In recent years, more and more Utahns have been able to access health insurance, but following the passage of President Donald Trump\u2019s mega-budget bill, industry experts say changes to the Affordable Care Act could result in skyrocketing insurance costs and mass coverage losses.<\/p>\n
The rate of Utahns without health insurance dropped dramatically between 2014 and 2022, from 14.3% of people under the age of 64 to just 8.8%, according to the state\u2019s Department of Workforce Services<\/a>. That drop, the department wrote last October, came with the advent of the Affordable Care Act, implemented under former President Barack Obama in 2014.<\/p>\n The shrinking uninsured rate reflects a trend that Matthew Rae, the associate director of the health care marketplace program at the health policy organization KFF, has been watching for some time.<\/p>\n \u201cAs long as I\u2019ve been alive, we\u2019ve been expanding health insurance to cover a higher percentage of the population,\u201d Rae said during a recent interview, noting the particular impact of the ACA. \u201cThe vast majority of people now are eligible for health coverage or have health coverage.\u201d<\/p>\n But in the coming months, Utahns who have been able to access health care through the Affordable Care Act may be forced to look elsewhere for coverage \u2014 if they can find it at all. <\/p>\n On the Fourth of July, Trump signed the \u201cBig Beautiful Bill\u201d into law<\/a>, a budget package that makes current tax rates permanent, increases funding for border security and, among other things, implements major changes to Medicaid and Affordable Care Act programs that the nonpartisan Congressional Budget Office estimates could put the health coverage of more than 10 million Americans at risk.<\/p>\n Every member of Utah\u2019s all-Republican congressional delegation voted for the megabill<\/a>. <\/p>\n The changes under the new law \u2014 particularly the expiration of enhanced premium tax credits at the end of this year \u2014 <\/b>could have dramatic consequences for thousands of Utahns who rely on ACA coverage, potentially significantly increasing premium costs, making it more difficult to renew coverage and putting a particular burden on members of Utah\u2019s immigrant and small business communities.<\/p>\n (Tierney L. Cross | The New York Times) President Donald Trump signs his signature policy bill legislation during a Fourth of July celebration event outside the White House in Washington, on Friday, July 4, 2025.<\/p>\n In Utah alone, the changes could mean nearly 200,000 people risk losing access to insurance, according to a KFF assessment<\/a> from early June of the House version of the bill. (The organization has not yet released an updated assessment since the passage of the bill, but the final changes to the ACA in the legislation were nearly identical to the House bill.) <\/p>\n Those projected losses include an estimated 52,000 Medicaid recipients<\/a> in Utah losing access to the program and another 130,000 people in the state losing access to care under the ACA.<\/p>\n Already, Rae said, many Americans \u2014 even some with health insurance \u2014 say they find health care prohibitively expensive. <\/p>\n \u201cThey skip doctors\u2019 visits and they don\u2019t get prescriptions, and they don\u2019t get all the care we want them to be getting, which is preventive care that makes you live a longer and happier life,\u201d he said. \u201cYour prevalence in not doing all those things goes up astronomically when you don\u2019t have health insurance.\u201d<\/p>\n Tax credits set to expire<\/p>\n Among the most significant changes to the ACA under the new law is what it did not include: a renewal of enhanced premium tax credits that help millions of Americans afford marketplace coverage.<\/p>\n When the ACA first became law, Congress set up premium tax credits for people making between 100% and 400% of the federal poverty level, and in 2021, in an effort to address the effects of the COVID-19 pandemic, lawmakers introduced enhanced credits that increased the value of the credits and expanded eligibility beyond 400% of the poverty level.<\/p>\n The expansion of the credits meant that enrollment in marketplace health coverage more than doubled<\/a>, from 11.4 million people in 2020 to 24.3 million in 2025. Without them, enrollees could see an average 75% increase in premium costs, according to a joint report<\/a> issued last month by KFF and the Peterson Center on Health Care. <\/p>\n Fernando Wilson, the director of the Matheson Center for Health Care Studies at the University of Utah, said in an interview that the credits are \u201csomething that Congress may or may not revisit later, separately,\u201d though most people expected that if Congress were to renew the credits, they would do so during the budget reconciliation process. <\/p>\n