Why Do Trump and GOP Lawmakers Want More Uninsured Americans?

Connor Tarter (CC-BY-SA)

Since the passage of the Affordable Care Act (ACA) during the Obama administration, the number of Americans without health insurance has declined. Yet the Trump administration and the Republican congressional majority appear intent on reversing that trend.

The ACA had two main elements. First, it offered states federal funding to expand Medicaid eligibility to people earning up to 138% of the federal poverty level (FPL). In 2025, that equates to about $23,600 for an individual. To encourage states to expand Medicaid, the federal government set its share of expansion costs higher than for traditional Medicaid.

The next graph shows the expansion of Medicaid before and after the ACA, using data from KFF, formerly the Kaiser Family Foundation. Each yellow dot represents a state. The horizontal axis shows the percentage of each state’s population enrolled in Medicaid before the ACA. The vertical axis shows the percentage enrolled as of June 2025.

On average, enrollment increased by 5 percentage points, as shown by the trend line. For example, states with 20% Medicaid enrollment before the ACA would now be expected to have about 25%. This result surprised some observers, who expected states with lower initial enrollment to see greater growth than states with higher enrollment.

Wisconsin is represented by the black ring. Its Medicaid enrollment rose from 16.3% to 18.7%, less than the growth in most states. This relatively modest increase reflects the state’s approach to the ACA. Wisconsin is one of 10 states that declined the federal government’s offer of more funding for Medicaid. It is the only one of the 10 that set the poverty level as the upper income limit for its Medicaid program, BadgerCare.

This decision meant some people, often parents with children, no longer qualified for BadgerCare. But they could purchase subsidized private health insurance on the ACA Marketplace. That made room in BadgerCare for childless adults with incomes below the poverty level.

The result is that Wisconsin’s Medicaid program has an upper income boundary of 100% of the poverty level rather than the 138% typical of most states.

Percent Medicaid before ACA

The next graph shows KFF’s estimates of the number of Wisconsin residents projected to lose health insurance starting in 2026, shown in green. The estimates are based on calculations by KFF, using data from the Congressional Budget Office, and carry a degree of uncertainty.

Number of Wisconsin Residents Losing Health Insurance

Not surprisingly, small-business owners and employees are disproportionately represented among those who get their insurance through the ACA Marketplace, according to KFF. As the next graph shows, while they make up 16.3% of the adult population under 65, they account for nearly half — 48.2% — of small-business owners and employees.

For many, the loss of enhanced tax credits could make health insurance unaffordable. Traditionally, small businesses have been pillars of the Republican Party.

This reflects a pattern seen during the Trump administration: policies often harmed some of his own supporters.

Share of general population versus self employed and small business

In recent years, the number of Americans without health insurance has dropped significantly. It is disturbing that Trump and the state’s congressional delegation are working to roll back that progress.