As a result of a little-known tweak to House Resolution “H.R.”1 (also known as the “One Big Beautiful Bill Act” or the “Working Families Tax Cuts”), more than one million lawfully present immigrants are expected to lose health insurance. One of the significant provisions of the bill will go into effect shortly on October 1, 2026.
Previously, a narrow category of “qualified noncitizens” (those Congress had long treated as close enough to permanent residents to warrant public benefits) were eligible for Medicaid, subsidized care on the Affordable Care Act marketplaces (also known as “Obamacare”), and Medicare. That group included lawful permanent residents (“LPRs”), asylees/refugees, survivors of domestic violence/trafficking, parolees (for at least one year), certain Cubans/Haitians, and Compact of Free Association (COFA) migrants.
As of July 4, 2025, H.R. 1 narrowed Medicare’s definition of “qualified noncitizen,” drastically curtailing new enrollment to citizens, lawful permanent residents, certain Cuban/Haitian entrants, and COFA migrants. Those currently enrolled whose status now fall outside of the definition of “qualified noncitizen” will be disenrolled on January 4, 2027. The Congressional Budget Office (CBO) estimates that this change will strip eligibility from roughly 100,000 lawfully present immigrants who have worked and paid Medicare taxes for years.
Beginning on October 1, 2026, H.R. 1 similarly narrows Medicaid and the Children’s Health Insurance Program (CHIP) eligibility to LPRs, certain Cubans/Haitians, and COFA migrants. The CBO estimates that this change will lead to an additional 100,000 lawfully present immigrants becoming uninsured.
Finally, beginning on January 1, 2027, that same narrowed group described above will be the only immigrants eligible for premium tax credits and cost-sharing reductions in the Marketplace. By far the largest group affected, the CBO estimates that 900,000 immigrants will lose coverage as a result of this change.
The complicated interplay of immigration statutes and our complex healthcare system can obscure who actually stands to lose coverage as a result of this seemingly minor change. The more than one million immigrants who will lose coverage under H.R. 1 are lawfully present, many are authorized to work, and are paying taxes. Consider the following practical examples of the negative impacts:
- An asylee with valid work authorization works part-time for a Fortune 100 company. Although the company is large and well-resourced, part-time employees generally don’t qualify for its group health plan. Even if they otherwise qualify based on other eligibility criteria, the asylee will no longer be eligible for Medicaid. Before H.R. 1, the Marketplace could have potentially filled this coverage gap. However, the asylee will no longer qualify for premium tax credits and cost-sharing reductions in the Marketplace, likely rendering participation too expensive to participate.
- A Ukrainian parolee who entered in 2022 has work authorization and is employed at a small nonprofit. The CBO estimates half of the employees of small businesses work for employers that do not offer health insurance at all. They now find themselves in the same position: no employer plan, and ineligible for Marketplace subsidies, likely pricing them out of coverage altogether.
- A survivor of domestic violence started a small business. Because a self-employed founder has no employer plan to rely on, the individual Marketplace is the realistic source of coverage, and the survivor’s eligibility for subsidies that made it affordable is exactly what H.R. 1 eliminates.
While the CBO estimates that over one million immigrants will be directly impacted by these changes, the number of family members who will feel the ramifications of this policy change will likely be greater than those who lose healthcare coverage. Many immigrant households are of mixed status. A naturalized citizen or LPR whose own status or health care coverage is unaffected by these changes may nonetheless still be absorbing the financial and emotional strain due to potential coverage loss of a family member. For example, a U.S.-citizen spouse whose partner with a trafficking visa loses access to Marketplace coverage may end up shouldering higher medical bills for the household, even though the U.S. citizen’s own coverage is unchanged.
These changes arise against a broader strain on employer-sponsored coverage. Family premiums for employer plans have been rising substantially for years, and employers have recently responded by narrowing coverage options. The consequence of this aspect of H.R. 1 will extend beyond immigration law: employee benefits experts are likely to field questions from HR departments; healthcare and hospital attorneys should anticipate more uncompensated care from hospitals and other providers as patients lose coverage; and employment lawyers advising companies with immigrant workforces will want to understand which employees are affected and on what timeline. For the workers and families impacted on all sides, the practical result is the same: fewer paths to affordable coverage.
For immigrants without access to an employer plan, Medicaid and the Marketplace have long served as the practical backstop: one that H.R. 1 has now substantially foreclosed for a large swath of lawfully present, often working, taxpaying individuals. The consequences will reach beyond the more than one million individuals who lose coverage directly; they will ripple through mixed-status households, workplaces, and communities that assumed lawful status would protect access to affordable health insurance. As these changes go into effect in the coming months, the window for practitioners and employees to plan around these changes is narrow, and the professionals best positioned to help those impacted may not have many attractive options to mitigate the harm.
The material contained in this article does not constitute direct legal advice and is for informational purposes only. An attorney-client relationship is not presumed or intended by receipt or review of this presentation. The information provided should never replace informed counsel when specific immigration-related guidance is needed.
Reprinted with permission from the September 17, 2026 edition of The Legal Intelligencer© 2026 ALM Media Properties, LLC. All rights reserved. Further duplication without permission is prohibited. ALMReprints.com – 877-257-3382 – reprints@alm.com.
