Following changes to New York's Essential Plan, thousands remain uninsured

ALBANY - Thousands of New Yorkers who lost coverage through the state's no-cost health insurance option due to federal funding cuts approved last year have just days left to enroll in a new plan.

Just under half of the approximate 450,000 who lost health insurance through the state's Essential Plan have still not enrolled in a new policy as of July 31, according to the state's Department of Health.

Cadence Acquaviva, a spokesperson for the state's Department of Health, said the department "is committed to using every resource at its disposal" to assist individuals previously enrolled in the Essential Plan who have still not obtained insurance.

"Between now and the end of the special open enrollment period we are continuing to reach out to the 44% of members who have not enrolled in coverage to ensure they're aware that they can still enroll and to learn which of those members may have found alternate health insurance from other sources," she said in a statement.

More than 183,000 previously enrolled in the Essential Plan through expanded income limits that went into effect in 2024 were able to re-enroll in the zero-premium health plan or now qualify for Medicaid due to changes in their income, according to the state.

But fewer than 60,000 others have enrolled in a qualified health plan through the state-run health exchange since losing their coverage on July 1. A special enrollment period to sign up for new insurance through the state-run health exchange is Aug. 30.

It's unclear how many of the nearly 192,000 that had still not enrolled in a new health plan may have acquired benefits through other means like employment or have signed up for health insurance through the state exchange in the last month.

But the lagging enrollment numbers could mean that up to 44% of those previously enrolled in the Essential Plan - including thousands throughout the Capital Region - could be left uninsured.

Changes to the Essential Plan are one of several the state is bracing for following the passage of the One Big Beautiful Bill Act, which slashed nearly $1 trillion of Medicaid over the next decade and imposes new work and enrollment requirements that will take effect next year that critics argue will lead to more people being uninsured.

Proponents of the legislation, including President Donald Trump, say the cuts are necessary to root out wasteful spending and fraud in the government-run health insurance program. They argue Medicaid incentivizes people to not participate in the workforce and better their financial position.

Changes to the plan

Changes to the Essential Plan can be traced back to the passage of the One Big Beautiful Bill Act last year. The reconciliation bill, approved by Congressional Republicans, included widespread cuts to government health spending.

Among the cuts was $7.5 billion in annual funding for the Essential Plan, which offers no-cost insurance to low-income New Yorkers who do not qualify for Medicaid.

The cuts were the result of a clause in the legislation that prohibits federal dollars from being spent on providing insurance for lawfully present immigrants, which New York has done since a 2001 state Court of Appeals ruling that determined the state has a constitutional obligation to do so.

For years, those individuals were served by the state's Medicaid program. That changed following the passage of the Affordable Care Act, which led to the creation of the Essential Plan. The transition allowed the state to save on Medicaid spending while meeting its constitutional obligation.

In the years since its inception, the Essential Plan continued to grow. New York in 2024 received a federal waiver to expand the program's income limits to 250% of the federal poverty limit, up from the previous 200%. Program enrollment increased to 1.7 million following the move.

But following the loss of funding, the state reverted back to the plan's original income limit, preserving health insurance for 1.3 million, but forcing 450,000 others to find alternative insurance.

The changes impact thousands throughout the Capital Region, including 5,371 Albany County residents who enrolled in the Essential Plan through the expanded income limits as of March 1. 

An additional 3,790 signed up for Essential Plan coverage through the expanded income limits in Schenectady County, while 1,259 enrolled in Columbia County and 698 in Essex County, according to state enrollment data.  

Other changes

Changes to the Essential Plan come at a time when health insurance premiums have increased for millions of Americans after Congress let expire a series of enhanced tax credits last year that were implemented during the coronavirus pandemic.

Insurance premiums are also expected to continue as health care costs grow. Insurance companies in New York have requested to increase premiums by more than 20% next year for individual and small-market plans available through the state's health exchange.

Looming changes to Medicaid are also set to take effect next year that some health care advocates fear could lead to thousands losing coverage, forcing patients to forgo preventative care and lead to more costly emergency room visits.

On Thursday, New York Attorney General Letitia James issued guidance on how New Yorkers can obtain financial assistance to medical care through the state's Hospital Financial Law. The law requires hospitals to offer discounted care for those earning up to 400% of the federal poverty limits and waive charges for those earning less than 200% of the federal poverty level.

"As federal cuts strip health coverage away from hundreds of thousands of New Yorkers, I urge anyone struggling to pay a hospital bill to use this guidance to understand their rights," James said in a statement. "Hospitals have a legal obligation to help patients who are eligible for financial assistance, and no one should be pushed into medical debt because they did not know where to turn."