides coverage to more than 1.9 million New Yorkers, including 270,000 Long Islanders. Those with ACA insurance include self-employed people — such as freelancers and entrepreneurs — and workers in jobs that do not offer health insurance.
Consumers choose among insurance companies through ACA "marketplaces," with most receiving tax credits that reduce the cost of a premium.
New York’s system is more generous than almost all other states’ because it offers a federally subsidized $0 premium, with low co-payments, to residents not on Medicaid with annual incomes up to 250% of the federal poverty level, or $66,625 for a family of three. The state runs the program, called the Essential Plan, but insurance is through private companies.
There were 120,000 Suffolk and 105,000 Nassau residents, and nearly 1.7 million people statewide, in the Essential Plan as of May, state health department data shows.
Another 222,000 New Yorkers with incomes above the Essential Plan ceiling — including 22,800 in Suffolk and 22,200 in Nassau — are in an ACA marketplace.
In 2021, Congress increased the amount of tax credits and the number of people eligible for them, helping double ACA enrollment nationwide from 12 million in 2021 to 24.3 million in 2025, according to a KFF analysis. The bill does not extend them. If the enhanced credits were to be made permanent, they would cost the federal government $335 billion between 2025 and 2034, according to a 2024 estimate by the nonpartisan Congressional Budget Office.
The bill would remove hundreds of thousands of "lawfully present" New York immigrants and temporary residents from Essential Plan coverage. They include temporary workers, student exchange visitors, adults brought to the country illegally as children but with a deportation reprieve, refugees and others, according to a Congressional Budget Office analysis.
In the four congressional districts that cover Long Island more than 35,000 immigrants of 224,000 statewide would lose all coverage, state estimates show.
"These are people, families that have been here legally, done everything right, paid taxes, followed all the rules, and now suddenly they're not going to have coverage?" said Elisabeth Benjamin, vice president of health initiatives for the Manhattan-based nonprofit Community Service Society, which provides assistance for people signing up for the ACA.
With earnings that are low but not low enough to qualify for Medicaid, "we expect at these income levels they will not be [able] to afford coverage and will become uninsured," health department spokeswoman Danielle DeSouza said in an email.
An even larger group of these types of immigrants — more than a half million people, including nearly 80,000 in the four congressional districts — would become ineligible for Essential Plan coverage, but a court order requires the state to provide them Medicaid coverage.
Medicaid typically is funded by a combination of federal and state money, but federal law prohibits paying for Medicaid for the types of immigrants who would be newly ineligible for ACA coverage, so the state would have to pay all costs, an estimated $2.7 billion.
In addition, subsidies would be significantly decreased for about 960,000 other Essential Plan members. The plan's promise of a $0 premium would mean a $7.5 billion cost to the state to make up for the loss of the tax credits, Danielle Holahan, executive director of NY State of Health, which is the state's health insurance marketplace, told Newsday on Thursday.
"A $7.5 billion reduction is more than the state is prepared to handle," she said. "So I don't know what the future of the Essential Plan is if this goes forward."
The measures would be phased in beginning in 2026 and 2027. The state’s seven Republican members of Congress signed letters urging a delay until 2029, to provide more time for the state, hospitals and others to prepare. But they said they support reducing the number of noncitizen residents eligible for coverage.
"Taxpayer-funded health benefits should go to American citizens and long-term legal residents, not recent arrivals or those here illegally," one of the signatories, Rep. Nick LaLota (R-Amityville), said in a statement to Newsday.
About 28,000 of the 45,000 Long Islanders with marketplace coverage receive subsidies, and they will on average face a 32% increase — or $219 a month more for a couple — in premiums, according to state estimates.
They are people who aren’t poor enough for Medicaid or the Essential Plan but don’t earn high salaries, many of them young people who won't pay for full-cost coverage because they view themselves as low-risk for health problems, said Vanessa Baird-Streeter, president and CEO of the nonprofit Health & Welfare Council of Long Island.
The exodus of younger, healthier people from the marketplace, and from the Essential Plan, would leave a pool of people with higher health care costs, Benjamin said.
That would lead insurance companies to increase premiums, causing potentially large increases even for ACA recipients without subsidies, Holahan said.
The large number of newly uninsured people would put a strain on hospitals, which are required to provide emergency care regardless of ability to pay, Baird-Streeter said.
LaLota, noting that the subsidies were timed to expire this year, said that, with a ballooning federal deficit, "we simply can’t afford to keep emergency-level spending in place indefinitely."
There are a number of other changes to the ACA in the bill that together would, according to the Congressional Budget Office, lead to hundreds of thousands more people nationwide losing coverage.
They include shortening the period for which people can enroll for ACA coverage — in New York, it would be cut from three months to a month and a half — and requiring additional documentation if reported income can’t be verified with tax records.
Provisions like those would further decrease the number of younger adults with coverage, because they typically wait longer to enroll in health plans and are less likely to search for documents, making the insurance pool even older, said Sara Collins, vice president for health care coverage at The Commonwealth Fund, a Manhattan-based nonprofit focusing on health care.
Bill Hammond, senior fellow for health policy at the fiscally conservative Empire Center for Public Policy, agreed that one reason for the verification provision is "to layer on levels of hassle and red tape with a view towards discouraging people from signing up."
But, he said, the government has a right to try to ensure only eligible people enroll.
"We’re talking about giving someone potentially thousands of dollars worth of tax credits," he said. "I think it makes sense to be careful about who we give that to."
DeSouza, the health department spokeswoman, said New York already has "robust verification requirements."
David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.
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Newsday Live Author Series: Christie Brinkley Newsday Live and Long Island LitFest present a conversation with supermodel, actress and author Christie Brinkley. Newsday's Elisa DiStefano hosts a discussion about the American icon's life and new memoir, "Uptown Girl."
Get more on these and other NewsdayTV stories
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