Donald Trump and congressional Republicans have found a sneaky new way to gut Obamacare without the messy optics of an outright repeal—and experts say it could be even more damaging than their failed 2017 effort.
Unlike the dramatic showdown that saw John McCain's famous thumbs-down save the Affordable Care Act, Republicans barely mentioned healthcare while ramming through Trump's massive domestic agenda package this year. But they're quietly pushing through changes that cause severe damage to former President Barack Obama's signature act, CNN reported.
"The net effect of the changes they are making is a partial repeal of the ACA," warned Larry Levitt, executive vice president for health policy at KFF.
“Many of the changes are so technical, it may be hard for the public to grasp what’s happening."
The so-called "big, beautiful bill," combined with new rules from the Centers for Medicare and Medicaid Services, is projected to leave millions more Americans without health coverage while jacking up costs for those who manage to keep their plans. The Congressional Budget Office forecasts that 2.1 million more people will be uninsured by 2034.
But even more immediately, up to 1.8 million people could lose their Obamacare coverage next year, with losses concentrated in GOP-led states including Florida, Georgia, South Carolina, and Texas.
The Republican assault includes brutal new verification requirements that effectively kill automatic reenrollment—a system that covered nearly 11 million people in 2025. Now, enrollees must verify their income upfront and face the nightmare of paying back entire subsidy amounts if they underestimate their earnings, CNN reported.
"It's a radical weakening of what the marketplaces will be able to deliver in the next few years," said Jennifer Sullivan from the Center on Budget and Policy Priorities.
The carnage extends beyond coverage losses. The rule forces low-income enrollees to pay $5 monthly for previously free plans, shortens enrollment periods, and bars certain legal immigrants—including refugees and trafficking victims—from receiving federal assistance.
Insurers are already fleeing. Aetna announced it won't offer Obamacare coverage next year, while remaining companies have proposed a median 18% premium hike for 2026—more than double last year's increase.
Republicans defend the changes as fraud prevention, with former Trump adviser Brian Blase claiming the bill "restores the ACA, rather than repeals it." But healthcare advocates aren't buying the spin.
The timing couldn't be worse. Enhanced federal premium subsidies that helped drive record Obamacare enrollment expire at the end of 2025, threatening to send premiums soaring even higher.
"It will be a tumultuous few years," Sullivan predicted, as millions of Americans brace for the healthcare chaos ahead.