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Republicans Blocked Healthcare Subsidies—and Now More Americans Are Going Uninsured

The Trump administration has chalked up the drop in insurance coverage to a crackdown on fraud. Data shows that rising costs is the real reason.

Representative Hakeem Jeffries (D-NY) speaks during a December 2025 press conference on the steps of the Capitol where Democratic lawmakers called for extending expiring Affordable Care Act subsidies.

ReShonda Young, a 51-year-old owner of a health and nutrition supplement store in Waterloo, Iowa, has been self-employed for over a decade. Out of the last ten years, she had employer-based insurance for just one—through her late husband, who passed away three years ago. Every other year, she’s turned to the Affordable Care Act to get health coverage. “I’m really dependent on the marketplace,” she said.

Two years ago, she enrolled in a “gold” plan, the top tier on the ACA marketplace. It was affordable for her—it cost $94 a month with a $1,500 deductible and out-of-pocket maximum of about $5,000—and offered a great network of doctors. “It was just a really solid plan. I was super happy with it,” she said. Then she got a letter last year saying that her premium for her plan would be increasing to $592 a month—a 530 percent increase. “I’m like, ‘Yeah I cannot do that,’” she said.

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In 2021, Congress expanded premium tax credits that reduced costs for over 20 million people who, like Young, obtained their health insurance on ACA marketplaces but didn’t previously qualify for the assistance. The subsidies helped more than double enrollment while they were in effect and helped bring the share of Americans covered by health insurance to record highs. But the expansion was set to expire at the end of 2025.

Bipartisan majorities in both the House and Senate supported extending the subsidies, and during debate over HR1, the Republican mega-bill focused on taxes and healthcare, members of Congress proposed amendments to extend them. “HR1 was the obvious vehicle to do that,” Anthony Wright, executive director of the healthcare advocacy organization Families USA, told me. But “the Republican leadership blocked them.” House Democratic leader Hakeem Jeffries successfully brought forward a discharge petition to force a bill extending the tax credits onto the House floor, only to have the measure fail in the Senate.

After Republicans failed to act and the subsidies evaporated this year, premiums have skyrocketed, forcing many Americans to downgrade their coverage. The share of people selecting bronze plans—the lowest tier, with smaller provider networks and the highest out-of-pocket costs—grew substantially, from 30 percent of marketplace enrollees to 40 percent. “People have responded by transitioning to lower-premium plans to try to save money and at least get some kind of coverage, but it’s often difficult for them to get the care that they need when they need it,” said Claire Heyison, health insurance and marketplace senior policy analyst at the Center on Budget and Policy Priorities.  

Meanwhile, the share of people who dropped their coverage altogether has shot up. Nearly 3 million fewer people enrolled in and paid........

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