The time for debate on whether the ACA is “Socialist” or the work of “Obama the Devil” or whatever else (blah blah blah) has passed.
Even though, to this day, Republicans vilify “Obamacare,” they never have adequately articulated what their objections are beyond it being “Socialist.” It seems like their real objection to the ACA is that Obama’s name is attached to it, which I think we can all agree is an incredibly juvenile response. And, not for nothing, but for those worried that our health care system is getting more “Socialist,” that ship sailed long ago. By their definition, we already have “Socialist” systems called Medicare, Medicaid, and the Veterans’ Administration.
The strangest thing about the Republicans sticking with the ACA is some sort of Socialist government takeover of the health care system narrative is that it’s just not true. In fact, in its purest form, the ACA draws on market-based ideas – like competition through the exchanges, which is a conservative theory, right? < that said, we have a way to go to make it truly competition-based, which we’ll work hard to do >
Besides – let’s get real – whether you like the ACA or not, we don’t really have a choice because neither major political party can seem to devise a viable alternative. We’ve already gone over the fact that the plans being pushed by progressive Democrats are just too expensive and unrealistic, and it’s obvious that the Republicans have NO IDEA how to solve our health care crisis (and, no, simply trying to destroy the ACA IS NOT a solution).
In the 2014 midterm elections, the Republicans took control of the U.S. House and Senate with the largest Republican majority since 1929. This means that for the final two years of Obama’s presidency, Republicans had a solid platform to outline their solutions for the nation’s health care challenges, and after Donald Trump’s election to the presidency the first time, their power became absolute.
Throughout the first Trump administration, the Republicans’ petty and insufficient sabotage efforts to destroy the ACA made our long-term crisis so much worse. Even with a vast amount of time and influence available to them, they were unable to craft an intelligent health care agenda. They clearly had no idea what to do, so to substitute for substance and compensate for incompetence, they reduced complex issues to inflammatory dogma and dirty little tricks.
They essentially tried to dismantle the ACA piece by piece with nothing to put in its place – basically the “repeal” without the “replace” that Donald Trump promised on the campaign trail.
The Republican efforts included canceling the all-important individual mandate; blocking reimbursements to insurers who sold ACA health plans; establishing new rules that allowed states to opt-out of the ACA’s most important provisions; cutting the open enrollment period in half; limiting the operating hours of HealthCare.gov; slashing funding for “navigators” (or, individuals or organization that were trained to help consumers, small businesses, and their employees look for health coverage and complete eligibility/enrollment forms); and killing an outreach program that helped people sign up for health insurance.
Eight years later, Republicans doubled down on their attempted detonation of the ACA with their One Big Beautiful Bill, stripping away health coverage from millions of Americans and significantly raising health care costs for millions more. They also changed who is eligible to receive Medicaid and Medicare benefits and who has access to Affordable Care Act plans, plus shifted most of the responsibility and costs to the states – a burden most states cannot even come close to shouldering.
In total, the One Big Beautiful Bill cuts $1.1 trillion from the ACA marketplaces and Medicaid. As a result, the Congressional Budget Office (CBO) estimates that around 15 million Americans will lose health coverage and become uninsured by 2034 (10 million will simply lose their health care and over five million more will lose coverage because the enhanced ACA tax credits won’t be extended).
The changes the Republicans have made are going to create huge challenges for many Americans but, by far, Medicaid got the biggest throttling in the bill – taking a hit of $911 billion over ten years.
We cannot overstate what massive chaos and hardship this is going to create. In fact, we have already had a tiny glimpse. Fifteen years ago, the ACA extended Medicaid eligibility to almost all people with incomes at or below 138 percent of the poverty line as the mechanism to cover low-income individuals. Since then, the U.S. Supreme Court ruled that states could individually decide whether they wanted to take advantage of this provision.
This decision by the highest Court created a huge coverage gap in many states because Medicaid expansion was the only assistance the ACA provided for people who had incomes above their state’s Medicaid eligibility threshold but below the poverty level (making them ineligible for marketplace subsidies). To this day, in the ten states that decided not to expand Medicaid – Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming – an estimated 1.4 million Americans remain in this coverage gap.
Now, the Republicans have made this far, FAR worse. Not only does the One Big Beautiful Bill make it harder to sign up and stay enrolled in Medicaid, with tedious new paperwork requirements, it also requires beneficiaries to prove they have worked at least 80 hours a month – and, just in case there is any confusion as to why, many Republican lawmakers made clear the reason is because, as House Speaker Mike Johnson (R-LA) said, many Americans “choose not to work when they can….that is called fraud; they are cheating the system.” (Good grief. It’s like they go out of their way to be as un-Jesus-like as humanly possible.)
Listen up, Mike, because here’s the deal: Most working-age adult enrollees in Medicaid do work. In 2023, around 31.2 million people ages 19 to 64 were enrolled in Medicaid. That number dropped to 26.1 million when you exclude the 2.4 million also covered by Medicare and the 2.7 million who also received disability benefits from Social Security. Among this 26.1 million people, 44 percent worked full time and 20 percent worked part time. For the most part, those who didn’t have a job were usually caregivers for family members; were in school; or had an illness or disability.
