Obamacare is under threat in Trump's tax bill

President Donald Trump's "big, beautiful" spending bill has gotten attention for its potential slashes to Medicaid, but analysts say another aspect of the American health care system could also be in jeopardy: Obamacare. If Trump's bill becomes law, it could put former President Barack Obama's signature health care statute, the Affordable Care Act, at risk. This could slash the number of Americans who can rely on the ACA — something Republicans have long pined for.

Millions could lose insurance

Trump's bill, already passed by the House of Representatives, would create several obstacles for people trying to sign up for Obamacare, health industry analysts say. This would "result in millions of people losing insurance coverage to help pay for Trump's tax cut extension," said The Hill. Many of the conversations "echo some of the debate surrounding the 2017 effort to repeal" Obamacare during Trump's first term.

Some of the changes to Obamacare could include "reductions to enrollment periods, adjustments to formulas, and additional paperwork requirements," said The New York Times. Premium subsidies for the program could also be at risk, as "additional Obamacare funding is set to expire at the end of the year, and Republicans do not plan to extend it." If all of this comes to fruition, about 4.2 million Americans would lose their health care, according to the Congressional Budget Office. When also factoring in Medicaid, the CBO estimates that 11 million people total could lose their insurance due to the bill.

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Trying to get a plan through Obamacare could also become more difficult, as the bill could "lead to higher premiums for people who shop for plans on the Obamacare exchanges and cause massive turmoil for actuaries," said Politico. This could leave "officials with little time between when the law is enacted and the start of open enrollment in the fall" to understand how the bill fully affects Obamacare. The expiration of premium subsidies could also "lead to insurance premiums increasing so steeply they could jeopardize the Obamacare market."

Republicans changing course

The Republicans' health care agenda as outlined in Trump's bill is a "notable departure from the Obamacare repeal and replace Republicans pursued for years," said The Washington Post, as the GOP is "not branding it a repeal." But their approach "still undermines the law's broad goal of getting most Americans covered."

It is "very much like a backdoor repeal and replace," said Matt Salo, the former executive director of the National Association of Medicaid Directors, to the Post. Republicans have "been too cute by half by doing it but not calling it that." Even though it is not a repeal and replace plan per se, the "coverage losses would be among many of the same people who would have lost their insurance under ACA repeal," said Larry Levitt, the executive vice president for health policy at the health nonprofit KFF, to the Post.

Republicans are angling around this by saying the bill would "merely reduce 'waste, fraud, and abuse' in Medicaid and other government health programs," including Obamacare, said CBS News. But others seem unconvinced. The bill is "their ACA repeal wish list without advertising it as Obamacare repeal," said Philip Rocco, an associate professor of political science at Marquette University, to CBS. This is because Republicans learned that the "headline of Obamacare repeal is really bad politics." This all comes as 64% of Americans have a favorable view of Obamacare, according to a January 2025 KFF poll.