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3.8 million people could lose health coverage next year.
And it has nothing to do with Medicaid.
The enhanced premium tax credits introduced under the Inflation Reduction Act have been one of the most impactful, least-talked-about coverage expansions in recent memory. They reduced marketplace premiums by an average of $800 per enrollee per year. They helped push ACA marketplace enrollment to record highs, surpassing 21 million people in 2026.
Those credits expire at the end of 2025.
The House reconciliation bill, passed on May 22, 2026, does not extend them.
The Congressional Budget Office has estimated that without renewal, roughly 3.8 million Americans will drop their marketplace plans, simply because the premiums become unaffordable. For many of these individuals, Medicaid is not an option, and employer coverage does not exist. The gap between what they can pay and what coverage costs becomes a wall.
Here is what that means in practice.
FQHCs will absorb the surge. Community health centers serve patients regardless of insurance status, but uncompensated care volume has real limits. When coverage disappears, patients delay care. When they finally show up, conditions are more advanced, more expensive, and harder to treat.
Hospitals feel it in their uncompensated care numbers. Safety-net providers especially, who are already navigating DSH payment pressure, will face an additional financial squeeze from uninsured volume returning to emergency departments.
Cancer screening rates will fall. Preventive care, which depends heavily on coverage, gets skipped when people lose insurance. The downstream effect on early detection, particularly for colorectal, cervical, and lung cancers, is not theoretical. It is documented from the pre-ACA era.
The Senate still has to act. There is a window. But healthcare leaders should not wait for a political resolution before planning operationally.
If you run an FQHC, an imaging center, or a hospital serving lower-income populations, the question is not whether this will affect your patients. It is how much, and how fast.
Are you modeling what a 3.8 million coverage loss scenario looks like for your patient panel?
Because that planning conversation needs to start now, not after open enrollment closes.
♻️ Repost if millions losing affordable coverage is not a policy footnote, it is a public health emergency.
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Author:
Jonathan Govette is a seasoned healthcare and technology executive with more than two decades of experience building, scaling, and advising digital health companies. He is the Co-Founder and CEO of Oatmeal Health, an AI-driven Lung Cancer Screening and Diagnostics company focused on expanding access to early detection for underrepresented populations, particularly patients served by Federally Qualified Health Centers and value-based health plans.
With a background in engineering, product development, and strategic partnerships, Jonathan has founded and led multiple health technology ventures across clinical care delivery, regulated medical software, and AI-enabled diagnostics. His work sits at the intersection of medicine, technology, and health equity, with a consistent focus on translating complex clinical problems into scalable, real-world solutions.
Jonathan has spent much of his professional life dedicated to improving outcomes for marginalized and underserved communities. He has designed and implemented frameworks that align clinical quality, reimbursement, and technology to sustainably advance health equity at scale. This mission is deeply personal and informs his leadership philosophy and long-term vision for healthcare transformation.
In addition to his operating experience, Jonathan is an author and long-time writer in the healthcare domain, with over 20 years of published work covering digital health, medical innovation, and healthcare systems. He is a frequent mentor to early-stage founders and regularly advises startups on product strategy, partnerships, and go-to-market execution in regulated healthcare environments.
Before entering industry full-time, Jonathan nearly pursued a career in medicine with an early path toward cardiothoracic surgery, an experience that continues to shape his clinical perspective and respect for frontline care delivery.
CEO | Oatmeal Health | AI Lung Cancer Startup | Engineer | Writer | Almost Became a Doctor (Cardiac Thoracic Surgeon) | 3x Health Tech Founder | Startup Mentor | Follow to share what I’ve learned along the way.
