Healthcare Costs and the Medicaid Cliff

4. Healthcare Costs and the Medicaid Cliff

The "Big Beautiful Bill" signed in 2025 included an estimated $1 trillion in Medicaid cuts, and the Affordable Care Act's enhanced premium tax credits expired at the end of 2025, driving up costs for millions of Americans who buy their own insurance ⁴. In 2026, 1.4 million fewer Americans selected marketplace health plans, and that number is expected to grow ⁴. Americans with employer-sponsored insurance also face higher deductibles and cost-sharing under new administration regulations ⁴. Trump's worst issue-specific disapproval ratings come on healthcare (52%) and the economy (51%) ¹⁶.

The political dimension: Healthcare was the defining issue of the 2018 blue wave, and the conditions in 2026 are worse on several measures. Joni Ernst's comment that "we all are going to die" in reference to Medicare has already been used as a recruitment tool by Iowa Democrats. Candidates running on healthcare expansion have a concrete, personal argument in every district where hospitals are closing and premiums are rising - and it's an argument that reaches voters across partisan lines, since Medicaid recipients and ACA enrollees include a substantial share of Republican voters in red states.