Out with the old strategy: “Repeal And Replace”
In with the new: Quietly gutting the ACA with no replacement

As we approach the 15th anniversary of the Affordable Care Act (ACA), Republicans are once again attacking health care.

For years, their strategy was clear: “repeal and replace.” Their goal? Dismantle the ACA and strip quality, affordable coverage from the more than 44 million people who rely on it.

That was Trump’s playbook in his first term. But this time, Republicans have a new approach: rather than a high-profile repeal, they’re quietly gutting the ACA—piece by piece, under the radar, with no plan to replace it.

Here’s how they’re doing it:

1. A Direct Attack on Medicaid: $880 Billion in Cuts, Millions at Risk

Trump endorsed and House Republicans passed a budget resolution that would slash $880 billion from Medicaid—the largest cut in the program’s history. These cuts put health care at risk for 70 million people, including children, people with disabilities, and older adults. This is about one-fifth of the U.S. population. States will be forced to make impossible choices: repeal Medicaid expansion, drop critical benefits like dental and mental health care, or deny substance use treatment.

The Impact:

Millions will lose access to care, families will be pushed deeper into medical debt, and hospitals and providers—especially in rural areas—will face financial strain, with many hospitals likely to close and put entire communities at risk.

Matthew’s Story: A Life Transformed by Medicaid

Ten years ago, Matthew McFarland was battling addiction and serious health issues, including stage 3 liver damage from Hepatitis C. Luckily, he was able to sign up for Medicaid. That access saved his life, cured his illness and helped him heal, both mentally and physically. Matthew credits Medicaid for how he contributes to his community now. He is currently a Vice President at TASC, Inc. (Treatment Alternatives for Safe Communities) as well as a proud father and homeowner.

“If it wasn’t for Medicaid, I wouldn’t be here,” Matthew says. “Please, do not end or restrict Medicaid. It is vital to people like me and my daughter, who welcomes me home every day.”

Matthew’s story is proof: Medicaid doesn’t just provide care—it helps people rebuild their lives. Trump and Republicans’ cuts would take that chance away.

2. Trump Gutted the ACA Navigator Program, Making It Harder to Enroll in Affordable Coverage

Trump slashed the ACA Navigator program budget by 90%, cutting resources for the trusted, community-based experts who help people enroll in affordable health care coverage and avoid junk health insurance plans.

The Impact:

Fewer people get the trusted, unbiased guidance they need, leading to lower enrollment and more people going uninsured. Signing up for health insurance is confusing and daunting. Many may unknowingly enroll in skimpy plans that don’t cover essential services like maternity care, mental health treatment, or prescription drugs—exposing them to massive medical bills.

Walter’s Story: Navigators as Lifelines

Walter Moreau, director of Foundation Communities in Texas, saw firsthand how critical navigators are. His organization helped nearly 7,000 people enroll in coverage with federal support—but drastic funding cuts made that work nearly impossible.

Without navigators, thousands of people—especially those with chronic conditions or unstable incomes—were left struggling to find coverage, leading to lower enrollment and more confusion.

3. Slashing Open Enrollment and Blocking Coverage for DACA Recipients

Trump and Republicans are making it harder for people to sign up for ACA coverage by scaling back open enrollment periods and restricting access for DACA recipients. The Biden administration expanded ACA access to DACA recipients for the first time—finally allowing hundreds of thousands of young people, who have lived in the U.S. since childhood, to get health insurance. Now, Republicans are trying to reverse that progress, limiting enrollment windows and cutting off access for Dreamers.

The Impact:

Shortening open enrollment means fewer people will sign up for coverage, leaving millions uninsured or stuck with expensive, inadequate plans. And by blocking DACA recipients from ACA access, Republicans are ensuring that hundreds of thousands of young people—many of whom are neighbors, teachers, firefighters, nurses, contributing to their communities, working, and paying taxes—will be left without care, forcing them into financial and health crises.

Selene’s Story: A Dreamer’s Struggle with Health Access

Selene Cruz, a DACA-protected teacher from Laredo, Texas, has faced significant mental health challenges due to her immigration status. She has experienced pervasive fear, anxiety, and uncertainty, exacerbated by potential deportation threats to her and her students’ families. These challenges are intensified by the lack of access to health insurance and mental health resources.

