The state covers most of its people. Its Latino families are the exception.

Maryland built one of the strongest coverage systems in the region, including its own state premium subsidy. It worked well enough to keep marketplace enrollment growing in 2026 even as national enrollment fell. And yet Maryland's Latino residents carry a 24.3% uninsured rate, the highest of any group in the DMV. The system that protects most Marylanders is not reaching Latino families at the same rate.

That gap did not appear this year, but it is widening this year. The enhanced Affordable Care Act premium tax credits expired on January 1, 2026, and were not restored. Nationally, roughly 4 million people dropped marketplace coverage in 2026 alone. The One Big Beautiful Bill Act layered $911 billion in Medicaid cuts on top. These changes hit everyone, but they land hardest on Latino households, who are more likely to depend on the marketplace, more likely to be self-employed or work in small businesses, and less likely to have employer coverage to fall back on.

The result is a Latino coverage gap in Maryland that is structural, not incidental, and now under fresh pressure. The frictions that make coverage loss more dangerous, higher diabetes prevalence, language barriers, immigration-status fear, all concentrate in the same households.

The part that matters most for anyone trying to respond: this gap is closable, and the evidence on how is clear. When outreach and enrollment assistance were cut nationally, coverage fell most among Hispanic and Spanish-speaking families. When culturally specific, Spanish-language communication is done well, enrollment rises sharply. Communication is not a cost of closing the gap. It is the mechanism.

Start with the people, not the policy. Maryland is home to roughly 730,000 Latino residents, 11.8% of the state, concentrated in Prince George's and Montgomery counties and growing across the Baltimore suburbs. Nearly one in four of them lacks health coverage.

A 24.3% uninsured rate is not a rounding error against the state's overall performance. Maryland covers the large majority of its residents. The people it is not reaching are disproportionately Latino, and within that population disproportionately immigrant, Spanish-dominant, and working in jobs that do not offer insurance. The gap is a specific population, not a statistical abstraction.

This matters before any discussion of federal policy, because it frames what follows. The 2026 changes did not create Maryland's Latino coverage gap. They are widening a gap that was already the widest in the region. Understanding why it was already there, and why it is now growing, is the rest of this report.

• Self-employed and small-business workers who do not qualify for employer coverage or Medicaid.
• Mixed-status households where some members are eligible and some are not.
• Spanish-dominant families for whom the enrollment system is difficult to navigate in English.
• Families managing a chronic condition, diabetes above all, for whom a coverage gap is a health emergency.

The Maryland gap sits inside a national shock. The enhanced ACA premium tax credits, first enacted under the American Rescue Plan and extended through the Inflation Reduction Act, expired on December 31, 2025. The House passed a three-year extension in January 2026, but the Senate never reached the votes to advance it. The credits lapsed and have not been restored.

The effect is no longer a projection. Federal effectuated-enrollment data released in June 2026 shows national marketplace enrollment fell from 23.1 million in January to 19.2 million by mid-year, roughly 4 million people in 2026 alone. For subsidized enrollees who stayed in the same plan, premium payments have roughly doubled. On top of the subsidy cliff, the One Big Beautiful Bill Act, signed in July 2025, includes an estimated $911 billion in Medicaid cuts phasing in through 2027, projected to push 14 million Americans off coverage by 2034.

These are national numbers, but they explain the Maryland gap. Latinos are 21% of the nonelderly U.S. population and 39% of the uninsured, nearly double their share. Their coverage grew faster than any group's during the enhanced-subsidy years, more than doubling to 3.4 million marketplace enrollees by 2023, which means they also have the most to lose now that the subsidies are gone. The national Latino uninsured rate is projected to climb from 24% toward 28%. Within the Latino population, Central Americans carry the highest uninsured rate of any subgroup at 28.5%, a group well represented in Maryland's suburbs.

Coverage that was gained because of price support is the first to disappear when the price support is withdrawn, regardless of continued need. That is the mechanism turning a national policy change into a Maryland Latino problem.

