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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........

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