Despite these obstacles, Selene continues to advocate for herself and her community, highlighting the critical need for accessible health care for all, regardless of immigration status.

4. Trump’s Executive Order Rolls Back Protections, Putting Affordable Coverage at Risk

Trump signed an executive order to undo a Biden-era directive that strengthened the ACA and Medicaid, ensuring more people had access to affordable, high-quality health care. By rescinding these protections, Trump is making it harder for people to enroll, driving up costs, and leaving millions at risk of being uninsured.

The Impact:

Medicaid enrollment will decline, especially for children and low-income families. Insurers could exploit weakened oversight to raise premiums or push junk plans with little real coverage. Hospitals, particularly in rural areas, will face rising uncompensated care costs, further destabilizing the health care system.

Case Study: The Consequences of Policy Reversals

We’ve seen this before. In 2017, when Trump cut payments to insurers that lowered the amount people had to pay out-of-pocket for health care, ACA premiums spiked, insurers exited the marketplace, and millions faced higher out-of-pocket costs or lost coverage. This latest rollback threatens to do the same—reducing access, increasing costs, and putting more families at risk for increased medical debt.

5. Trump and Republicans Are About to Raise Health Care Costs for 20 Million People

Trump and Republicans are letting ACA tax credits expire, which have kept premiums affordable for 20 million people. These tax credits ensure no one pays more than 8.5% of their income for ACA plans—but Trump and Republicans refuse to extend them, while pushing tax cuts for billionaires.

The Impact:

Without action, premiums will skyrocket, pricing millions out of coverage. Many will be forced into bare-bones plans, go uninsured, or take on crushing medical debt—all while Republicans prioritize giveaways to the wealthy.

Jason’s Story: Tax Credits Save Lives

Jason, a freelance illustrator, relies on ACA tax credits to afford health insurance. Shortly after accessing insurance through premium tax credits, Jason was able to go in for a check up where he was diagnosed with thyroid cancer. Without coverage, he would have missed this diagnosis and wouldn’t have been able to afford the care and treatment he’ll need for the rest of his life. He’s on the road to recovery now and shares his experience to advocate for the extension of tax credits. 

“Not to be too blunt about it, but people are going to die without these tax credits, because they’re going to lose their coverage,” Jason said.

“Not only did this plan save my life, along with the doctors [but] I don’t know what I’ll do if it’s taken away. It would be catastrophic for me to lose this coverage. And that’s why I think it’s imperative [to] extend these tax credits or possibly even make them permanent.”

6. Trump and Republicans Are Threatening to Reinstate the “Family Glitch,” Putting Health Care Out of Reach for Millions

Trump and Republicans want to repeal the fix for the “family glitch,” a loophole that blocked over five million people—mainly women and children—from accessing affordable coverage. The Biden administration fixed it, ensuring families could finally get ACA tax credits. Now, Republicans want to undo that progress.

The Impact:

Millions of families could be priced out of health coverage again, forcing impossible choices between health care, rent, and food. Without coverage, people will delay or skip care, leading to worse health outcomes and more medical debt.

Felicia’s Story: A Win That Could Be Erased

For years, Felicia struggled to afford coverage for her children. Though her job offered “affordable” individual insurance, adding her family made premiums unaffordable—yet she wasn’t eligible for ACA tax credits. She spoke out, joining advocates in pushing for change.

Learn more about Felicia here

In 2023, the Biden administration finally fixed the glitch. Now, that progress is under threat. If Trump and Republicans succeed, families like Felicia’s will be right back where they started—facing skyrocketing premiums and an unfair system that puts profits over people.

Don’t Be Fooled—This New Strategy Is Just as Dangerous as Repeal

Republicans know outright ACA repeal was and is deeply unpopular. So instead, they’re taking a more insidious approach—drastically unwinding protections, cutting critical funding, and letting health care costs rise.

But the goal is the same: strip away affordable, comprehensive coverage, benefit the wealthy, and leave everyday people struggling to afford essential care.

We can’t let them get away with it.

Add your name to this petition and send a message to your representatives demanding they protect Medicaid and reject these dangerous cuts.