Shifts in biodiversity and ecological processes in stream ecosystems in response to rapid climate change will depend on how numerically and functionally dominant aquatic insect species respond to changes in stream temperature and hydrology. Across 253 minimally perturbed streams in eight ecoregions in the western USA, we modeled the distribution of 88 individual insect taxa in relation to existing combinations of maximum summer temperature, mean annual streamflow, and their interaction. We used a heat map approach along with downscaled general circulation model (GCM) projections of warming and streamflow change to estimate site-specific extirpation likelihood for each taxon, allowing estimation of whole-community change in streams across these ecoregions. Conservative climate change projections indicate a 30–40% loss of taxa in warmer, drier ecoregions and 10–20% loss in cooler, wetter ecoregions where taxa are relatively buffered from projected warming and hydrologic change. Differential vulnerability of taxa with key functional foraging roles in processing basal resources suggests that climate change has the potential to modify stream trophic structure and function (e.g., alter rates of detrital decomposition and algal consumption), particularly in warmer and drier ecoregions. We show that streamflow change is equally as important as warming in projected risk to stream community composition and that the relative threat posed by these two fundamental drivers varies across ecoregions according to projected gradients of temperature and hydrologic change. Results also suggest that direct human modification of streams through actions such as water abstraction is likely to further exacerbate loss of taxa and ecosystem alteration, especially in drying climates. Management actions to mitigate climate change impacts on stream ecosystems or to proactively adapt to them will require regional calibration, due to geographic variation in insect sensitivity and in exposure to projected thermal warming and hydrologic change.