- New York’s July 1 eligibility cut removed about 450,000 residents from the Essential Plan, with preliminary data showing roughly 225,000 are now uninsured.
- Former enrollees moving to ACA marketplace plans face much higher costs, including monthly premiums, deductibles and cost-sharing the Essential Plan largely avoided.
- The disruption offers an early view of wider US coverage losses expected under President Donald Trump’s 2025 tax-and-spending law, which reduced federal health care funding and cut several bn dollars from New York’s Essential Plan.
Nearly 450,000 New Yorkers removed from the state’s federally funded Essential Plan are now trying to buy health insurance coverage in a more expensive and confusing insurance market.
The Essential Plan serves low-income residents who earn slightly too much for Medicaid and do not receive health insurance through an employer.
A July 1 policy change ended eligibility for people earning more than 200% of the federal poverty line. That equals about $31,920 a year for one person, or $66,000 for a household of four.
The change forced former enrollees to search for replacement coverage. Roughly half have enrolled in other insurance, according to preliminary state data. Those plans often carry far higher costs than the Essential Plan.
Silver plans are designed to cover 70% of an enrollee’s health care costs.
New York now gives an early look at the coverage disruption expected across the US next year. States are preparing for as many as 10 mn Americans to lose health insurance under President Donald Trump’s 2025 tax-and-spending law, when its largest health coverage changes take effect.
The 2025 law, known as the One Big Beautiful Bill Act, cut federal health care spending by more than $1 tn. It also cut several bn dollars from New York’s Essential Plan.
Democratic Gov. Kathy Hochul responded to the program’s looming funding gap by lowering the eligibility threshold to 200% of the federal poverty line from 250%.
Hochul blamed the coverage losses on the Trump administration and congressional Republicans. She also rejected a proposal from Democratic state lawmakers to fund a less generous Essential Plan replacement for people losing eligibility, saying the state would face excessive costs.
The result has confused New Yorkers who learned through mailed notices that their Essential Plan coverage was ending.
Some residents remained eligible for the Essential Plan or moved automatically to Medicaid after their income declined, according to the state Department of Health. Preliminary state data still indicate about 225,000 people are newly uninsured.
New Yorkers who lost Essential Plan coverage have until Aug. 30 to choose new plans during a special enrollment period through the NY State of Health marketplace.
State health officials acknowledge the shift is a significant change. Marketplace plans usually bring monthly premiums and cost-sharing requirements. The Essential Plan charges no premium, has low cost-sharing and carries no deductible.
We are committed to providing personalized guidance to these New Yorkers as they transition to new plan options through our enrollment assistors, ensuring advance notices and providing resources and information to make the path to new coverage as clear and as smooth as possible.
Danielle DeSouza, Department of Health
The transition has been uneven, with some New Yorkers reporting problems switching to new health insurance coverage.