Maryland is a useful case because it did more than most states, and the results show both what state action can do and what it cannot reach. Maryland created its own state-based premium subsidy program, and it worked: while national enrollment fell, Maryland's marketplace enrollment grew about 3% during open enrollment.

The number of Marylanders receiving state subsidies rose from 65,000 to 177,000 as the program expanded. That is the state safety net absorbing part of the federal withdrawal. It is also why Maryland's overall enrollment held up in early 2026 while Virginia's fell, before Virginia's own new state subsidy takes effect this November.

And yet the Latino uninsured rate remains 24.3%, the highest in the DMV. This is the central lesson of the Maryland case: a well-designed state subsidy can blunt the coverage gap, but it cannot close it on its own. Subsidies lower the price. They do not, by themselves, reach the Spanish-dominant, immigrant, and mixed-status households that are hardest to enroll and most likely to disenroll. Price is one barrier. Information, trust, and language are the others, and Maryland's experience shows they are not solved by funding alone.

• State subsidies work: they kept enrollment growing when the federal credits expired.
• State subsidies are not enough: the highest-uninsured group in the DMV is still in Maryland.
• The remaining gap is a communication and access gap, not only a price gap.

Coverage loss is more dangerous for Maryland's Latino families than the topline rate suggests, because four structural frictions compound it. Each one turns a coverage gap into a health outcome.

This is the part that turns a problem into something you can act on. The research is unusually clear: for Latino and Spanish-speaking families, how coverage is communicated is one of the strongest predictors of whether they stay covered. It is not a supporting detail. It is the lever.

Read that in reverse. The communication and enrollment support that was cut had been holding coverage in place for Latino and Spanish-speaking families. Remove it, and they are the first to fall out. Provide it, and they stay in. This is the clearest available evidence that communication is causal, not cosmetic.

One finding runs through all of it: translation is not enough. What works is culturally specific communication, in trusted settings, that explains what changed and corrects misinformation in the language families actually speak, then points people toward where to enroll and get help. El Tiempo Latino does not run the enrollment desk. It is the trusted layer in front of it, and the next section is what that looks like in Maryland.

The gap is closable, the evidence says communication closes it, and the communication that works is culturally specific and Spanish-first. El Tiempo Latino does not run the enrollment desk. What we do is the layer in front of it: explaining what changed in articles and video, holding attention in Spanish, and pointing families toward where to enroll and get help, at the moments they are deciding. For health plans, hospitals and clinics, and public agencies, that is where the problem becomes a plan, each for a different reason: plans protect membership through open enrollment and redetermination, providers reduce the uncompensated care that follows coverage loss, and agencies keep eligible residents connected to benefits.

Across social (+38K followers, 6.91% engagement vs. a 2.18% market average), the website (+65K monthly views), the daily newsletter, and a print edition whose readers are 76% "very interested in health issues." Native, in-language content outperforms standard display ads by 37%. Source: El Tiempo Latino 2025 Media Kit.

Programs combine explainer articles and video, Spanish-language social distribution, newsletter placement, and print, and they are priced by reach. As a benchmark, a month-long campaign putting a Spanish-language message in front of a large share of our reachable DMV Latino audience runs in the low-to-mid five figures; a smaller, targeted program starts around $9,000 for roughly 400,000 impressions. We report reach, impressions, clicks, and trackable actions such as co-branded landing-page visits and event RSVPs within seven days.

On compliance: we work with regulated health plans and public agencies. Creative and claims run through your compliance and legal review, and we follow CMS and carrier marketing guidelines. We stay on the awareness-and-education side and direct audiences to your official enrollment channels.

This report synthesizes publicly available data from federal, state, nonprofit, and peer-reviewed research sources, current as of July 2026. Where Maryland-specific or Latino-specific figures were not directly published, the closest available proxy or national rate is used and labeled accordingly.

All figures reflect the most recently available data as of July 2026 and are subject to revision. The navigator natural-experiment figures describe national effects by demographic group and are applied to Maryland as directional evidence, not as Maryland-specific measurements. Audience and campaign figures are from the El Tiempo Latino 2025 Media Kit and past Tiempo Company campaign reporting; they are indicative of reach, not a guarantee of future results.