< Sidebar: U.S. Works – 1787’s jobs program – requires anyone who is capable of work, receives federal assistance, and is unemployed to register with an Empower Society to actively look for a job OR be engaged in the specialized education/training programs provided there for at least 20 hours every week. The clients will be paid the federal minimum hourly wage, and the first funds earned will go toward the total amount of money the participant receives in federal government assistance. Any remaining funds go directly to the client. BUT people who receive Medicaid benefits only are exempt from this. Read more here. >
If you or your loved ones are not on Medicaid, you may think these cuts don’t affect your life – but think again. The Butterfly Effect is in full force with this one. Over 40 percent of the funding for community health centers across the nation comes from Medicaid. Medicaid also provides much of the money for addiction treatment and inpatient psychiatric care, plus well over a third for home health care, nursing homes, and births.
Medicaid also pays a significant amount of the money needed for hospitals in low-income and rural communities. Now, thanks to the Republicans, many of these facilities will be forced to substantially cut services or close altogether. This means that people will once again be forced into extremely expensive emergency rooms, like they were before the ACA.
But perhaps the biggest reason we should ALL care about the changes in the One Big Beautiful Bill is that they are going to cause health care costs to skyrocket beyond belief.
Costs were already out-of-control before the Republicans’ wreaked their legislative havoc. The annual health benefits survey of employers by KFF, a nonpartisan health policy organization, found that the cost of health insurance increased for a third year in a row in 2025, reaching an average of almost $27,000 for a family plan. This is a 6 percent rise from 2024, building on two prior years of 7 percent gains. Employees contribute $6,850 annually to the cost of family coverage, which obviously eats into their paychecks.
The U.S. Department of Labor reports that the amount of money individual consumers spent on health insurance in 2023 was an increase of almost 20 percent from five years before and has almost doubled over the past decade. Already, the average American spends around eight percent of their money on health care, which is more than they spend on clothes, education or just on having a little fun.
The Centers for Medicare and Medicaid Services reports that U.S. health care spending reached $5.3 trillion in 2024, an increase of 8.2 percent. The amount Americans spend on health care goods and services account for 18 percent of our gross domestic product (GDP). They project health care spending will grow another 7 percent in 2025.
Now, on top of this, average ACA premiums are about to increase up to 30 percent, impacting at least 17 million Americans who buy coverage on the marketplaces – meaning millions of people will see their health insurance payments double or even triple in 2026.
Everyone will feel the squeeze but people in some states more than others. If you live in New Jersey, for example, you may see your out-of-pocket premium increase over 175 percent, while if you live in Maryland – a state that is kicking in money to minimize the pain of the surge – you will see around a 30 percent increase.
The weird thing is that most Americans who rely on Obamacare live in super red areas. This is why we can’t understand for the life of me what the Republican Party is thinking. We know they don’t really seem to care about people, but do they care about votes?
Fifty-seven percent (57%) of people enrolled in the Marketplace live in congressional districts represented by a Republican. In Florida, there are ten congressional districts where at least 20 percent of the population is enrolled in a Marketplace plan. In fact, the top five congressional districts by marketplace enrollment are all in Florida. In Georgia, Mississippi and South Carolina, at least 10 percent of the population is enrolled in a Marketplace plan. Since these states didn’t expand Medicaid, they are more dependent on tax subsidies to help low-income Americans get health insurance (this goes for Florida also).
So, the result of this legislative disaster is that premiums are going to substantially increase at the same time many Americans are losing the subsidy that helps reduce their costs. This ignites a devastating cycle because, now that the subsidies will dwindle, many Americans will likely leave the ACA marketplaces. Unfortunately, the people who leave will probably be the healthiest, which blows the entire model up.
We hate being the skunk at the garden party, but in any health insurance model, you have to have healthy people to balance out the unhealthy people. It just doesn’t work otherwise. This means that the inescapable reality is that, if we want to keep covering things like pre-existing conditions – and we promise you, Americans will freak out if that provision goes away – there must be some sort of individual mandate in our plan (meaning we get insurance or pay a penalty). That’s just a fact. Anyone who says differently is just lying or does not understand how insurance models work at all. You can’t have one without the other. Period. For this to work, healthy people must offset people who are not as healthy. There’s just no way around it.
< And a quick word to all the healthy people out there: This may annoy you today, but keep in mind that there will probably come a day, if only temporarily, that you get sick, or someone in your family gets sick. Remember, it works both ways! >
To be clear, we're not suggesting that without the individual mandate the health insurance markets would suddenly come crashing down. In fact, we already know they won’t. When Congress set the penalty to zero in 2017 – effectively repealing the individual mandate provision in the ACA – the markets survived. BUT, without the individual mandate the markets will not operate at optimal efficiency, and we will never get costs down. Just look at costs since 2017. Even though the number of Americans with health insurance has increased, health care costs have continued to explode.
Solving our health care challenges cannot happen without coming to terms with some pretty brutal realities – something that politicians don’t want to deal with because it’s not what voters want to hear.
What lawmakers need to understand, however, is that trying to disguise these facts or sugarcoat the uphill battle we face does nothing more than waste precious time. Yes, there are tough pills to swallow, but Americans can handle the truth.