Medicaid, which is jointly funded by states and the federal government, has always operated under pressure, but this moment feels different. The program is facing a unique period of change, defined by factors that are significant on their own but far more consequential together. Centrally, the 2025 health care cuts to Medicaid and beyond, to the tune of $1 trillion over the next decade, will add nearly 10 million people to the uninsured ranks. These cuts will also trigger state budget holes and new funding gaps for the nation’s health care safety net.

The funding cuts are compounded by new administrative burdens for consumers because of new Medicaid work reporting requirements and other red-tape hoops people will need to jump through to get and keep coverage. Paperwork is a tried-and-true method for reducing enrollment, undermining decades of bipartisan efforts to streamline enrollment while ensuring program integrity through data-driven verification of eligibility. State Medicaid agencies will also feel the pinch as they operate with steep new administrative costs and fewer resources, and health providers who continue to serve low-income populations will be faced with patients churning in and out of coverage and a rise in uncompensated care.

The “old Medicaid rubric” doesn’t make sense anymore. It’s one that we’ve moved beyond for good reason through the Affordable Care Act expansion. The vast majority of Americans support and value their Medicaid coverage, including their expansion coverage, as vital to keeping their families safe, healthy and financially secure.