President Donald Trump signed a series of executive orders on Monday that could impact nearly 24 million Americans, including large numbers of people in Republican states.
These orders, aimed at dismantling key provisions of the Affordable Care Act (ACA), or Obamacare, would tighten enrollment periods and reduce federal subsidies—changes that the administration says are meant to streamline the process and reduce federal expenses.
Critics argue these changes could result in reduced health care coverage for millions of Americans, particularly in Republican states that have not expanded Medicaid.
Why It Matters
Trump's executive actions reversed expansions that were crucial in increasing health care accessibility under the ACA during the Biden administration.
These reversals could particularly impact Republican states such as Texas, Florida and Georgia, which have some of the highest enrollment rates in the ACA.
Known for their higher uninsured rates due to the lack of Medicaid expansion, these states could see increases in health care costs and a decrease in overall health security for millions of Americans.
What To Know
On his first day in office, President Trump issued executive orders that significantly altered key aspects of the Affordable Care Act, particularly targeting expansions aimed at increasing coverage and reducing costs. These changes are part of a broader strategy to reduce federal health care spending but could make insurance less accessible, especially in states that did not expand Medicaid.
Trump's Plan on Health Care
Trump's executive orders effectively rescinded policies that had previously extended open enrollment periods and increased federal subsidies. This shift is central to President Trump's health care strategy, which critics have labeled "Trumpcare." The objective is not only to dismantle prior ACA expansions but to also introduce a system that significantly alters the health care landscape.
Impact on Enrollment and Subsidies
Allison K. Hoffman, health care policy expert and professor of law at the University of Pennsylvania Carey Law School, told Newsweek that while these policies are likely to reduce ACA marketplace enrollment, the impact may not be severe.
However, the reduction in enrollment periods and subsidies could discourage many Americans from obtaining insurance, particularly those experiencing significant life changes such as job loss or relocation.
State-Level Impact: Affordable Care Act Marketplace Enrollment
In 2024, Florida (4.2 million), Texas (3.5 million), California (1.8 million) and Georgia (1.3 million) led the nation in ACA marketplace enrollments.
This indicates a high demand for Affordable Care Act plans, particularly in states like Florida, Texas and Georgia that have not expanded Medicaid.
What People Are Saying
Allison K. Hoffman, health care policy expert and professor of law at the University of Pennsylvania Carey Law School, told Newsweek: "These early executive orders are the low-hanging fruit. They may or may not be emblematic of exactly what is to come, but they do signal that Congress and the Trump administration will not prioritize, for example, ensuring that Americans have good, affordable health insurance or that public health processes are in place in the case of future crises. That theme is consistent with early Congressional proposals on how to save money from health care to fund tax cuts or other priorities."
Kevin Thompson, founder and CEO of 9i Capital Group, previously told Newsweek: "The most vulnerable populations will be the hardest hit. Non-expansion states—many of which are red states—tend to have higher percentages of their populations enrolled in the ACA Marketplace. These states will face significant challenges with shorter enrollment periods and reduced subsidies. What was once campaigned as "we won't touch entitlements" is now coming dangerously close to contradicting that promise."
Xavier Becerra, who served as the Secretary of Health and Human Services under the Biden-Harris administration until early 2025, said in a recent press release: "Since the law was enacted, 50 million people — or one in seven Americans — have signed up for coverage through the Marketplace. Now, Congress must do its job so those millions of Americans remain covered. The tax credit that has helped people purchase coverage will expire at the end of 2025 unless Congress makes it permanent or extends it. Congressional inaction would result in costs going up. More than five million people could lose their coverage entirely, and millions of other hard-working Americans could face premium increases of more than 50%. The Affordable Care Act belongs to the American people. Let's keep it that way."
President Donald Trump said in a press release on Monday: "The previous administration has embedded deeply unpopular, inflationary, illegal, and radical practices within every agency and office of the Federal Government. The injection of 'diversity, equity, and inclusion' (DEI) into our institutions has corrupted them by replacing hard work, merit, and equality with a divisive and dangerous preferential hierarchy... To commence the policies that will make our Nation united, fair, safe, and prosperous again, it is the policy of the United States to restore common sense to the Federal Government and unleash the potential of the American citizen. The revocations within this order will be the first of many steps the United States Federal Government will take to repair our institutions and our economy."
What Happens Next
As Trump's executive orders begin to take effect, the implications for health care policy and coverage will become clearer.
"... More changes are likely to come for the ACA marketplaces. In particular, Congress may not extend the enhanced tax credits that have enabled many more people to afford coverage. The tax credits end at the end of 2025 unless extended," said Hoffman.
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