• AP on January 1: “Health subsidies expire, launching millions of Americans into 2026 with steep insurance hikes.” The Associated Press reported on January 1, “Enhanced tax credits that have helped reduce the cost of health insurance for the vast majority of Affordable Care Act enrollees expired overnight, cementing higher health costs for millions of Americans at the start of the new year. Democrats forced a 43-day government shutdown over the issue. Moderate Republicans called for a solution to save their 2026 political aspirations. President Donald Trump floated a way out, only to back off after conservative backlash. In the end, no one’s efforts were enough to save the subsidies before their expiration date.” [The Associated Press, 1/1/26]
• A September KFF analysis estimated that the expiration of the enhanced premium tax cuts would “more than double what subsidized enrollees currently pay annually for premiums—a 114% increase from an average of $888 in 2025 to $1,904 in 2026,” and approved rate changes show an average increase of 20% for all enrollees, more than double the increase for the previous year. An analysis by the Peterson-KFF Health System Tracker noted: “This is the largest rate change insurers have requested since 2018, the last time that policy uncertainty contributed to sharp premium increases.” [KFF, 9/30/25; Peterson-KFF Health System Tracker, updated 1/15/26]
• In June, the Congressional Budget Office estimated that 4.2 million people will become uninsured by 2034 from the expiration of the enhanced premium tax credits. The CBO also estimated that permanently extending these tax credits would increase the number of people with insurance by 3.8 million in 2035. [Congressional Budget Office, 6/4/25, 9/18/25]
• According to KFF, January data from the Centers for Medicare and Medicaid Services shows that ACA Marketplace sign-ups this year so far are “down by over a million people.” KFF cautioned that “these data may not fully show how much the expiration of the enhanced premium tax credits has affected enrollment in the Marketplaces. A better picture of the enrollment changes likely won’t be known until this summer, when effectuated enrollment data are typically released.” [KFF, 1/29/26]

Right-wing media are claiming that the Affordable Care Act has caused Marketplace plans, which cover specific essential health benefits, to become unaffordable. Yet according to the Center on Budget and Policy Priorities, Marketplace costs are growing at similar rates as employer-sponsored health insurance, which is also heavily subsidized in that employer contributions are not taxed. And in fact, it was Republicans who controlled Congress and refused to extend the enhanced premium tax cuts before they expired, even though they extended Trump’s tax cuts for the rich before their scheduled expiration.

• Fox contributor Dr. Nicole Saphier: “What happened is these insurance companies are being told that you have tvo cover all of these patients. You have all of these mandatory things you have to cover, which — that was a big flaw of the Affordable Care Act, which rose costs by essentially saying everything has to be covered.” Saphier continued: “Imagine if your car insurance covered your oil changes, covered everything about your car. That's not how insurance works. But the Affordable Care Act made that, which is why it got so expensive.” Saphier also said she was “frustrated” that “these politicians have failed” to extend the subsidies, even as she criticized the ACA. [Fox News, Fox & Friends, 1/1/26]
• Newsmax guest Jennifer Kelly: “The nightmare for Americans remains many still paying premiums higher than their own mortgage payment. And the blame for that falls squarely on Barack Obama and the Democrats’ shoulders. So the GOP should just keep pounding that message all the way to the midterms.” [Newsmax, Wake Up America, 1/1/26]
• Fox contributor Lisa Boothe called it the “Affordable Care Act that’s not affordable.” [Fox News, Outnumbered, 1/1/26]
• Fox host Julie Banderas: “Democrats, by the way, who backed Obamacare, … they are the ones that actually put a halt on Obama’s subsidies, which effectively are going to increase people’s medical care costs.” Conservative economist Stephen Moore replied, “What we don’t have in America today is affordable health care.” [Fox News, Fox News Live, 1/1/26]
• Newsmax guest host David Harris Jr.: “This is the real legacy of Obamacare, friends: skyrocketing prices, more government dependance, and a broken system that Democrats propped up with temporary handouts to mask the inevitable.” [Newsmax, The Chris Salcedo Show, 1/1/26]
• Fox Business host David Asman: “The premiums have not gone down. They have tripled. They have gone up three times with Obamacare. ... And now they're blaming Republicans for the rates going up.” [Fox Business, Kudlow, 1/2/26]
• Newsmax host Rob Astorino: “It’s not really debatable anymore that the so-called Affordable Care Act, aka Obamacare, has been a very expensive failure. And Democrats don't care how unaffordable or broken the system actually is. They just want to shovel more money into the pit and add more people to it.” Astorinio added: “Democrats created the mess. Republicans are going to get the blame.” [Newsmax, Saturday Agenda, 1/3/26]
• Fox contributor Mollie Hemingway: “This Obamacare has been a failure, Democrats know it but don’t want to deal with it, and Republicans, too many of them probably don’t have the courage to tackle it.” [Fox Business, Varney & Co., 1/8/26]
• Newsmax senior political analyst Rick Santorum: The enhanced premium tax credits were “all a farce to keep the gravy train rolling.” Santorum also downplayed the loss of more than a million ACA enrollees compared to the previous year, saying that many people were fraudulently enrolled and “the quote dramatic increases actually didn’t affect very many people.” [Newsmax, The Record, 1/16/26]
• Fox Business host Dagen McDowell downplayed enrollment losses from the expiration of the enhanced premium tax credits. Citing conservative economist Stephen Moore, she said: “It was the fact that the number of people who dropped out of Obamacare was, for the current enrollment year, was incredibly small. And these super-sized subsidies going away had minimal impact on the number of people enrolling in Obamacare.” [Fox Business, The Bottom Line, 1/16/26]
• Fox Business host Elizabeth MacDonald: “Since Obamacare passed, insurance premiums have nearly tripled.” [Fox Business, The Evening Edit, 1/19/26]
• Heritage Foundation’s EJ Antoni on Fox & Friends First: The premium increases from the lapsed tax credits are “once again exposing yet another lie of Obamacare, the so-called Affordable Care Act. Obviously it was the unaffordable care act.” [Fox News, Fox & Friends First, 1/28/26]

