A new report from UnidosUS, a Latino civil rights and advocacy group, warns that the federal policy changes are poised to reverse 14 years of progress in Latino health coverage and urges Congress to reverse the policy decisions.
More than four million Latinos are among the 14 million Americans who could lose health coverage over the next 10 years due to federal cuts to Medicaid and the Affordable Care Act (ACA), according to a new analysis from the Latino civil rights and advocacy group UnidosUS.
The report attributes the projected rise in the uninsured rate to two congressional decisions that together cut more than $1 trillion in federal support for Medicaid and Affordable Care Act (ACA) coverage. Authors say the passage of the One Big Beautiful Bill and the decision to allow enhanced premium tax credits to expire at the start of 2026 will lead to:
- More red tape and paperwork that can terminate eligible people from Medicaid and make renewal harder, including more frequent recertification and documentation requirements.
- Cost shifts to states that can force cuts to eligibility, benefits, or provider payments to balance budgets.
- New disincentives for states to expand Medicaid, leaving more low-income adults in non-expansion states without a stable coverage option.
- Eligibility terminations for certain lawfully present immigrants across multiple programs, increasing the risk of coverage losses in families that already face barriers to care.
- Administrative actions that deter enrollment and use of care, including policies that increase fear of information-sharing with immigration enforcement and deep cuts to funding for community organizations that help families enroll and stay covered.
As a result of these decisions, UnidosUS finds the country will face:
- Historic coverage losses: The Congressional Budget Office projects the number of uninsured Americans will grow by 8.7 million from 2025 to 2028, an increase of 33 percent, more than double the largest prior four-year rise recorded in comparable Census-era data.
- Latinos will be hit especially hard: More than four million Latinos are projected to lose coverage over 10 years. In several states, Latinos comprise an outsized share of those expected to become uninsured (including major impacts in Florida, New Mexico, California, Texas, and Arizona).
- Hard-won ACA-era gains are at risk: From 2010 to 2024, the share of Latinos without insurance fell from 31 percent to 17 percent, which means nearly 10 million Latinos gained coverage—progress the report says is now being reversed.
- Rising premiums push people out of coverage: After Congress let enhanced premium tax credits expire in January 2026, average costs rose by roughly $1,000 per year for more than 20 million people, including 6.5 million Latinos who buy their own ACA coverage; the report notes immediate coverage drops among marketplace enrollees.
- Immigration enforcement deters enrollment and care: The share of immigrant parents reporting that their families avoided public programs due to deportation fears increased from 11 percent to 18 percent between 2023 and 2025, affecting many U.S.-citizen children in mixed-status households.
“Unlike major coverage losses of the past, which resulted from recession-driven layoffs and terminations of employer-based coverage, today’s far larger coverage losses are entirely self-inflicted, resulting from policy choices made by Congress and the administration,” said Stan Dorn, director of the Health Policy Project at UnidosUS, in the report announcement. “At a time when families across the country are struggling with rising costs, lawmakers are choosing to worsen health care affordability and accessibility, threatening to erase 14 years of hard-won gains under the Affordable Care Act. Lawmakers must reverse course now to protect American health care.”
The report recommends policymakers act now and repeal health coverage provisions in the Big Beautiful Bill Act, restore and extend the enhanced premium tax credits, and reverse administrative policies that deter policies from enrolling in health coverage or seeking care.
However, meaningful improvements to the healthcare infrastructure will require:
- Health coverage to become significantly more seamless and paperless. Eligibility should be redefined so that people automatically qualify for a minimum level of assistance based on prior-year tax returns or their prior qualification for programs like SNAP, making it unnecessary for many families to provide redundant paperwork showing low income.
- Improved customer service. Medicaid agencies and ACA marketplaces need better resources to run effective websites, call centers, and social services offices. In states that refuse to expand Medicaid to cover poor adults, ACA coverage should be immediately available.
- ACA coverage to be immediate available to Americans in states that refuse to expand Medicaid to cover poor adults.
- Health care to be linguistically accessible and culturally attuned, supported by investments to develop a workforce that can achieve those important goals.