Federal cuts to Medicare, Medicaid and ACA subsidies could reshape access to healthcare in 2026, raising premiums by over 70% and pushing millions especially seniors, low-income families and immigrants toward a system with fewer benefits and greater inequity.
The U.S. healthcare system could undergo a dramatic shift next year. Continuous cuts to social health programs like Medi-Cal are clear signs of an imminent breaking point that is already alarming a large sector of the population.
American Community Media (ACoM) hosted a conference to discuss what social healthcare may look like in 2026. Experts examined budget reforms, changes to Medicare and Medicaid, and the consequences of rolling back essential subsidies and benefits for millions of people. The outlook warns of rising costs, reduced access, and political uncertainty as a decisive force shaping the system.
Massive Cuts, Higher Premiums, and Subsidies at Risk
Tomas Bednar, Senior Vice President & Counsel at Healthsperien LLC, did not hesitate: “Costs are going up, access is going down, and the likelihood of large-scale gridlock is increasing.”
Eliminating ACA marketplace premium tax credits would be devastating. Without financial support, people insured through the individual market could see their monthly premiums increase by more than 70%. Today, around 22 million Americans rely on this system.
Bednar stressed that removing these credits means costs “have to rise no matter what,” since base insurance prices don’t drop—only the subsidy disappears. The blow would be immediate for low-income consumers.
The fiscal outlook offers no relief. Analysts project $45 billion in Medicare budget cuts in 2026, accumulating nearly $536 billion over the next decade. Added to that are “One Beautiful Day” measures, which would slash $900 billion from Medicaid funding over 10 years and impose new work requirements that many beneficiaries will not be able to meet.
Public Charge Returns to the Table
One of the most contentious points was the return of the public charge rule reinstated under the Trump administration. The change would once again allow the government to consider Medicaid use in green card applications. Bednar called it “a ping-pong match” in which policy swings back and forth depending on who controls the White House.
While he noted that protected categories still exist, Bednar expressed concern about the current climate: “Access hasn’t changed much, but the stance and pressure of this administration have.” The likely outcome, he warned, is more fear, fewer medical visits, and immigrant communities with growing healthcare needs but less willingness to seek coverage.
HR1 and Its Impact on Social Healthcare
Amber Chris, attorney at Justice & Aging, was clear: the tax overhaul (HR1) reallocates federal resources by sacrificing social programs to finance tax cuts for high-income earners. “Those with the least could see their resources reduced by up to 3%, while the wealthiest may gain more than $13,000 a year in tax benefits,” she warned. “The impact is not only economic it’s human.”
Most cuts land directly on social health programs. Medicaid, SNAP, and Earned Income Tax Credits would be hit hardest. HR1 also reverses coverage for legally present immigrants (refugees, asylees, Temporary Protected Status holders) who have contributed to Medicare for years. “They will lose insurance they already pay for through taxes. There is no historical precedent for this,” Chris noted.
The measure disproportionately threatens adults aged 65+. Seventy-five percent earn less than $50,000 a year, a population already struggling with gaps in medical and dental care. “Medicare doesn’t cover essential services like dental or vision Medicaid fills that gap. If you cut Medicaid, you cut people’s daily lives,” she stressed.
The long-term picture looks even worse: HR1 outlines massive reductions continuing through 2027 and 2028. States are already preparing for budget tightening. “You can’t cut billions from the system without triggering a domino effect. We will see more hospitalizations, more emergencies, and more preventable deaths,” Chris warned. If the policy stands, the future points toward a sicker, more indebted, and more unequal country.
In a scenario where Democrats regain control of Congress, some provisions of HR1 could be reversed. However, Chris cautioned that “the damage is already underway,” and states are already feeling the financial void the cuts will leave behind. Any future correction may soften the harm but not undo it.