Trump Is Making America Uninsured Again

In 2025, the Trump administration successfully pushed Congress to enact nearly $1 trillion in health care cuts over the coming decade, which the Congressional Budget Office analysis estimated would result in 10 million people losing health coverage by 2034. More recently, it has blocked any and all efforts to extend the Affordable Care Act (ACA) tax credit subsidies for people buying insurance on the state exchanges. In demanding that the GOP leadership in Congress prevent at all costs a continuation of the expanded ACA tax credits, Donald Trump intimated that his administration was on the verge of proposing a better and more affordable health care reform to replace the ACA system.

Nothing of that nature has materialized. Instead, the administration’s health reforms have been shockingly small-bore — a handful of measures to lower the costs of prescription drugs, more incentives for consumers to create health savings accounts, a rollback of regulations on catastrophic coverage plans — thus, making it easier for younger, healthier, patients to buy junk insurance, but doing nothing for those who are older or suffer from chronic conditions.

Over the past months, even these baby steps have stalled out, with the GOP seemingly and inexplicably resigned to the fact that it will be heading into the midterm elections as the party that is putting health coverage out of reach for millions of Americans. Early in the Iran war, Trump was caught saying that the federal government could no longer afford its massive Medicare commitments now that the country was engaged in an expensive overseas conflict, and it would have to roll back responsibility for paying for this bedrock safety net program onto the states.

This represents a stunning reversal of government efforts to bring health care access to millions who had previously lacked it. In 2020, when Congress expanded tax credits during the pandemic for Americans accessing health insurance plans through the ACA, millions of Americans were finally able to access health insurance at reasonable rates through the state exchanges.

Expanding the tax credits patched a hole through which large numbers of Americans had fallen. Under the original provisions of the ACA, anyone at or under 138 percent of the federal poverty level would qualify for Medicaid; and anyone between 138 and 400 percent of the poverty level would be able to access tax credits on a sliding scale to help them cover the cost of health insurance. None of these recipients would be expected to pay more than 10 percent of their income on insurance.

Expanding tax credits did two things: It ended what advocates had taken to calling the “affordability or eligibility cliff” — a situation in which, if your income went even one dollar over the 400 percent of the poverty line limit, you suddenly lost all tax credits and your insurance costs soared virtually overnight. It also lowered the maximum payment for credit recipients from 10 percent of their income to 8 percent if they bought a so-called “silver plan” with relatively low deductibles.

Taken together, these new terms were enough to bring millions of families under the health insurance umbrella, and it allowed millions of additional families, who previously had to opt for catastrophic insurance with huge deductibles, to access the silver plans.

“It’s an advanceable, refundable tax credit,” Anthony Wright, executive director of the health advocacy organization Families USA, explained to Truthout. “And it was tied to the point of sale.” In other words, people buying health insurance wouldn’t have to fork out thousands of dollars and then wait for a tax refund. Instead, the calculated refund would be applied to the cost of insurance from the beginning.

Congress initially passed these credits in 2021 and then, under the Inflation Reduction Act, extended the credits for another three years in 2022. Last year, despite a congressional majority in support of extending the credits, GOP leadership, at Donald Trump’s urging, stood firm against marshalling the votes needed to ensure their continuation. The affordability cliff was suddenly resurrected. As a result, from January of this year, millions of people renewing their insurance policies suddenly found themselves facing far higher bills. According to Wright, for a young person just above the Medicaid cut-off, that meant finding an extra $50 or $100 a month, itself an oftentimes insuperable obstacle for someone scrabbling just to cover their basic bills. For many older persons at the higher income side of the subsidy spectrum, it in many cases meant monthly insurance bills rising by more than $1,000, according to Wright. For some families, he says, it rose by upwards of $2,000, the equivalent of adding a second mortgage payment to families’ monthly bills.

“Congress made deliberate decisions to have premiums spike, to have more people uninsured or underinsured,” Wright argued. “People who are older, they are the ones who got socked in a big way.”

Predictably, following Congress’s failure to renew the expanded tax credits, in the first months of 2026 state exchanges calculated that up to 2 million people dropped coverage, and millions more shifted to lower cost plans with far higher deductibles, some in the $10,000 a year range. “So it really is a different product; they’re paying more and getting less,” explained Wright.

More recently, as additional insurance plans come up for renewal, and as more and more people fall months behind on their premium payments and, in consequence, get dropped by insurers, the numbers predicted to end up uninsured have soared. The New York Times published data showing that over the next couple of years, those on ACA-backed insurance plans would likely decline from 24 million to 19 million, a drop of more than 20 percent. In some states, such as Georgia, the exchanges are already reporting falloffs far in excess of 35 percent.

California has stepped in to at least partially replace the lost federal tax credits for hundreds of thousands of lower-income ACA customers who use the Covered California marketplace. But even there, according to Jessica Altman, executive director of Covered California, as of March 2026, there were 135,000 fewer marketplace users than a year earlier. That represents a 7 percent drop in coverage, and Altman believes the numbers will only grow over the coming months. She said there are “farmers, gig workers, small businessmen who need the marketplace because they don’t have access to employment-based coverage,” and yet these are precisely the individuals now being hit by the rollback of subsidies: people too affluent to qualify for California’s partial subsidies, but income-insecure enough to be pushed into financial hardship by increases in premiums. “This middle-income group is the only part of the health care system where we are asking the consumer to pay the full price,” Altman argued.

Add up the cuts to Medicaid, the cuts to federal ACA tax credits, and the escalating rhetoric about further paring back Medicare — despite growing popular support for Medicare for All — and “collectively we are looking at millions of people going uninsured across the country as a result of federal policy. It has ripple effects through the economy and for health care providers,” said Altman. More people, she fears, will skip vaccines, go without preventative care, including cancer screening, forgo wellness checks. Eventually, as was the case before the ACA expanded health care access, those people will present at hospital emergency rooms with untreated diseases that, had they had access to regular doctors’ visits, would have been managed far earlier.

“Our system,” said Altman, “will bear the cost of less healthy people.”