The safety net that caught me, and how it’s shrinking
New York’s healthcare under the 2025 budget bill
A few years ago, I found myself between jobs and couldn’t keep my health insurance. Living in the expensive Bay Area, fresh out of grad school, I was stressed about affording coverage out-of-pocket.
Thankfully, under the Affordable Care Act (ACA), I was able to get a government subsidy on health insurance through the state marketplace. But, even after the subsidy, my monthly premium for the most basic plan was ~$400 per month—a heavy burden when my income was $0 at the time.
I hadn’t planned to take time off or be uninsured, but when it happened, a social safety net—the ACA marketplace—caught me.
Now, that net is shrinking. On July 4, President Trump signed the “One Big Beautiful Bill,” officially cutting a trillion in funding from Medicaid and reshaping the ACA marketplace. This will directly impact New Yorkers, but there is still action you can take.
Millions of New Yorkers will lose health insurance
The bill, signed July 4, cuts Medicaid and the ACA by $1 trillion over 10 years. For a plain language breakdown on how this is happening and the national impact, see our earlier post.
In short, the bill will make it harder to get and keep Medicaid and ACA coverage in a number of ways.
Analyses estimate that 1.5 million New Yorkers will lose their health insurance coverage due to these changes. Locally, that translates to about 33,000 New Yorkers in Syracuse, ~40,000 in Buffalo, ~39,000 in the Adirondacks, and ~700,000 in NYC potentially losing their healthcare. You can see how this affects your New York district here.
In New York state, roughly 35% of residents depend on Medicaid, one of the highest shares of any state and far above the national average of about 20%. In New York City, just over half of residents are enrolled.
Medicaid enrollment is high in New York because:
Poverty is high. In New York City, 25% of residents live in poverty; statewide, the rate is 13.9% versus 12.8% nationally.
There are large, high-need populations, including those with disabilities, seniors needing long-term care, and immigrants.
Many New Yorkers lost jobs during the pandemic, losing work health care plans or the means to pay for insurance.
New York expanded eligibility, providing coverage for more New Yorkers.
Rural clinics and nursing homes in New York will have less funding
This won’t just impact individuals on Medicaid. It will have ripple effects into health care systems.
Rural hospitals, nursing homes, and clinics will be hit especially hard. In some regions, Medicaid makes up 40% of hospital revenue. Take the Adirondacks—28% of residents, half of births, and two thirds of nursing home residents in the region rely on Medicaid. Many in the region have seasonal or part-time work that doesn’t come with employer health insurance.
Already in New York state, nearly a third of rural hospitals are at immediate risk of closing due to low revenue. Senator Edward Markey listed 11 rural New York hospitals at risk due to the Medicaid cuts in this bill.
If Medicaid support shrinks, clinics already on the brink may close, leaving entire communities without local access to care. Even though a national rural health fund of $50 billion was added to the bill, hospital organizations say this likely won’t be enough when spread across the entire rural health infrastructure. Nationally, 338 rural hospitals, and many more clinics, are estimated to be at risk based on their reliance on Medicaid payments for the patients they serve.
Planned Parenthood serves 88,000 patients annually in New York, many in rural areas, providing reproductive and basic care like cancer screenings and blood pressure checks. The bill bans Medicaid payments to any non-profit providing abortions and receiving more than $800k in federal funds (though this is currently being debated in the courts). This would defund larger Planned Parenthood clinics in New York, where abortion remains legal, and could force 200 clinics nationwide to close.
Lastly, the bill withholds some funds to states like New York that provide non-emergency care to undocumented immigrants. While federal law requires hospitals to provide emergency care to everyone, New York provides additional care, like prenatal and elderly care, for undocumented residents.
Food assistance is being cut
In New York, a little over 12% of residents (2.4 million people) rely on SNAP (Supplemental Nutrition Assistance Program), a federal program that provides benefits to low-income people to purchase groceries. SNAP used to be referred to as food stamps, and is the primary safety net for food insecurity in the United States. The Big Beautiful Bill cuts $186 billion from SNAP, and expands work requirements for SNAP eligibility for adults up to age 64 (previously 54) and for parents of children 14 or older.
These changes could push millions off benefits, especially in rural New York, where jobs are often seasonal or scarce for older adults. The hardship of unemployment can be worsened by losing access to nutrition support. With food prices still high, cuts to SNAP risk deepening food insecurity across the state.
The bill will affect local economies
The effects from these bills are not restricted to access to medical care, they will also affect local economies. In New York state, hospitals and health systems are among the top 10 employers in every region.
It’s estimated that the bill will cut ~$8 billion from New York’s hospitals and health systems alone. These cuts could lead to 63,000 lost hospital jobs and related jobs, and result in $14.4 billion in lost hospital-generated economic activity. You can check estimated local economic impacts here.
What can we do?
Such huge policy changes can feel overwhelming. (They sure do to me.) But there are some things we can do to take action:
Help neighbors: Many will face new forms, deadlines, and confusing rules. In New York City, many community based organizations can help with applications. (Filter for Medicaid or SNAP assistance organizations here.)
Keep kids covered: Check CHIP or the Child Health Plus program in New York. Kids often lose coverage when parents do, even if they still qualify, due to paperwork gaps or confusion.
Inform families: Nationally, kids aren’t auto-enrolled in free school lunch anymore, but in all NYC public school students now get free lunch, no forms needed. These universal free meals will also be available across New York state starting this fall. Food banks and pantries in New York can be found through the Food Help NYC tool, calling 311, or through food assistance providers across the state.
Support: Donate to rural hospitals, food pantries, and care networks.
Call your reps: This was a policy choice, but we can still make our voices heard.
Spread the word: Many Americans don’t know that this bill cuts Medicaid and the ACA.
Bottom line
Honestly, this bill does a lot of damage to health safety nets. For tens of millions of Americans, the bill will have direct impacts on their lives. But unexpected events—layoffs, job transitions, injury, family issues—can happen to any of us. While there’s no easy answer to the problem of a shrinking social safety net, we can still do what New Yorkers do best: take care of our communities.
Love,
Your New York Epi
Dr. Marisa Donnelly, PhD, is an epidemiologist, science communicator, and public health expert. This newsletter exists to translate complex public health data into actionable insights, empowering New Yorkers to make informed and evidence-based health decisions.