Millions Are Losing Coverage: What Employers Need to Know

The One Big Beautiful Bill is reshaping the American healthcare system in ways that will reach well beyond Medicaid rolls and marketplace enrollment.

The coverage math is stark. Roughly 9 million people stand to lose Medicaid eligibility, another 2 million face displacement from the ACA marketplaces due to changes in the law itself, and an additional 4 million could exit if enhanced premium tax credits are allowed to expire. When younger, healthier people leave a risk pool that size, premiums rise for everyone who stays. The result is a cost shift to employer-sponsored plans that will compound an already punishing trend, with commercial healthcare costs already running about 10% annually.

Patty Boozang, senior managing director at Manatt Health, traces what HR1 actually does and why employers cannot afford to treat it as someone else's problem. The trillion-dollar reduction in federal healthcare funding adds a second layer of pressure. Hospitals and providers absorb uncompensated care, then pass costs downstream to payers, including employers. Rural health systems face the sharpest exposure, and the $50 billion rural health fund included in the bill falls far short of offsetting those losses.

For employers with hourly or lower-wage workforces, the practical implications are immediate. Work requirements tied to Medicaid eligibility take effect in 2027, and schedule volatility can flip an employee out of coverage by a few hours in a single month. Employers should connect with state Medicaid agencies now, help employees document eligibility, and rethink the role of predictable scheduling as a health benefit. The employers who act before these changes land will be better positioned than those waiting to react.

Watch Patty Boozang join Kirk to trace what belongs on a 2026 HR1 readiness plan and which provisions she expects to hit first.