As of July 2025, there have been significant cuts and changes to Obamacare (the Affordable Care Act or ACA), and more are anticipated.
Here’s a breakdown of the key developments:
Recent Legislation (The “One Big Beautiful Bill Act”):
Passed by Congress and signed into law by President Trump (July 2025): This comprehensive tax and spending bill includes substantial cuts to federal funding for Medicaid and the Affordable Care Act.
Expected Coverage Losses: The Congressional Budget Office (CBO) estimates that an additional 11.8 million people could become uninsured by 2034 due to this bill, with some analyses suggesting up to 17 million total when other policy changes are considered.
Medicaid Cuts: A large portion of the coverage loss is expected to come from Medicaid cuts, including new work requirements for able-bodied adults, more frequent eligibility reviews (every six months instead of annually for ACA expansion enrollees), and reduced federal matching rates for states that cover certain immigrants.
ACA Marketplace Changes:
Premium Tax Credit Expiration: Enhanced premium tax credits, which significantly reduced costs for many enrollees and led to record enrollment, are set to expire at the end of 2025. This is expected to cause out-of-pocket premiums to rise substantially (an average of over 75%), leading millions to drop coverage.
Stricter Enrollment Requirements: The bill, along with a recent Trump administration rule, introduces more rigorous income verification processes and eliminates the year-round enrollment opportunity for very low-income individuals. Automatic re-enrollment, used by a large percentage of enrollees, will end for the 2028 sign-up season.
Documentation Requirements: People applying for or renewing coverage will need to provide more documentation of income, household size, and immigration status to qualify for premium tax credits.
DACA Recipients Excluded: Deferred Action for Childhood Arrivals (DACA) recipients are explicitly excluded from eligibility for Marketplace plans and premium tax credits.
Shorter Open Enrollment Period: The annual open enrollment period for 2027 plan year onwards will be standardized to end by December 31, a month earlier than some previous periods.
Out-of-Pocket Maximums: Proposed changes could increase annual out-of-pocket limits for both Marketplace and employer plans.
Other Notable Changes and Context:
Trump Administration Rules: The Trump administration has finalized rules that will contribute to more people becoming uninsured, focusing on “program integrity” and combating what it considers fraud.
Navigator Program Cuts: Funding for the Navigator program, which helps people sign up for health insurance, has been significantly cut by the Trump administration.
Incremental Dismantling: Critics argue that these changes represent a less transparent, incremental approach to dismantling the ACA, aiming to reduce enrollment and spending.
Impact on States: States are bracing for significant operational and financial challenges in implementing the new law, with potential reevaluations of their budgets.
In essence, while a full repeal of the ACA has not occurred, recent legislative and administrative actions are projected to significantly roll back its coverage gains, primarily through cuts to Medicaid and changes that make ACA Marketplace coverage more difficult to access and less affordable for many.
QUINNSCOMMENTARY 
One last time, all this law does is return us to a less stupid world when it comes to health coverage – what President Obama’s law provided and what President Clinton’s law required.
Consider this: Federal poverty level of 400% for a family of four is $103,000 this year.
Tell me, why should a taxpayer earning the median income of about $58,000 a year, who is the sole income in his family, probably contributing two to three hundred dollars a year for his employers coverage of his family of four, have to pay more taxes so that a family of four, with two earners, each at almost the same income level, almost twice the household income, should receive a taxpayer subsidy for health coverage?
That is stupid, no? That is vote buying, right?
After the law takes effect, Health Reform still continue to provide taxpayer subsidized health coverage through the Exchange. The new legislation reverts us to pre-COVID structure which was in effect from the date the Exchanges were added in 2014 until 2020.
Here is what happens to the taxpayer subsidies, for a SILVER level insurance option – probably better coverage than what most workers have through their employer:
FPL – With Added Subsidy – Original ACA, 2026
< 150% – 0% – 2.07 – 4.14%
150-200% – 0% – 2% – 4.14% – 6.52%
200-250% – 2.0% – 4.0% – 6.52% – 8.33%
250-300% – 4.0% – 6.0% – 8.33% – 9.83%
300-400% – 6.0% – 8.5% – 9.83%
>400% – 8.5% – Subsidy Eliminated
Tell me again, why is Health Reform so bad? If Health Reform was so great, so why do you denigrate returning to pre-COVID levels now that we are mostly post-COVID?
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