The Affordable Care Act and America’s Uninsured
Americans have experienced a large and steady decrease in our uninsured rates since the Affordable Care Act (ACA) was adopted. https://www.shadac.org/news/15-years-affordable-care-act-more-americans-ever-have-health-insurance-coverage
California has been the nation’s leader in reducing its uninsured rate, catching up to other states like Massachusetts that had already made huge progress. Ibid, and https://www.chcf.org/wp-content/uploads/2025/09/CoveringUninsured_ConsiderationsPrepareCoverageLoss.pdf
States like Texas, Mississippi, and Florida have lagged considerably in covering their state’s uninsured citizens. https://www.shadac.org/news/15-years-affordable-care-act-more-americans-ever-have-health-insurance-coverage This is primarily because they have steadfastly refused to adopt the federal Medicaid expansion to cover the working poor despite the 90/10 federal Medicaid match. https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/ These are primarily Republican dominated legislatures and GOP governors from states from the deep South who are refusing to cover their states’ working poor. As a nation, we could reduce our uninsured rates by an additional 40% if these states adopted the Medicaid expansion for the working poor (adults with incomes less than 133% of the federal poverty level, $20,815 for an individual). https://www.shadac.org/news/15-years-affordable-care-act-more-americans-ever-have-health-insurance-coverage
President Trump is taking the nation in a radically different direction. The “Big Beautiful Bill” would take money away from the poor and moderate-income Americans and redistribute it to the very wealthy, largely by cuts to Medicaid and Food Stamps. https://www.cbo.gov/publication/61469 The CBO scorecard shows 10 million Americans lose their Medicaid coverage and the federal deficit is increased by $3.4 trillion. https://www.politico.com/news/2025/07/21/gop-megabills-final-score-3-4t-in-red-ink-and-10-million-kicked-off-health-insurance-cbo-says-00465546
As if that were not enough damage to the progress made under the ACA, President Trump and GOP leaders plan to allow the enhanced tax credits that help subscribers pay for their individual private health insurance to expire at the end of this year. It is projected that this will double premiums that subscribers must pay in the Exchanges and cause 5 million Americans to become uninsured. The harms will be worst in the same deep South states which have refused to adopt the Medicaid expansion. https://www.urban.org/sites/default/files/2025-09/4.8-Million-People-Will-Lose-Coverage-in-2026-If-Enhanced-Premium-Tax-Credits-Expire.pdf and https://bipartisanpolicy.org/issue-brief/enhanced-premium-tax-credits-who-benefits-how-much-and-what-happens-next/
Needless to say, American voters are very strongly opposed to Trump’s health care policies although GOP voters have stronger faith in the President than do independents and Democrats. https://www.ap.org/news-highlights/spotlights/2025/what-americans-think-about-rising-health-care-costs-according-to-a-new-ap-norc-poll/