Long before Trump’s second term tax cut for the rich further eviscerated the ACA, Republicans were sabotaging the health insurance expansion in numerous ways. This includes at least 70 separate attempts by Republicans in Congress to repeal or weaken the ACA, according to The Washington Post.

• The first Trump administration undertook nearly 100 separate actions “to sabotage the ACA by destabilizing private insurance markets or reversing the law’s historic gains in health coverage.” The Center on Budget and Policy Priorities’ list of actions taken by the first Trump administration to sabotage the ACA spans from January 20, 2017, when Trump was first sworn into office, to January 19, 2021, his last full day in office during his first term. [Center on Budget and Policy Priorities, 2/2/21]
• In 2015, The New York Times described a Republican campaign against risk corridor provisions of the ACA as “legislative sabotage.” The Times called a successful effort led by then-Sen. Marco Rubio (R-FL) to limit funding to the “so-called risk corridor provision” of the ACA, which protected “insurance companies against financial losses,” “quiet legislative sabotage.” According to a later study published by the National Bureau of Economic Research, the insurers denied risk corridor payments in 2015 “had 7% higher premium increases over the next two years than did non-claiming insurers.” [The New York Times, 12/9/15; Fierce Healthcare, 12/20/17]
• In 2013, The Washington Post reported that Republicans promised to block any efforts to build a federal exchange and urged states to “refuse to build their own online insurance marketplaces.” [The Washington Post, 11/2/13]
• In 2013, Politico reported that “Republicans refused repeatedly to appropriate dedicated funds” for the ACA’s implementation. Politico noted that after “most Republican governors declined to create their own state insurance exchanges” and “congressional Republicans refused repeatedly to appropriate dedicated funds” needed for the federal government to “take at least partial responsibility for creating marketplaces serving [those] states.” Republicans’ stonewalling left “the Health and Human Services Department and other agencies to cobble together HealthCare.gov by redirecting funds from existing programs.” [Politico, 11/1/13]
• Many Republican-controlled states initially refused to participate in the ACA’s Medicaid expansion, leaving millions without insurance. The New York Times reported in 2013 that many states “largely controlled by Republicans … declined to participate in a vast expansion of Medicaid.” [The New York Times, 10/2/13]

Instead of calling on Congress to extend the expired tax credits, Trump announced his “Great Healthcare Plan” and a rural hospital fund created last year announced its first disbursements. Right-wing media endorsed both.

