President Trump sent shockwaves throughout the country on July 3 when he signed into law his “Big, Beautiful Bill.” The bill has a number of implications and will radically change the way funding is allocated in this country — with billions more for national defense and Immigrations Customs Enforcement, and severe cuts to Medicaid and SNAP. 

Per an estimation from the Congressional Budget Office, due to these reductions in federal funding for Medicaid and Affordable Care Act marketplaces, an estimated additional 12 million people will be uninsured by 2034. We know much of our freelance community and those without access to traditional employer-sponsored healthcare rely on Medicaid and the open marketplace — and that your access to healthcare may be if not taken away completely, then the financial and logistical barriers increasingly difficult to clear. These are the biggest things for freelancers to know.

What will happen to Medicaid?

One reason why millions of Americans stand to lose their access to Medicaid is due to new employment requirements. Beginning January 2027,  “able-bodied” Medicaid enrollees under the age of 65 will have to file paperwork documenting they’re working, volunteering, or attending school for at least 80 hours per month, with some exceptions granted for those caring for a young child. (This rule does not apply to states where Medicaid has expanded to include non-disabled enrollees.)

Work requirements like these have previously been tested and often led to enrollees being kicked off Medicaid due to paperwork backlog and logistical issues, which is cause for alarm amongst a bigger population. States will be required to perform eligibility checks, adding more red tape and possibilities for patients to be kicked off plans because of case backlog. And for those who remain on Medicaid, out-of-pocket costs are currently projected to rise.

What does this mean for the Affordable Care Act?

There are three major changes to know about how this will impact healthcare purchased via the Affordable Care Act:

• The annual Open Enrollment period, typically lasting from November 1 to January 15 (though longer in certain states), will be shortened to December 15. Additionally, opportunities for Special Enrollment Periods — the ability to enroll for people with incomes up to 150% above the poverty line — will be limited.
• Policyholders will be forced to re-enroll each year, updating their income, immigration status, and other eligibility requirements.
• The biggest change of all will be whether or not Affordable Care Act subsidies that are set to expire at the end of the year will actually expire — the subsidies and tax credits that help pay for out of pocket costs and keep the Affordable Care Act actually affordable.

“It’s deeply concerning to see these subsidies at risk—especially now, when so many freelancers and independent workers are already under financial strain,” said Thomas Morrissey, Founder of Solo Health Collective. “For millions, these subsidies are the only thing making healthcare affordable. Losing them could mean losing access to care. But I want people to know: There will still be options. Even outside the exchanges, alternative models are emerging to serve independent workers who deserve dependable, affordable coverage.”

Whether or not you are on Medicaid or enrolled through ACA, here is how these changes could affect you:

Medicaid is inextricable from our country’s healthcare system. Hospitals, particularly in rural areas, rely on Medicaid payments to help subsidize their costs. With lower levels of Medicaid funding, hospitals in rural areas are at risk of closure — which is extremely dangerous for these populations, no matter who your healthcare provider is. Although Republicans have included a $25 billion fund to attempt to offset these cuts, per Sarah Jane Tribble, chief rural correspondent at KFF Health News, it is only 43% of what these hospitals would need to up for in funding. Similarly, the bill eliminates Medicaid funding towards Planned Parenthood and matching federal funds for gender affirming care for enrollees under 18, which could make this vital care even more inaccessible.

Still, there is action that can be taken

Although there is a lot to be concerned about in this bill, there is still a possibility that the Affordable Care Act subsidies will not be allowed to expire, given that the language around them has been explicitly left out of the bill. 

“We’re continuing to monitor the situation closely and are reminding elected officials at every level that the freelance worker population makes up a large percentage of their constituents. They have a duty to represent and serve them, and to act in their best interest,” said Rafael Espinal, Executive Director of the Freelancers Union.

You can still urge your representatives to renew the Affordable Care Act subsidies. This won’t undo all the damage the “Big, Beautiful Bill” may cause, but can help curtail some of its worst effects. We also encourage you to contact your representatives in your state legislature and ask them to strengthen the Affordable Care Act marketplace at the state level.