New Law and Trump's Stance Project 2.1 Million More Uninsured Under ACA

Recent legislative changes, coupled with former President Donald Trump's renewed calls to overhaul the Affordable Care Act (ACA), are projected to significantly impact health insurance coverage, potentially leaving millions more Americans uninsured. Critics warn that a new law, dubbed the "One Big Beautiful Bill," along with administrative changes, could lead to a substantial increase in the nation's uninsured population.

The "One Big Beautiful Bill Act" includes provisions that are expected to make it harder to enroll in and renew ACA coverage. These changes involve increased verification requirements, higher out-of-pocket costs for enrollees, and restrictions on certain legal immigrants qualifying for federal subsidies. The Congressional Budget Office (CBO) forecasts that these measures could result in an additional 2.1 million people becoming uninsured by 2034.

The debate over the ACA's effectiveness and future has been a contentious one since its inception. Social media influencer Ian Miles Cheong recently weighed in, stating, > "Obamacare made insurance companies rich, not Americans healthy. President Trump should end this corrupt arrangement once and for all." This sentiment reflects a long-standing criticism that the ACA disproportionately benefits insurers. While some analyses suggest initial struggles for insurers under the ACA, many reports indicate increased profitability for health insurance companies, particularly those involved in Medicaid expansion and Medicare Advantage, often attributed to government subsidies.

However, the ACA's proponents point to its success in expanding coverage and improving access to care. Since its implementation, the ACA has significantly reduced the uninsured rate, with an estimated 20 million previously uninsured individuals gaining coverage through Medicaid expansion and health insurance marketplaces. Studies have shown improved access to preventive services, reduced financial hardship, and some evidence of better health outcomes, such as earlier cancer detection and reduced mortality rates in states that expanded Medicaid.

During his previous term, former President Trump made multiple unsuccessful legislative attempts to repeal and replace the ACA. His administration also took administrative steps to weaken the law, such as eliminating cost-sharing reduction subsidies, reducing the individual mandate penalty to $0, and cutting enrollment outreach. With a potential second term, Trump has reiterated his commitment to finding "alternatives" to the ACA, signaling a renewed push for significant changes. The current legislative and administrative actions are seen by many as a "backdoor" approach to achieving some of the changes that failed to pass through direct repeal efforts.