Republicans are trying to hide these healthcare cuts

A worker with a non-profit helps a woman, not shown, to enroll in health insurance coverage under the Affordable Care Act in New Berlin, Wis., on Jan. 8, 2024. President Donald Trump and congressional Republicans have effectively cut subsidies for the Affordable Care Act’s marketplaces, making it harder for people who do not receive insurance through work to afford a plan. (Jamie Kelter Davis/The New York Times)

By THE EDITORIAL BOARD

One of the federal government’s great achievements this century was making health insurance affordable to millions more Americans. In 2010, nearly 18% of people under 65 lacked insurance. By 2024, the rate had fallen below 10%, thanks to the Affordable Care Act and later legislation that built on it.

President Donald Trump and congressional Republicans are working to dismantle that achievement. They have effectively cut subsidies for the Affordable Care Act’s marketplaces, making it harder for people who do not receive insurance through work to afford a plan. This year, the subsidy cuts led 3 million people to lose their health insurance. In Ohio, nearly a third of previous marketplace enrollees lost their insurance.

The situation stands to worsen next year. In addition to reducing the marketplace subsidies, Trump and congressional Republicans enacted sweeping cuts to Medicaid, which expanded under the Affordable Care Act. They will take effect after this year’s midterm elections. (Yes, that timing is deliberate.) By 2034, the combined cuts will most likely erase about half of the gains from the Affordable Care Act, causing 14 million Americans to lose insurance.

Politicians from both parties have talked up affordability in the run-up to this year’s elections. Republicans, however, are taking deliberate steps to make healthcare less affordable. Many middle-class and poor Americans will struggle — even more — to afford important medical care as a result.

Americans have good reasons to be disappointed in their government. Progress on healthcare, imperfect though it was, represented a positive counterexample of the government working to genuinely improve people’s lives. The president and Congress are trying to ruin that success story.

Republicans’ attacks on affordable healthcare have taken two forms: one more passive, the other more direct.

In the passive approach, Trump and congressional Republicans allowed the expiration of enhanced subsidies for the Affordable Care Act’s marketplaces. The Obama administration and congressional Democrats created the marketplaces for people who fell through the cracks. These people did not receive coverage through their jobs, and they were not poor enough to qualify for Medicaid.

In 2021, President Joe Biden and Congress increased the size of the subsidies, but they set them to expire in 2025, which mitigated their impact on the federal debt. Congressional Democrats shut down the government last year to call attention to the expiration and pressure Republicans to extend the subsidies. Trump and other Republicans refused.

The federal debt is a genuine problem, having soared in the 21st century relative to the size of the American economy. But taking away people’s health insurance is not the answer. Repealing Trump’s foolhardy tax cuts, which benefit mostly the wealthy, would have a bigger fiscal effect than his health insurance cuts.

Those health insurance cuts led premiums and deductibles to spike this year. As an example, a middle-income, middle-aged couple with two children could see their premiums more than double, costing an additional $3,500 a year.

In the more direct approach to cutting healthcare coverage, Republicans targeted Medicaid, the program focused on the poor and disabled. Last year, the federal government enacted what Republicans call a work requirement. In reality, it is a paperwork requirement — one that forces Medicaid enrollees, most of whom are working or have a valid reason for not working, to file repeated documents proving they have a job or a valid exemption. Americans lead busy lives, and many of them may not know of the new requirement. About 2 in 3 enrollees who will lose health insurance should, in fact, be eligible for it, the Center on Budget and Policy Priorities estimated.

Arkansas enacted a version of this policy before the federal law passed, and it was a failure: Workforce participation did not rise, and eligible people lost their insurance because of paperwork problems.

The Affordable Care Act was a triumph of government, and it is justifiably popular. Trump and other Republicans once promised to repeal the law, but they have largely stopped making such statements. Instead, they have sought to weaken the law — partly out of an ideological aversion to government, partly to finance tax cuts for the wealthy — and hope that voters do not notice.

Democrats should not let the president get away with this subterfuge. They should make the health insurance cuts a central piece of their midterm campaign and, as important, offer voters a vision that includes other improvements to the nation’s costly, rickety healthcare system, both to continue expanding access and to reduce costs. The Affordable Care Act also happens to be a model on costs; it meaningfully slowed growth in healthcare prices over the past decade.

Congress should be looking for next steps, not moving backward. The Affordable Care Act demonstrated that progress is possible.