Smart policy over the past 15 years lowered the percentage of uninsured Americans under age 65 by almost half, from roughly 1 in 5 to fewer than 1 in 10. That’s a remarkable achievement largely benefiting working people.
Yet the Trump administration seems determined to reverse those hard-won gains.
Since January 2025, President Donald Trump and almost all congressional Republicans have been working to make it harder for middle- and low-income people to access care ‒ wreaking havoc on people’s health and lives ‒ while lying about their reasons for doing so.
Red tape makes health care less accessible
First, Republicans falsely state that a large number of recipients of Medicaid, the nation’s health program for the lowest-income population, are choosing not to work.
Republican critics use this caricature to justify legislating burdensome and time-consuming requirements and documentation for applicants and enrollees, more than 90% of whom, even before the new law passed, were already participating in work, school or childcare responsibilities, or who live with disabilities, exempting them from the new requirements.
This “solution seeking a problem” creates a large and very real problem, because the law’s onerous red-tape demands will primarily lead to the denial of insurance coverage to eligible low-income people who are complying with the law’s strict rules, since meeting the strict reporting requirements will be confusing and difficult for many.
Cynically, the onerous restrictions become effective right after November’s midterm elections to diminish fallout for its political champions.
Substitute health plans don’t provide adequate coverage
Second, Republicans have falsely asserted that their vague proposals to put some cash in health savings accounts or expand the availability of cheap, weaker health plans would make consumers better off than the government-funded premium tax credits.
That’s not even close to being true.
The unregulated plans Trump and his team are so fond of as substitutes for affordable comprehensive insurance have extremely limited benefits: They can be denied outright to people with preexisting conditions and can leave enrollees exposed to enormous out-of-pocket costs once receiving care.
Additionally, any cash amounts they would contribute to savings accounts would be a drop in the bucket compared with the costs of a significant illness or injury. That would be medically and financially endangering consumers.
Meanwhile, cutting the credits for comprehensive insurance means that the cost of buying a federal government marketplace plan will be more than four times greater for low-income people. For middle-income people, costs will typically more than double.
Millions will lose insurance as a result of the congressional rollback, leaving people stranded between financial ruin and forgoing necessary care when facing illness or injury.
‘Waste, fraud and abuse’ used as a political pretext
Third, the Republicans wrongly claimed that recent changes to law and regulations prevent
Health care ‘fraud’ is a smokescreen for denying coverage
