More than 10 million Americans have lost health coverage under Trump, new analysis finds

Between 10.27 million and 11.75 million more Americans lack Medicaid, the Children’s Health Insurance Program or Affordable Care Act marketplace coverage than did when President Donald Trump returned to office in January 2025, according to a new analysis by the independent healthcare researcher Charles Gaba.

Gaba’s analysis, published September 2 on his site ACA Signups, tracks federal enrollment data across three programs. Medicaid and CHIP enrollment fell from about 79.4 million people in January 2025 to roughly 73.5 million in May 2026, a drop of 5.9 million, the analysis found. Medicare enrollment rose by about 1.6 million over the same period, driven largely by the aging of the population rather than any policy change. ACA marketplace enrollment, which peaked at 22.2 million during the 2025 open enrollment period, had fallen to less than 19.2 million by February 2026, a drop of more than 3 million; Gaba estimated a further decline of 1.5 million to 3 million between February and May, which would put marketplace enrollment at roughly 16 million to 18 million by May.

The net loss, adjusted for population growth of roughly 1.5 million people over the period, is what produces Gaba’s headline estimate of more than 10 million people newly uninsured or underinsured.

Children have absorbed a disproportionate share of the losses. Two million fewer children were enrolled in Medicaid and CHIP in April 2026 than in January 2025, according to the Georgetown Center for Children and Families. “When child enrollment in Medicaid and CHIP goes down, the child uninsured rate goes up,” said Joan Alker, the center’s executive director. Alker said the decline is difficult to explain because income eligibility rules for children have not changed. “Federal officials should be scrambling to figure out the root cause of this coverage loss for children,” she said.

The coverage losses have two main drivers. The tax and spending law that Trump signed in July 2025 phases in new Medicaid work-reporting requirements and eligibility checks over the next several years, and Gaba’s analysis notes that more than half of its provisions had already taken effect by September 2026. Separately, the enhanced ACA subsidies that Congress approved during the COVID-19 pandemic are expiring, and lawmakers have not renewed them, pushing marketplace premiums higher for enrollees who do not qualify for other coverage.

Gaba’s estimate is a projection built from federal enrollment data rather than a government tally of the uninsured, and the final numbers could shift as more states report. Gaba separately noted that the Centers for Medicare and Medicaid Services’ own April 2026 report showed combined Medicaid and CHIP enrollment falling by 398,000 people from March to April, to about 73.9 million nationwide, in line with the broader trend his analysis tracks.

The last time Medicaid enrollment fell this quickly was during the “unwinding” of pandemic-era continuous enrollment protections in 2023 and 2024, when states resumed eligibility checks that had been paused since 2020. That process also fell hardest on young children: a separate Georgetown analysis found the uninsured rate for children under six rose from 4.3% in 2022 to 5.3% in 2024, with more than half of that rise concentrated in Texas, Georgia and Florida.