Since early 2025, the administration and its allies have made it harder for Americans to get health care. Their “One Big Beautiful Bill” piles on paperwork, adds new costs, shrinks who qualifies for ACA coverage, and could leave about 10 million more people uninsured. New Republican rules add fees and extra steps to re-enroll or use special enrollment in the marketplace; the agency says 750,000 to 2,000,000 people could lose coverage. They also cut by 90% the funding for helpers who guide families through sign-ups. On top of that, the government blocked Medicaid payments to Planned Parenthood, froze family-planning grants, and moved to stop enforcing a new mental-health rule that helped people get care.
The example content is only intended to illustrate potential uses of the included research, it has not been vetted or cleared for paid distribution.
- On July 4, 2025, the One Big Beautiful Bill Act became Public Law 119-21, legislating major changes to Medicaid and the ACA marketplaces. (congress.gov)
- The law requires Medicaid expansion adults to file massive new paperwork burdons involving “community engagement” (work/education/service) of at least 80 hours, verified by states and not waivable, beginning no later than the first quarter after December 31, 2026. (congress.gov)
- The law mandates new costs on families for expansion enrollees over 100% of the federal poverty line beginning in FY2029. (congress.gov)
- The law restricts states’ ability to fund health care, barring federal matching for Medicaid provider taxes and by directing CMS to limit certain Medicaid state-directed payments to Medicare rates. (congress.gov)
- CBO projects the law will increase the number of people without insurance by about 10 million in 2034 and reduce federal spending on Medicaid and the marketplaces by roughly $1.06 trillion over 10 years. (aha.org)
- The law tightens ACA premium tax credit eligibility for immigrants, eliminating access for lawfully present immigrants under 100% FPL who are ineligible for Medicaid due to immigration status (effective Jan 1, 2026). (congress.gov)
- Beginning Jan 1, 2027, premium tax credits are limited to U.S. citizens, lawful permanent residents, Cuban/Haitian entrants, and COFA migrants; KFF estimates 1.4 million lawfully present immigrants will lose coverage due to these and related changes. (congress.gov)
¶ Trump and Republicans Added New Barriers, Paperwork, And Annoyance Try To Kick Families – Up To 2 Million People – Off Of Health Care
- Trump’s CMS finalized the 2025 “Marketplace Integrity and Affordability” rule adding a $5 monthly bill for auto-reenrolled $0-premium enrollees unless they confirm eligibility, eliminating the monthly SEP for ≤150% FPL, requiring pre-enrollment SEP verification, changing income verification to require documentation when IRS data are unavailable, and shortening the federal open enrollment period to Nov 1–Dec 15 starting in plan year 2027. (cms.gov)
- The rule removes DACA recipients from “lawfully present” eligibility for exchanges (cms.gov)
- CMS and AHA note the agency estimated 750,000–2,000,000 people could lose coverage due to the rule’s combined changes. (aha.org)
¶ The administration and republicans slashed funding, making it harder for families to sign up for health insurance coverage
- On Feb 14, 2025, Trump’s CMS reduced federal Navigator funding for FFE states from $100 million to $10 million per year, reversing recent investments in outreach and enrollment assistance. (cms.gov)
- KFF highlights that similar cuts in the prior Trump term produced staff layoffs and reduced outreach; it warns the new 90% cut will likely diminish enrollment and post-enrollment help. (kff.org)
- News coverage underscores Navigators’ role in Medicaid/CHIP and marketplace enrollments and the likely impact of the 90% cut on low-income communities. (axios.com)
¶ Trump And Republicans Engaged In A War To Make It More Difficult For Families To Access Reproductive Health Care
- Defunding Planned Parenthood Clinics: A 2025 provision blocks federal Medicaid payments for one year to nonprofit family planning providers that both perform abortions and received >$800,000 in Medicaid reimbursements in 2023; on Sept 11, 2025, an appeals court allowed the administration to block Medicaid funds to Planned Parenthood while litigation proceeds. (pbs.org)
- Maine Family Planning announced it would halt primary care services due to the Medicaid reimbursement ban’s financial impact, illustrating effects beyond abortion services. (apnews.com)
- On April 1, 2025, the administration began withholding about $66 million in Title X grants from Planned Parenthood and other providers, leaving several states without Title X funding and jeopardizing low-cost family planning services. (washingtonpost.com)
- In May 2025, the administration told a federal court it would stop enforcing—and may rescind—the new federal mental health parity rule for employer plans, weakening requirements intended to ensure equitable access to mental health and substance use care. (reuters.com)
¶ Republican Executive actions weakened public health institutions and capacity that support domestic health security
- Executive Order 14155 (Jan 20, 2025) directed U.S. withdrawal from the World Health Organization, revoked prior pandemic-response directives, paused future WHO funding, and recalled U.S. personnel. (federalregister.gov)
- Health policy experts warn that leaving WHO undermines global disease surveillance, vaccine coordination, and preparedness for threats such as avian influenza—reducing protective benefits for people in the U.S. as well. (healthaffairs.org)
- Reporting links concurrent U.S. foreign aid freezes/cuts to setbacks in global malaria control efforts, illustrating broader erosion of health capacity that can reverberate back to U.S. health security. (reuters.com)