Republicans Shift Focus on Health Care Reforms

President Donald Trump and Congressional Republicans have stepped away from their pledge to completely dismantle Obamacare. However, this doesn’t exactly mean they’ve abandoned their attempts to roll back this major health reform law.

This year, unlike in 2017 when Senator John McCain’s vote derailed their efforts to repeal the Affordable Care Act, Republicans have hardly mentioned Obamacare while advancing Trump’s ambitious domestic agenda. Instead, they’ve concentrated on tackling Medicaid issues while expressing the need to protect this program for the most vulnerable populations.

In a somewhat striking turn, their current initiatives have led to a significant setback for affordable healthcare access. The proposed legislation, which they’ve dubbed “big, beautiful,” along with new rules from the Centers for Medicare and Medicaid Services, could potentially leave millions without any health insurance. Moreover, many Americans who manage to keep their Obamacare plans may find their premiums rising, effectively undoing years of progress in reducing the uninsured rate across the nation.

Additionally, Trump’s proposed changes are likely to impact a key provision of the Affordable Care Act that extends Medicaid coverage to low-income adults.

As Larry Levitt, a vice president of health policy at KFF, pointed out, “The net effect of the changes they’re making is partial repeal of the ACA.”

Furthermore, Republicans may have an opportunity to further weaken Obamacare by the end of the year if they choose not to renew the enhanced federal premium subsidies that were enacted in 2021 under the Biden administration.

Democrats have begun highlighting the looming expiration of these subsidies, which could lead to higher premiums and millions opting out of their health plans, according to experts. Some Republicans have shown interest in exploring this issue, particularly since it may affect constituents in GOP-leaning states.

The “big and beautiful” bill proposes the largest reduction in federal support for health insurance to date. It remains unclear whether the Republicans’ softer rhetoric regarding Obamacare will help them avoid the backlash they faced in 2018, when their repeal efforts were largely blamed for significant Democratic gains in the House.

Levitt also remarked, “A lot of the changes are so technical that it can be difficult for the public to grasp what’s going on. Many of the changes take years to work.”

In addition, new laws and regulations make it increasingly challenging to enroll or renew Affordable Care Act coverage. These changes include heightened verification requirements and increased out-of-pocket costs for participants. Furthermore, certain legal immigrants may no longer qualify for federal support.

The rules could lead to around 1.8 million Americans losing their Obamacare coverage by next year, with the most substantial losses expected in GOP-led states like Florida, Georgia, South Carolina, Texas, and North Carolina, even where Democrats oversee state governorships.

According to the Congressional Budget Office, provisions in the Affordable Care Act could potentially leave 2.1 million people uninsured by 2034.

Jennifer Sullivan, from a left-leaning think tank, expressed concern, stating, “This is a fundamental weakening of what the market can offer over the next few years.”

Supporters of the GOP’s approach argue that these measures aim to reduce the expanding flexibility in enrolling and verifying eligibility that the Biden administration has incorporated into Obamacare.

One representative from a conservative think tank asserted, “One big and beautiful bill will restore the ACA rather than abolishing it,” claiming it’s about protecting the program’s integrity.

They argued that simple reforms, like regular updates on income verification, could save billions without undermining the program.

In terms of regulation, it appears registrants will need to verify their income before receiving premium support to ensure eligibility. This could involve more than just filing tax returns—those who fail to file or resolve their taxes might find themselves ineligible for federal grants. Should their income be underestimated, they may have to repay the surplus in subsidies.

The new verification requirements effectively dismantle automatic re-enrollment for Obamacare—a significant method of maintaining coverage for millions. KFF estimates that approximately 11 million individuals, or 45% of those enrolled, were automatically re-registered in 2025.

The new rules also temporarily mandate low-income beneficiaries qualifying for zero-premium plans to pay $5 monthly until their eligibility is verified. Insurers may also require upfront payments for past premiums before coverage begins.

Moreover, the open enrollment timeframe for the federal Healthcare.gov exchange is set to shorten from November 1st to December 15th, with state-run exchanges needing to wrap up by the end of December.

The rules will temporarily eliminate year-round registration for individuals with household incomes below 150% of the federal poverty line, and those enrolling during specific special periods will be barred from receiving federal aid.

Other technical changes are expected to lower premium subsidies, driving up annual coverage costs and out-of-pocket expenses. Certain legal immigrants are no longer eligible for federal assistance, complicating matters further.

With these new requirements, the healthiest participants might opt-out of coverage, potentially leading to a rise in sick patients that could strain the insurance market, forcing companies to hike premiums or limit offerings.

The new regulations are currently being challenged in lawsuits brought forward by a coalition of Democratic states and various organizations, citing concerns that they will increase the number of uninsured individuals, consequently escalating healthcare costs for states and cities.

According to analyses from KFF, insurers are already proposing an average premium increase of 18% for 2026, and Aetna has announced it will not offer coverage for Obamacare next year.

As Sullivan noted, “It’s going to be a tumultuous few years as people who rely on the market for insurance navigate these changes.”