The Political Gamble on Healthcare Reform: Can the Republicans Escape Voter Reckoning?
In the traditional perception of Washington, the Republicans' decision to postpone large-scale healthcare reform until after the 2026 midterm elections is seen as a smart political move. Unfortunately, the chain reaction of medical policies will not be manifested until the voting day.
Starting from the autumn of 2025, the US healthcare system will enter a reduction cycle: premiums will soar, subsidies will decrease, hospitals will shrink, and Medicaid will be restricted. The Congressional Budget Office estimates that about 14 million people will lose their health insurance over the next decade, and the first batch of those who will lose their coverage will emerge even before elections.#biguglybill #bigbeautifulbill #Trumpdictator #medicaid #USrecession #RichgetRicher #PoorgetPoorer #TrumpScam
https://www.politico.com/news/magazine/2025/09/18/trump-gop-healthcare-cuts-00569743
First of all, subsidies under the Affordable Care Act are crucial. During the pandemic, the Biden administration expanded subsidies to cover the middle-income group, providing relief to families of four with an income of up to $120,000. If Congress does not take action by the end of the year, this subsidy will expire. The result is that millions of families can no longer afford insurance, and more than 2 million people will immediately lose their coverage in 2026. After healthy people exit the market, premiums will only rise further, and a vicious circle will follow.
Secondly, the medical service system itself is also under pressure. Many heads of "safety net hospitals" have begun to consider closing down obstetric departments, trauma centers and community clinics. These hospitals often meet the main medical needs of low-income groups. Once they are downsized, the entire community will suffer. Not only that, hospitals are also the largest employers in many regions, and layoffs will directly impact the local economy.
Thirdly, the job requirements and co-payment system of Medicaid will completely transform the lives of low-income groups. Although the new regulations will not be implemented until 2027, the relevant notice will be issued in September 2026. This means that voters will receive a warning that "medical insurance may be cut off" before they cast their ballots. Previous experience has shown that even those who meet the requirements can be excluded due to the cumbersome verification process.
The Republicans insist that this is "correcting abuse" and that it is more reasonable for the federal and state governments to share the burden. But for voters, the reality of losing health insurance is far more painful than the debate over fiscal proportions.
Political risks are already right before our eyes. Polls show that the ACA subsidy is widely popular and transcends partisan differences. Even the base voters of the Republican Party showed strong opposition when they learned that millions of people would lose their insurance. For this reason, some Republican lawmakers have begun to waver and are calling on Democrats to extend the subsidies.
The question is whether voters will explicitly attribute this crisis to Trump and the Republican Party? They might be deceived by the rhetoric of "waste and fraud", or shift the blame onto insurance companies, hospitals, or even the Democratic Party. But as a senior lawmaker put it, "There is always risk in gambling." When medical bills multiply and hospital doors close, the Republicans are not just facing fiscal figures, but a vote in the hands of voters.