New York: 450,000 to lose Essential Plan eligibility as state is forced to end expansion due to GOP's #BigUglyBill

I knew this was coming but it's still depressing to see it officially announced. Via NY State of Health:

Following Devastating Federal Funding Cuts, New York State Takes New Action to Preserve Health Care for As Many New Yorkers As Possible

• Washington Republicans Cut $7.5 Billion in Annual Funding, Threatening Coverage for 1.7 Million New Yorkers
• Cuts Will Force New York to Make Major Changes to Its Successful Essential Plan to Preserve Coverage for 1.3 Million New Yorkers
• Despite This Action, 450,000 New Yorkers Will Lose Essential Plan Eligibility Due to the Newly-Enacted Federal Law
• A 30-Day Public Comment Period Opens Today on State’s Plan to Return to a Basic Health Program

ALBANY, N.Y. (September 10, 2025) – The New York State Department of Health today announced that the State is taking proactive action to preserve access to health care for as many New Yorkers as possible following devastating cuts in federal funding from the Republican-passed budget bill H.R.1. A 30-day public comment period opens today on the State’s proposed plan to end the State Innovation Waiver and return to a Basic Health Program.

The federal law eliminates $7.5 billion in annual funding for New York State’s Essential Plan, jeopardizing health care coverage for the nearly 1.7 million low- and middle-income New Yorkers who are currently enrolled in the program.

Due to this funding cut from H.R.1, the State has no choice but to terminate its groundbreaking Section 1332 State Innovation Waiver and Essential Plan expansion. To preserve coverage for as many New Yorkers as possible, Governor Hochul is proposing to revert to the Basic Health Program. This action would allow an estimated 1.3 million New Yorkers to remain enrolled in the program and mitigate revenue losses to the health care delivery system despite the federal Government’s targeted disinvestments.

It's important to note that this doesn't necessarily mean that all ~450,000 will become uninsured; many of them will become eligible for subsidized ACA exchange coverage instead. Of course, those subsidies are themselves becoming far less generous as well, which means this population, who earn between 200 - 250% FPL, will have to pay between 6.6 - 8.44% of their income for the benchmark Silver ACA exchange plan, which amounts to $172 - $275/month for a single adult.

By comparison, right now they aren't paying a dime in premiums, so this will technically be an infinite premium increase for them.

Here's the official Essential Plan enrollment figures as of August 2025: 1,245,999 earning up to 200% FPL plus another 446,332 who earn 200 - 250% FPL; it's the latter population who's being cut off from the program.

It's also worth noting that when NY announced the Essential Plan program expansion, they were only projecting perhaps 100,000 additional New Yorkers to sign up...actual additional enrollment has been nearly 4.5x that.

SIDENOTE: I've deleted a post from last week in which I claimed that total BHP enrollment across NY, MN & OR had broken 2.0 million total; it turns out I was misreading the NY total, which included QHP enrollees as well. My apologies for the bone-headed error on my part.

“I have been very direct and clear with New Yorkers about the disastrous impact of H.R.1 on our health care system, and the devastating choices it would force states to make,” State Health Commissioner Dr. James McDonald said. “By reverting to a Basic Health Program, Governor Hochul is making sure that 1.3 million working people will be able to keep their affordable health insurance. Even with these steps, too many New Yorkers – nearly half a million– will lose affordable health coverage and be forced to choose between keeping food on the table and paying their medical bills. I am grateful to Governor Hochul for standing up and doing what’s right while Washington Republicans rip health care away from their constituents.”

As a result of the drastic budget cuts in the newly enacted federal Law, an estimated 450,000 middle class New Yorkers will lose access to zero-premium comprehensive health insurance despite the State’s efforts.

The reduction of federal funding will lead to coverage losses and increases in uncompensated care for New York State providers, who will be left to cover the costs of uninsured New Yorkers. This will affect the delivery of health care services for all New Yorkers and could force facilities to close. Communities across the state will also incur job losses and economic loss as healthcare dollars disappear from communities. Congressional inaction to repeal or delay H.R.1 changes to premium tax credit eligibility for lawfully-present individuals will force New York State to terminate its waiver and leave hundreds of thousands of New Yorkers uninsured.

The 1332 Waiver proved that innovative healthcare policy can work. Last year, NYS officials celebrated New York's Section 1332 waiver as a groundbreaking achievement. The program expanded the Essential Plan to New Yorkers who are not eligible for Medicaid with incomes up to 250% of the federal poverty level, or about $39,125 annually for an individual, providing comprehensive health insurance with zero monthly premiums, no deductibles, and minimal cost-sharing. The expansion saved participants an average of over $6,000 per year compared to Qualified Health Plan coverage.

NY State of Health Executive Director Danielle Holahan said, “The Essential Plan has been the linchpin to driving down New York’s uninsured rate among those who do not qualify for Medicaid but still struggle with health care costs. Many enrollees are essential workers, small business employees, and families working multiple jobs to make ends meet. Our decision to terminate the waiver allows us to preserve coverage for as many New Yorkers as possible and protect more than a decade of progress in expanding healthcare.”

As the full impact of these federal changes comes into effect, New York State is committed to an orderly transition, as well as collaborating with the Centers for Medicare & Medicaid Services (CMS) to design and provide affordable coverage options for impacted enrollees. In addition to providing consumers with 90-days notice prior to their eligibility change, New York State will provide a special enrollment period for CMS-approved coverage options and enhanced customer service assistance to affected consumers to ease the transition.

The New York State Department of Health is opening a public comment period today, September 10, 2025 through October 10, 2025, on the plan to transition from the 1332 waiver to a Basic Health Program. Instructions for submitting public comments are posted here.

The transition to a Basic Health Program is anticipated to take effect by July 1, 2026, pending approval by CMS, giving the State time to implement these protective measures while following federal requirements for waiver termination.