The GOP is heading into the midterms as the party that made health coverage out of reach for millions of Americans.
U.S. President Donald Trump speaks during a health care affordability event where he announced a deal with pharmaceutical company Regeneron to lower drug prices, in the Oval Office of the White House in Washington, D.C.
, on April 23, 2026. Did you know that Truthout is a nonprofit and independently funded by readers like you? If you value what we do, please support our work with, 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 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.making it easier for younger, healthier, patients to buy junk insurance 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 thatnow 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 Congressduring 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.
— 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..
“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. over the next couple of years, those on ACA-backed insurance plans would likely decline from 24 million to 19 millionCalifornia 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— 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.
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