The Three Most Foolish Republican Failures on Health Care

Republicans often claim they support health care programs, yet their policy choices suggest a different storyone focused on dismantling protections for the very people and principles they claim to prioritize. Recent GOP actions in health care reveal this disconnect clearly. Here are three major examples.

1. Small Businesses and ACA Subsidies

Republicans frequently praise entrepreneurs and small business owners, especially during occasions like National Small Business Week. However, their long-standing opposition to the Affordable Care Act (ACA) contradicts this rhetoric. The GOP has attempted to weaken or repeal the ACA more than seventy times over fifteen years. Their latest strategy is to end the enhanced premium subsidies that Democrats established, which will expire at the end of the year unless reversed.

Nearly half of adults under 65 with individual market coveragepeople buying insurance through ACA marketplacesare linked to small businesses, either as owners, self-employed entrepreneurs, or employees of companies with fewer than 25 workers, according to the Kaiser Family Foundation. By contrast, only 16% of all U.S. adults work in small businesses nationwide.

Pre-ACA research showed that U.S. small businesses were already at a disadvantage compared with other developed countries. Entrepreneurs often delayed starting businesses or faced job-lock due to employment-based insurance limitations. The ACAs support for small businesses has been called a game-changer for entrepreneurship. Without premium subsidies, advocacy groups warn that many small business owners would struggle to maintain coverage.

2. Work Requirements and Medicaid

Republicans often champion the idea that social programs should require skin in the game. In practice, these work and contribution mandates in Medicaid expansions created bureaucracy without improving health outcomes. Indianas program under Mike Pence, for example, required minimal monthly payments to a health savings account. The result was administrative headaches, coverage gaps, and no improvement in employment or health.

Under Trump, work requirements were implemented in thirteen states, the first in Medicaid history. A Harvard study later found that 18,000 eligible people lost coverage without increasing employment. The Biden administration later suspended or reversed these requirements, acknowledging their ineffectiveness. Yet, similar mandates are returning in national proposals set to take effect in 2027, despite experts labeling them among the worst features of new legislation.

3. Excluding Able-Bodied Adults from Medicaid

Some conservative leaders argue that able-bodied, single men shouldnt receive Medicaid expansion. This perspective ignores reality: these individuals often work low-wage jobs without insurance, and can face serious health emergencies or financial ruin from medical costs. Excluding them is not just politically and economically unwiseits a matter of common sense and fairness.

Political and Financial Consequences

These three misstepsattacking ACA subsidies, imposing burdensome work requirements, and excluding able-bodied adultsharm both the public and Republican political interests. Democrats have successfully highlighted rising health care costs, while local initiatives continue to support small businesses and accessible health care. Trumps voter base, which includes men, non-college-educated individuals, and families with modest incomes, may also be adversely affected.

Financially, these GOP policies could reduce federal spending by nearly $1 trillion over a decade, mainly by forcing ACA and Medicaid enrollees to lose coverage. This aligns with Republican priorities of tax breaks for the wealthy, yet comes at the expense of the broader populations health and financial security.

Ultimately, these policy decisions reveal a consistent pattern: prioritizing fiscal savings for the wealthy while undermining health care access for ordinary Americanspolitically and socially risky moves that show no signs of reversal.

Author: Aiden Foster