As of Wednesday, July 1, approximately 450,000 New Yorkers no longer have the subsidized health coverage they had the day before. Changes to New York’s Essential Plan under the federal HR1 spending bill (President Donald Trump’s “One Big Beautiful Bill”) officially took effect, ending low- to no-cost health insurance for hundreds of thousands of low-income residents, according to City & State.

The Essential Plan is a state-run, federally subsidized insurance program that provides low- or zero-premium coverage to New Yorkers who earn too much to qualify for Medicaid but too little to afford marketplace plans. New York managed to avoid a worse outcome: without a state waiver to return to a Basic Health Program structure (which unlocked billions in a federal trust fund) more than 1 million enrollees would have lost coverage, according to City & State. But that waiver came with a trade-off. The 450,000 people who gained coverage under an expansion of the Essential Plan two years ago, those earning between 200% and 250% of the federal poverty line, lost their insurance Wednesday.

The cuts disproportionately affect low-income residents and immigrant communities, City & State reports. New York is required by law to provide health insurance to certain immigrant populations, and those enrollees were prioritized under the waiver that preserved the broader program.