• Fox contributor Dr. Nicole Saphier: The rural hospital fund is “going to help health care tremendously.” [Fox News, Fox & Friends, 1/1/26]
• Fox Business host Dagen McDowell: “The year of health care is here. Or hopefully fixing it. Supersized Obamacare subsidies have officially expired, and the Trump administration's sweeping changes to the industry are now taking effect.” Co-host Brian Brenberg added: “Beginning this month, all 50 states will receive a share of $10 billion in federal funding aimed at revitalizing and protecting rural health care systems.” [Fox Business, The Bottom Line, 1/2/26]
• Fox Business host Larry Kudlow introduced a segment by calling Trump’s plan “the greatest health care plan in the history of civilization.” [Fox Business, Kudlow, 1/15/26]
• Fox Business host Brian Brenberg: Trump’s health plan is “good economics” because it’s “getting consumers more in touch with the spending rather than all of the middlemen.” [Fox Business, Kudlow, 1/15/26]
• Newsmax host Katrina Szish: “The president putting decision-making power back into the hands of Americans. Seems practical to me.” [Newsmax, Ed Henry: The Briefing, 1/16/26]
• Newsmax host Shaun Kraisman called Trump’s plan a “new framework of ideas to revolutionize health care in America.” [Newsmax, The National Report, 1/16/26]
• Fox guest Steve Forbes: Trump’s plan “could cut out, over time, a trillion dollars [from] the cost of health care.” [Fox Business, The Big Money Show, 1/16/26]
• Newsmax White House correspondent Mike Carter: The rural hospital fund is “focusing on those folks, those Americans that live in more rural parts of the country, making sure they have great access to health care by funding rural hospitals.” [Newsmax, Newsline, 1/16/26]

The Washington Post described Trump’s plan as a “grab bag of initiatives” that “falls far short of President Donald Trump’s promises to deliver a replacement for the Affordable Care Act.” The Post continued:

Trump’s proposal includes a mix of initiatives that are already underway, such as Trump’s push to cut U.S. drug prices by linking them with the lower cost of drugs sold abroad, and some of his stalled ambitions, such as his desire to redirect billions of dollars in federal funding away from health insurers and toward average Americans. Trump also called to restore funding for the ACA’s cost-sharing reduction program, an insurance subsidy program that he ended in his first term, and to institute “maximum price transparency” by requiring hospitals and insurers to make more information available to consumers.

The proposal does not include new ideas to expand health coverage or simplify America’s often-byzantine health care system.

Additionally, other existing Republican policies stemming from their latest tax cut for the rich are estimated to cause up to 15 million Americans, and possibly more, to lose their health insurance. Other experts said Trump’s plans are so vague that it is unknown what effects they may have but they put people with preexisting conditions at risk and don’t reestablish the expired subsidies:

