Nearly 3 million Americans lost their health-care coverage last year as the Trump administration executed what The Atlantic describes as the most sweeping rollback of social spending in American history. Millions more were thrown off Medicaid while the president and his Republican allies in Congress refused to extend enhanced subsidies for people buying individual health insurance on Affordable Care Act exchanges.
Last week, insurers announced premium increases averaging 14 percent, following a 20 percent hike 1 year ago. The Congressional Budget Office projects that by 2028 the number of uninsured Americans will have risen by a third, with almost 10 million people losing coverage. Hundreds of rural hospitals are at risk of closing.
The Republican Rollback
Health insurance is becoming a crisis again because Republicans decided to make it one. Donald Trump rarely mentioned health care during his most recent presidential campaign. His 2024 convention speech ran for more than an hour and a half without referring to his plans to cut the Affordable Care Act.
Republicans haven't acknowledged the straightforward effect of their subsidy cuts. Trump and his allies prefer to discuss almost any other subject. When they do address the consequences, they claim the cuts don't deprive people of insurance but instead eliminate fraudulent claims.
Mehmet Oz, the former celebrity doctor now serving as the administrator for the Centers for Medicare and Medicaid Services, said at a press conference last month that the administration is cutting benefits for "millions of people, literally, who are getting insurance that they don't want; they don't even know they have it." He claimed the point of Trump's subsidy cuts wasn't to throw people off the program but to strengthen it. "If you care about the ACA, then you'll want us to take the fraud out," he said.
The Fraud Claim Doesn't Hold Up
Oz is repeating a conclusion from the Paragon Health Institute, a conservative think tank, which has claimed that the ACA has given benefits to "improper" beneficiaries. The group's findings are described as very questionable. Paragon extrapolates from the number of recipients who don't file any claims on their insurance that the program is handing out subsidies to people who either don't exist or don't want coverage.
That's not persuasive. Not everybody who gets insurance through an employer files a claim, and not filing a claim doesn't mean a person doesn't want the plan. Matthew Fiedler, a health expert at the Brookings Institution, examined the number of Obamacare policyholders who didn't file claims and concluded that "these data do not provide persuasive evidence that 'phantom' enrollments are widespread."
Oz misinterprets Paragon's study, which asserts that there are 6 million "improper" recipients this year, including a million and a half people who are ineligible to receive subsidies. Most of those ineligible recipients aren't pretending to be poor; they're inflating their income in order to be eligible for coverage. They're doing this because of a perverse, Republican-imposed policy.
The Affordable Care Act split the task of covering the uninsured into two programs. The poorest households, below 138 percent of the poverty line, would be enrolled in Medicaid, and those above that threshold would get subsidized coverage on the new exchanges. A Supreme Court ruling 14 years ago allowed states to opt out of the Medicaid expansion. Many red states did so, creating a hole in the program: the subsidies for people above the income cutoff remained intact, but in nine states, no programs covered those below it. In many of these Republican-led states, people desperate for coverage have pretended to have more income in order to get insurance. Those payments might not be legal, but the people getting them are very real.
Democrats Built Universal Coverage
Before the Affordable Care Act passed 16 years ago, nearly 20 percent of Americans under 65 were uninsured. By 2023, that number had been cut in half. Democrats were wrong about the long-term fate of the Affordable Care Act in one way: they assumed that once the public experienced the benefits of Obamacare, Republicans would be unable to take those benefits away. That calculation has proved mostly false.
Nearly the entire Republican caucus voted to repeal the law 9 years ago, falling just short when a handful of senators defected. In 2025, the GOP sat on its hands and allowed a portion of health subsidies to expire, then voted to claw back Medicaid. Those votes, and the consequences that are only beginning to be felt, are politically toxic. This is a social catastrophe for people who're too poor and sick to afford health insurance.
The Democratic Party's commitment to giving all Americans access to health insurance dates back to the New Deal. Franklin D. Roosevelt considered it but settled for a more limited Social Security program. Other Democratic presidents pushed through incremental expansions, such as Medicare and Medicaid under Lyndon B. Johnson, and the Children's Health Insurance Program under Bill Clinton.
Under Barack Obama, Democrats finally did establish a universal health-care program. Obama's plan relied on regulation of the individual health-care market, plus subsidies and expansion of Medicaid, to make coverage available to all Americans. The effort drew a ferocious right-wing backlash and probably cost many congressional Democrats their careers.
A conservative-controlled Supreme Court nearly overturned Obama's Affordable Care Act. The Court's final ruling was a partial rollback that made the Medicaid expansion optional for states. This ruling, not any decision by Democrats, made Obamacare a non-universal program. About 40 percent of uninsured Americans live in the states that haven't expanded Medicaid.
Democrats Keep Fighting
Since then, Democrats have continued to fight to extend coverage to more Americans. They've campaigned relentlessly to get red states to accept Obama's Medicaid expansion, and it's their best issue in those states. They've won ballot initiatives in seven states supporting Medicaid expansion and have elected governors in Kansas, Kentucky, Louisiana, and North Carolina by emphasizing the issue. Just 25 states and D.C. were enrolled in the Medicaid expansion after the Court's ruling, but 15 more have since joined.
A major weakness in the Affordable Care Act was that the subsidies were too stingy for middle-class people at the higher end of the income spectrum. When Democrats regained control of government 5 years ago, they fixed that problem, expanding the subsidies and, within two years, bringing the uninsured rate down from 9.7 percent to 7.7 percent. Republicans have since let those higher subsidies expire, causing the uninsured rate to rise again.
Bernie Sanders responded to last week's premium increases by writing on X, "We have a fundamental choice to make. We can maintain a broken healthcare system that allows insurance companies to make billions by raising premiums by 14%-35% next year. Or we can enact Medicare for All and save the American people $650 billion a year." Sanders's message didn't mention that Democrats had done anything on the issue, and it didn't mention the Trump administration or Republicans, whom The Atlantic says caused the problem.
Congressive activists, especially those associated with the Democratic Socialists of America, are blaming the wrong party for the crisis that socialists say they're fighting to solve. The DSA has set itself up in opposition to the Democratic Party, selling itself to progressive voters by promising to do what Democrats won't. The Wall Street Journal recently surveyed the four DSA-affiliated congressional candidates, and all of them cited universal health care as one of their core beliefs.
The Democratic Party also supports universal health care. It's one of the party's deepest and most consistent causes. More than half of the House caucus has endorsed Medicare for All. The remainder favor universal coverage by building on Obamacare. Nobody in the Democratic Party opposes universal coverage.
About a third of Americans trust the Democrats to do a better job on health care than the Republicans, according to polls, but that leaves two-thirds of Americans feeling otherwise. Meanwhile, congressional Democrats have prioritized the provision of health care to such an extent that they recently shut down the federal government in an effort to defend health-insurance subsidies.
Why This Matters:
Millions of Americans are losing access to medical care because of Republican policy choices, not because Democrats haven't fought for universal coverage. The human cost is mounting: families facing medical bankruptcy, rural communities losing hospitals, people with chronic conditions going without treatment. Republicans outsource their social-policy expertise to conservative wonks who argue that it just isn't the government's business to help people who're too poor or sick to cover their own medical expenses. Democrats have spent decades building and defending programs that provide health security to working families, expanding Medicaid in red states through ballot initiatives and gubernatorial campaigns, and strengthening subsidies when they held power. The challenge now is turning Republicans' flouting of public opinion into electoral defeats while correcting the mistaken belief, instilled through endless repetition by progressive critics, that the Democratic Party lacks commitment to health care. That belief is completely mistaken, and it obscures who's actually responsible for the crisis unfolding right now.