Massive Health Insurance Upheaval Leaves New Yorkers With Big New Bills

NEW YORK — Nearly half a million New Yorkers recently booted from a federally funded health insurance program are confronting an expensive and confusing marketplace as they search for new coverage.

New York’s Essential Plan caters to low-income residents who earn slightly too much to qualify for Medicaid and do not get health insurance through their jobs. But a July 1 policy change nixed eligibility for people earning over 200 percent of the federal poverty line — roughly $31,920 annually for individuals, or $66,000 for a four-person household.

The upheaval left about 450,000 former Essential Plan enrollees scrambling to find a new plan they can afford. Roughly half of them have enrolled in other kinds of insurance, according to preliminary state data shared this week with POLITICO. But those plans are bringing big new bills.

Ulster County resident Lee Bonvissuto, who was previously on the Essential Plan, signed up for a silver-level insurance plan — designed to cover 70 percent of an enrollee’s health care costs — from the state’s Affordable Care Act marketplace and now has to shoulder about $800 in monthly premium payments.

“It’s exorbitantly expensive,” Bonvissuto, a self-employed public speaking coach, said in an interview. “It feels like we have no choices.”

As states brace for as many as 10 million Americans to lose their health insurance under President Donald Trump’s 2025 tax-and-spending law, New York offers a preview of the upheaval expected to ripple through the U.S. next year when the biggest changes go into effect.

The 2025 megalaw, dubbed the One Big Beautiful Bill Act, slashed federal health care spending by more than $1 trillion, including a multibillion-dollar cut to New York’s Essential Plan. Democratic Gov. Kathy Hochul addressed the program’s suddenly looming insolvency by restricting eligibility to New Yorkers earning less than 200 percent of the federal poverty line, down from the prior 250-percent cutoff.

Hochul pins the blame for the coverage losses on the Trump administration and congressional Republicans. Yet she rejected a proposal this year from Democratic state lawmakers to fund a slightly less generous version of the Essential Plan for people losing eligibility, saying it would cost the state too much money.

The complicated picture has bewildered New Yorkers who discovered their Essential Plan coverage was ending from a notice in the mail.

“Consumers are confused and upset,” said Elisabeth Benjamin, vice president of health initiatives at the Community Service Society of New York, a nonprofit that helps people navigate the state’s insurance marketplace. “I don’t think people are understanding that this is because of Donald Trump signing the One Big Beautiful Bill a year ago. They’re thinking that the state has abandoned them.”

Some New Yorkers were eligible to stay on the Essential Plan or automatically qualified for Medicaid because their income went down, according to the state Department of Health. But the preliminary state data indicate roughly 225,000 people are newly uninsured.

That may change, since New Yorkers who lost Essential Plan coverage have until Aug. 30 to transition to other plans during a special enrollment period through the NY State of Health marketplace. Even state health officials, however, acknowledge the shift is a “significant change.” Marketplace plans typically come with hefty monthly premiums and cost-sharing requirements, while the Essential Plan is premium-free with very low cost-sharing and no deductible.

“This is a challenging time for those impacted by the new laws,” Department of Health spokesperson Danielle DeSouza said in a statement. “We are committed to providing personalized guidance to these New Yorkers as they transition to new plan options through our enrollment assistors, ensuring advance notices and providing resources and information to make the path to new coverage as clear and as smooth as possible.”

Benjamin said the transition has been bumpy, noting some New Yorkers are having issues switching to new plans.

One of them is Bonvissuto, who purchased a marketplace plan from Fidelis Care ahead of the July 1 transition yet has received multiple erroneous disenrollment notices from the insurer. Bonvissuto qualifies for financial assistance, too, but a NY State of Health notice reviewed by POLITICO says those tax credits do not kick in until Aug. 1 — making it unclear exactly how much the Fidelis plan will end up costing.

“I’m just so burnt out on calling them,” Bonvissuto said. “I can’t really deal with it right now emotionally.”

Fidelis Care handled Essential Plan coverage for about 123,000 New Yorkers who are newly ineligible for the program — more than any other insurance company, according to state enrollment data from May.

Fidelis spokesperson Dan Smith said the company cannot comment on a specific member’s situation due to privacy reasons but noted the Essential Plan change has been a “significant transition for many New Yorkers.”

“Throughout this process, Fidelis Care’s focus has been helping affected members understand their options, stay covered, and continue to access the care on which they rely,” Smith said in a statement. “While significant progress has been made, this work is ongoing. Fidelis Care will continue to support members who have yet to take action during the Special Enrollment Period to help transition them to other available coverage options.”