• Trump’s plan to shift funds from subsidizing insurance plan premiums to health savings accounts is “a terrible approach for” the part of the population that needs assistance with expensive health care bills, according to Johns Hopkins University's Bloomberg School of Public Health health policy professor Gerard Anderson. [Bloomberg, 1/23/26]
• According to a December Cornell Health Policy Center survey of health care policy scholars, 70% “believed that depositing the value of a household’s enhanced premium tax credit into an HSA (rather than applying it directly to monthly premiums) would measurably worsen Marketplace affordability.” [Health Affairs, 12/17/25]
• KFF senior vice president Cynthia Cox: “The president’s plan is vague and, without knowing more, it is impossible to say what the implications would be for people with pre-existing conditions who rely on the ACA markets. The framework does not explicitly say people with pre-existing conditions are protected.” In a comment to NPR, Cox also said: “This looks much more like a compilation of Republican ideas, including some that are already in the Affordable Care Act. It doesn't appear to address the rising premium payments that we're seeing.” [KFF, 1/16/26; NPR, 1/15/26]
• Georgetown University McCourt School of Public Policy research professor Edwin Park: “The plan clearly opposes extension of the expiring ACA marketplace subsidies, without which roughly 4 million people will end up uninsured and many millions more will see their marketplace premiums double or increase by even more.” Park added that Trump’s plan also “appropriates the ‘cost-sharing reductions’ under the Affordable Care Act,” which he said would “have the effect of reducing premium tax credit amounts for those eligible for subsidies (while lowering unsubsidized premiums). The result would actually be more uninsured as low-income people see smaller subsidies and higher premiums they cannot afford.” [The Guardian, 1/15/26]
• University of Pittsburgh assistant professor Miranda Yaver: “The result would be inequity (and likely worse health outcomes) and further sabotage of the progress of the ACA.” She added that “it isn’t clear that the plans the Trump administration wants to help people to purchase would be ACA-compliant, which would mean that while healthy patients may enjoy cost savings, there won’t be remotely sufficient protection for the millions of Americans with pre-existing medical conditions.” [The Guardian, 1/15/26]
• NYU Grossman School of Medicine head of medical ethics Art Caplan: “It’s a broken plan and a broken idea.” He added: “The average consumer doesn’t really have time to go shopping when they need to go to the hospital for a premature birth or a car accident.” [NBC News, 1/15/26]
• Multiple studies have concluded that consumers simply don’t shop for cheaper health care. A 2018 New York Times report explained that even though “scholars have estimated that as much as 30 or 40 percent of care” is “shoppable,” studies show “very few people shop for this type of care.” It also covered a National Bureau of Economic Research working paper examining how people sought out nonemergency MRIs, which found that, “in the context of other studies … if people can’t shop for elective M.R.I.s, there’s hardly a chance they are going to do so with other health care procedures that are more complicated and variable.” A 2024 KFF analysis of Medicare beneficiaries also concluded that “the vast majority of the nation’s 67 million Medicare beneficiaries will not shop around among the coverage options for 2025 or switch plans,” even though it’s “a decision that could have a significant impact on enrollees’ coverage and costs.” The KFF analysis determined that “nearly 7 in 10 Medicare beneficiaries (69%) did not compare their Medicare coverage with other Medicare options during the program’s annual open enrollment period for coverage in 2022.” [The New York Times, 7/30/18; KFF, 9/26/24]
• KFF Medicare policy expert Juliette Cubanski: “Generally speaking, most people with insurance coverage will continue to be better off using their insurance to obtain medications rather than purchasing through the TrumpRx direct-to-consumer portal.” [NBC News, 1/8/26]

The rural hospital fund was added to Trump’s tax cut bill for the rich to convince Republican holdouts to pass the law after they expressed concerns that the Medicaid cuts in the bill would devastate rural health care. The $50 billion fund doesn’t come close to replacing the rural Medicaid funding that was cut in Trump’s tax cut bill, and one state senator characterized it as a thinly disguised “sort of blackmail” given that it’s being used to coerce states into adopting Trump administration priorities and the money can be clawed back at a later date.

• KFF explained that the rural hospital fund “provides $50 billion for state grants” over a five-year period, of which half is to be distributed “equally among all states with an approved application,” and the other half subject to the Trump administration’s discretion. KFF noted that “while the fund is described as a ‘rural’ program, the law appears to give states some ability to direct some of the dollars to urban and suburban areas, pending CMS approval.” KFF further noted that “while many of the major cuts related to Medicaid and the ACA Marketplaces under the law are not time limited, the rural health fund is temporary.” [KFF, 8/4/25]
• The reconciliation package also cuts an estimated $137 billion in rural Medicaid spending over 10 years. KFF explained that its estimate may undercount the lost funding for rural areas: “The analysis allocates each state’s estimated spending reductions from the KFF analysis of the reconciliation package to urban and rural areas using the percentage of Medicaid spending that paid for services used by rural enrollees within each state. The estimates may understate the effects on rural areas because they do not account for the full change in total Medicaid spending, which would include the federal spending reductions and the associated reduction in state Medicaid spending stemming from lower enrollment. The estimates also do not account for spending cuts related to Affordable Care Act (ACA) Marketplace coverage from the reconciliation bill, the expiration of enhanced ACA premium tax credits that were enacted during the COVID-19 pandemic, and the impact of proposed Marketplace integrity rules.” [KFF, 7/24/25]

• CBS News: An analysis from the University of North Carolina's Cecil G. Sheps Center for Health Services Research determined that 338 rural hospitals are at risk of closure due to the Republicans' cuts of Medicaid spending. The research was commissioned by Democratic senators. [CBS News, 6/12/25]

• AP: $12 billion of the fund is tied to “whether states are implementing health policies prioritized by the Trump administration’s ‘Make America Healthy Again’ initiative” and can be clawed back if “state leaders don’t pass promised policies.” This includes further restricting the types of food that Supplemental Nutrition Assistance Program funds could be used to purchase. [The Associated Press, 12/29/25]