The unprecedented cuts to Medicaid in President Donald Trump’s tax bill rightfully garnered headlines in recent months. After all, the latest estimates from the Congressional Budget Office predict some 10 million people eventually will lose their public insurance.
But attention now should turn to the less visible ways his policies are undermining the Affordable Care Act.
Instead of the full-blown attack on the ACA waged in his first term, when Trump tried — and failed — to repeal the law, he is letting crucial parts of it wither on the vine, and millions of Americans will be affected while potentially not even realizing who is to blame.
Some will log in to sign up for care in 2026, only to discover their plan has gotten a lot more expensive — and an estimated 4.2 million of them will risk going uninsured because of it.
“It’s a stealth sabotage,” says Benjamin Sommers, a physician and health economist at the Harvard T.H. Chan School of Public Health. “Many folks won’t even see the small print that led to that outcome.”