Nearly 3 million Americans lost health-care coverage last year after Republicans allowed enhanced Affordable Care Act subsidies to expire, setting off a chain reaction that's now driving insurance premiums up 14 percent on average. The Congressional Budget Office projects that by 2028, almost 10 million Americans will have lost coverage, pushing the uninsured rate up by a third.
The Trump administration has overseen what critics call the most sweeping rollback of social spending in American history. Millions have been thrown off Medicaid. Republicans in Congress refused to extend the enhanced subsidies that Democrats enacted under the Biden administration. Last week, insurers announced the 14 percent premium hike, following a 20 percent increase 1 year ago.
Bernie Sanders responded on X by framing the choice as binary: "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." He didn't mention that Democrats had already cut the uninsured rate in half through the Affordable Care Act, or that Republicans caused the current crisis by letting subsidies lapse.
The Republican Defense
Republicans haven't acknowledged the straightforward effect of their subsidy cuts. Trump rarely mentioned health care during his 2024 campaign. His convention speech 2 years ago ran over 90 minutes without referring to plans to cut the Affordable Care Act. When pressed on the consequences now, GOP officials say they're eliminating fraud, not coverage.
Mehmet Oz, administrator for the Centers for Medicare and Medicaid Services, claimed 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 insisted the point wasn't to throw people off but to strengthen the program. "If you care about the ACA, then you'll want us to take the fraud out," he said.
Oz is repeating conclusions from the Paragon Health Institute, a conservative think tank claiming the ACA has given benefits to "improper" beneficiaries. Paragon extrapolates from the number of recipients who don't file claims that the program hands out subsidies to people who either don't exist or don't want coverage. Matthew Fiedler, a health expert at the Brookings Institution, examined the data and concluded "these data do not provide persuasive evidence that 'phantom' enrollments are widespread." Not filing a claim doesn't mean a person doesn't want the plan—plenty of people with employer coverage don't file claims either.
Paragon's own study asserts there are 6 million "improper" recipients this year, including 1.5 million ineligible for subsidies. Most aren't pretending to be poor. They're inflating their income to qualify for coverage because of a Republican-imposed policy gap. Nine red states still haven't expanded Medicaid, creating a coverage hole: subsidies exist for people above 138 percent of the poverty line, but nothing covers those below it. People desperate for coverage in these states have pretended to earn more to get insurance. Those payments might not be legal, but the people getting them are real.
Democrats' Long Commitment
The Democratic Party's commitment to universal health insurance dates back to the New Deal. Franklin D. Roosevelt considered it but settled for Social Security. Other Democratic presidents pushed through Medicare and Medicaid under Lyndon B. Johnson, and the Children's Health Insurance Program under Bill Clinton, who spent much of his first two years trying to establish universal health care.
Under Barack Obama, Democrats finally established a universal health-care program. 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. Obama's plan relied on regulation, subsidies, and Medicaid expansion. The effort drew ferocious right-wing backlash and probably cost many congressional Democrats their careers.
A conservative-controlled Supreme Court nearly overturned the law. The Court's final ruling made Medicaid expansion optional for states—a decision, not any choice by Democrats, that made Obamacare non-universal. About 40 percent of uninsured Americans live in states that haven't expanded Medicaid.
Since then, Democrats have campaigned relentlessly to get red states to accept the expansion. It's their best issue in those states. They've won ballot initiatives in seven states supporting Medicaid expansion and elected governors in Kansas, Kentucky, Louisiana, and North Carolina by emphasizing it. Just 25 states and D.C. were enrolled after the Court's ruling 14 years ago, but 15 more have since joined.
When Democrats regained control of government 5 years ago, they fixed a major weakness: subsidies were too stingy for middle-class people at the higher end of the income spectrum. They expanded the subsidies and within two years brought the uninsured rate down from 9.7 percent to 7.7 percent. Republicans have since let those higher subsidies expire, causing the rate to rise again.
The Socialist Confusion
Progressive activists, especially those associated with the Democratic Socialists of America, are blaming the wrong party for the crisis. The DSA has set itself up in opposition to the Democratic Party, promising to do what Democrats won't. Its candidates routinely cite universal health care as what distinguishes democratic socialists from Democrats.
The Wall Street Journal recently surveyed four DSA-affiliated congressional candidates, and all cited universal health care as a core belief. Jia Lynn Yang argued in The New York Times Magazine that "The Democratic Socialists of America platform calls for universal health care, an idea long since implemented by their counterparts in Europe." There are two odd things about this. First, support for universal health care is probably the least controversial element of the DSA's official platform—the group also supports government ownership of major corporations, ending all immigration enforcement, and "abolishing the carceral forces of the capitalist state." Second, the Democratic Party also supports universal health care. It's one of the party's deepest and most consistent causes.
The Democratic Party is roughly divided on the practicality, not the morality, of government-provided health care. 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. Obama has said that if starting from scratch, he'd design a single-payer system; he settled for a hybrid model to avoid disrupting care for the majority of working adults who get coverage through their jobs.
Advocates of single-payer health care have directed the bulk of their efforts into pressuring Democrats to accept their preferred measures, rather than supporting programs Democrats have fought to enact. Sanders's decision to condemn the consequences of Republican health-care policy without blaming Republicans is typical. Decades of the left refusing to credit Democrats for advocating universal coverage has helped lead many Americans to believe the party doesn't care about the policy. About a third of Americans trust Democrats to do a better job on health care than Republicans, according to polls, leaving two-thirds feeling otherwise.
Meanwhile, congressional Democrats recently shut down the federal government in an effort to defend health-insurance subsidies. Young people often say they're let down by the Democratic Party, believing it lacks commitment to health care. That belief has been instilled through endless repetition but is completely mistaken. Hundreds of rural hospitals are now at risk of closing.
Why This Matters:
The health-care debate reveals a fundamental divide: Democrats believe all Americans should have access to medical care, even if that requires government subsidies. Republicans do not. The current crisis isn't an accident—it's the result of deliberate policy choices by Republicans who let subsidies expire and clawed back Medicaid funding 1 year ago. Yet progressive activists are obscuring this basic fact by attacking Democrats for not embracing single-payer quickly enough. The result is political confusion that benefits Republicans, who prefer to discuss almost any subject other than the consequences of their cuts. Democrats face adversaries on both flanks who obscure the party's consistent commitment to universal coverage—a commitment that dates back decades and has delivered tangible results, cutting the uninsured rate in half before Republicans reversed course. The challenge now is turning Republicans' flouting of public opinion into electoral defeats, a task made harder when allies on the left refuse to acknowledge which party is actually fighting to expand coverage and which is systematically dismantling it.