Senate Majority Leader John Thune (R-South Dakota), Senator John Barrasso (R-Wyoming), and Senator Mike Crapo (R-Idaho) exited the West Wing of the White House on June 4, 2025, just as the Senate commenced deliberations on President Donald Trump’s expansive “Big Beautiful Bill.” This bill, which narrowly passed the House on May 22, raises significant concerns among Republican senators regarding its staggering costs and cuts to essential programs, including Medicaid and clean energy tax credits.
Photographer: Eric Lee/Bloomberg via Getty Images
The Republican leadership is considering legislation projected to slash billions from the Affordable Care Act, potentially leaving millions without health coverage. These glaring cuts do not align with the needs of their constituents, as polling indicates widespread discontent.
Surprisingly, nearly half (45%) of adults enrolled in ACA health plans identify as Republicans, according to a recent survey by KFF, a nonpartisan health policy research group.
A note-worthy segment of this Republican demographic — over three-quarters — aligns with “MAGA” principles, underscoring that a substantial number of ACA users are critical constituents of the party. Meanwhile, only 35% of Democrats use these insurance plans.
In May, House Republicans passed a multitrillion-dollar tax and spending package designed to cut approximately $900 billion from vital health programs, including Medicaid and the ACA. As this measure moves to the Senate, it is crucial to remember that it encapsulates several of President Trump’s domestic priorities. The goal is to pass this behemoth by the Fourth of July.
If implemented as currently drafted, without extending crucial tax credits that help reduce ACA health premiums, an estimated 15 million individuals could lose their health insurance, according to the Congressional Budget Office. This is nothing short of a betrayal to a significant portion of their base, as highlighted by Audrey Kearney, a senior survey analyst at KFF.
The survey, conducted among a nationally representative sample of 2,539 U.S. adults between May 5 and 26, illustrates the real consequences of government action.
Republicans more likely to be self-employed
The ACA exchanges primarily cater to Americans without employer-sponsored coverage. Self-employed individuals, who represent a larger percentage of Republicans, find themselves navigating this coverage gap. Naturally, their skew towards self-employment makes the higher enrollment rates among Republicans in ACA plans understandable, as articulated by Kearney.
Research indicates that 5.5% of Republicans venture into entrepreneurship, compared to just 3.7% of their Democratic counterparts, reflecting the values of hard work and individual initiative that Republicans espouse.
Many red-leaning states didn’t expand Medicaid
The Affordable Care Act was designed to broaden Medicaid coverage. However, 10 states — Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming — opted not to adopt this expansion, all of which were Trump strongholds in the 2024 presidential election.
Republicans inhabit a higher proportion of non-expansion states, according to John Graves, a professor of health policy and medicine. This fact adds another layer of complexity to the current healthcare enrollment landscape.
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In non-expansion states, a larger population is eligible for tax credits that make ACA plans more accessible. For those who reside in expansion states, almost all adults earning up to 138% of the federal poverty line qualify for Medicaid.
However, in non-expansion states, the subsidy structure is designed to assist those between 100% and 138% of the poverty line, including many low-income Republicans.
The Affordable Care Act has faced relentless criticism from Republicans since its inception. Yet, features within this legislation, such as the establishment of ACA marketplaces, protections for individuals with pre-existing conditions, and the extension of parental coverage until age 26, enjoy substantial bipartisan support. This paradox highlights the disconnect between political rhetoric and the needs of the American people.
As of 2023, nearly 1 in 7 U.S. residents have engaged with ACA marketplace plans since their rollout in 2014, according to a 2024 report from the U.S. Department of the Treasury.
Polling data consistently shows that while Republicans are often unfavorable toward the ACA, the individual provisions resonate positively with the public. This discrepancy need not exist if leaders prioritize the American people over entrenched political narratives.
