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Daily news & progressive opinion—funded by the people, not the corporations—delivered straight to your inbox.
Any self-proclaimed deficit hawk who is not all hair on fire about Trump’s budget demand is a lying hypocrite who only uses concerns about the deficit to argue against programs they don’t like.
President Donald Trump is asking for $1,500,000 million for the military for next year. That’s close to $600 billion (adjusted for inflation) more than we were spending on the military in fiscal year 2025, before Trump took office.
This increase is huge by any measure. It comes to around $4,600 per household. It is around 8% of the total budget. This spending request dwarfs sums that are often the subject of major debates in Washington.
For example, last year Democrats pushed to have the enhanced subsidies in the Affordable Care Act exchanges extended. This would have cost $30 billion a year, one twentieth of what Trump and Pentagon chief Pete Hegseth are demanding.
People may recall Elon Musk gleefully putting the US Agency for International Development into the “wood chipper” last spring. While ending this program is expected to lead to 4 million additional deaths over the next four years, it only saved around $35 billion a year. That is less than 6% of the increase in military spending that Trump is asking for.
Is the argument that in just 18 months in office, Trump has made the world so much less safe that we have to increase the defense budget by two-thirds?
The annual cost of extending the enhanced child tax credit, which cut child poverty in half, was around $100 billion a year, less than one-fifth of Trump’s proposed increase. And the annual appropriation for the Corporation for Public Broadcasting was $550 million, less than one thousandth of the additional spending for the military that Trump is demanding. (It’s in the chart, just small to see.)

People need to know that Trump’s military spending request is really big money, compared to almost anything else that ever comes up for public debate for Congress. Unfortunately, because of incompetent or corrupt budget reporting, few news accounts make any effort to put these huge numbers in a context that makes them understandable for their audience. As a result, most people will probably have little idea of what is at stake with this military request.
Any self-proclaimed deficit hawk who is not all hair on fire about Trump’s budget demand is a lying hypocrite who only uses concerns about the deficit to argue against programs they don’t like. We got along fine with the former level of military spending, which almost everyone, including Donald Trump in his first term, considered adequate.
Is the argument that in just 18 months in office, Trump has made the world so much less safe that we have to increase the defense budget by two-thirds? Most of us knew that making our former allies into enemies was not a good idea, but Trump is placing a huge price tag on this mistake. And remember, this is Trump’s own number, not his critics’.
As politicians debate “universal healthcare,” we need those two words to be much more than a campaign slogan or an empty promise. Healthcare must be a true human right, easily exercised by every single person in America.
As a Maryland pediatrician, I serve patients and communities who struggle at the broken edges of the American healthcare “system.” My patients are from families working three or four jobs with no benefits, just barely getting by. With more grace than I could ever summon, these families diligently follow the protocols to determine their children’s “eligibility” for healthcare. The American healthcare system scrutinizes a family’s pay stubs, bank statements, and employment status—a process called means testing—to determine if they are eligible for Medicaid or a pittance of help to purchase a private insurance plan. It is not enough to be a human being. Our healthcare system must determine where you are on the spectrum of worthy to unworthy before you can get any medical care.
My pediatric patients whose parents get health insurance through their employment are not doing much better. An inhaler that helps an asthmatic breathe easier is covered by the insurance corporation one year, but not the next. Similarly, a specialist who has masterfully managed a patient’s seizures for several years is suddenly “out of network.” Never mind that the patient’s parents are paying premiums from every single paycheck to that multibillion-dollar insurance corporation. Playing by the corporate greed machine’s rules does not protect patients from arbitrary decisions that are supposedly good for business.
Over the course of my 20 years working in healthcare, I have seen more and more patients with supposedly good insurance avoid necessary medical care because the out-of-pocket costs keep increasing. In the richest country in the world, families are stuck between the false choices of paying for rent, groceries, utilities, or healthcare. Choosing healthcare can cost anywhere from feeding your family to putting a roof over their head.
All of us are trapped in this infuriating maze of puzzles and peril. Looking at this cruel mess of a system, we have politicians saying a “public option” is enough to fix things. There are think tanks describing a system of “universal healthcare” where the expensive (and yet, worthless) plans from private insurance corporations, the 50 shades of Medicaid, and a public option somehow achieve a magical harmony. To make things even more complicated, it is unclear what exactly a public option could look like. It could mean patients have the option of buying into Medicare or Medicaid. Or it could mean a separate public insurance plan at the federal level, possibly available to everyone or possibly just the ones deemed needy enough.
Medicare For All is true universal healthcare, where patients and families have peace of mind whenever and wherever they need medical help.
We need to be clear about what “universal healthcare” ought to mean. Everybody getting expensive-but-worthless plans from insurance corporations is universal financial stress, not universal healthcare. Similarly, adding any kind of “public option” fragment to a ridiculously fragmented system is universal confusion, not universal healthcare.
Insurance corporations have a long track record of deploying lobbyists and misinformation to undermine provisions of the Affordable Care Act. It is foolish to think these greed machines will become good-faith partners in our healthcare, competing fair and square with any kind of public option. Corporate lobbyists will see to it that any public option uses complicated means testing to determine which members of the public are worthy or unworthy of the care. These corporations will also manipulate their own plans to shut out patients who need healthcare the most, leaving them to a public option struggling to pay doctors and hospitals. Insurance greed machines do not want competition, and will undermine a public option any way they can.
Rather than tinker with a corporate-driven healthcare system determined to put profits before patients, let’s build universal healthcare through Medicare For All. Because healthcare is a human right, Medicare For All guarantees every single person living in America is eligible. We can save billions of dollars when we stop scrutinizing who is worthy or unworthy. Medicare For All provides the kind of coverage that stays with people from cradle to grave. It is mobile coverage, staying with patients from state to state, or job to job. Hospitals and clinics will remain open and properly staffed because Medicare For All puts patients first, not profits. Because all 342 million of us are covered, Medicare For All will have powerful leverage to negotiate with Big Pharma about the cost of prescriptions. Medicare For All is true universal healthcare, where patients and families have peace of mind whenever and wherever they need medical help.
We have tolerated an intolerable healthcare system for far too long. In the coming years, as politicians debate “universal healthcare,” we need those two words to be much more than a campaign slogan or an empty promise. Healthcare must be a true human right, easily exercised by every single person in America. We can and we will make that right a reality with Medicare For All.
"Every day the consequences of GOP healthcare cuts get worse," said one campaigner.
Health insurance companies that offer plans on the Affordable Care Act marketplace are proposing double-digit premium increases for 2027, signaling the second consecutive year of out-of-pocket cost hikes following President Donald Trump and congressional Republicans' refusal to extend enhanced subsidies that lapsed last December.
The health policy research group KFF and the Peterson Center on Healthcare released an analysis on Wednesday showing that ACA marketplace insurers "are proposing a median premium increase of about 14% in 2027." While that would represent a decrease compared to the median finalized premium increase of 20% for 2026, it marks "the second-highest requested rate change since 2018, as premium growth had been relatively flat in this market for several years," the analysis notes.
"If these early indications of median premium increases for 2027 hold, typical premiums for insurers participating in the ACA marketplaces will have jumped by more than one-third over a two-year period," KFF and the Peterson Center found, pointing to the significance of Trump and the GOP's deciseion to oppose an extension of enhanced ACA premiums that were established in 2021 during the Biden administration.
KFF and the Peterson Center explain:
As anticipated, many healthier enrollees left the ACA Marketplaces in 2026 as their subsidies decreased—leading to an average increase in premium payments after subsidies of 58% this year—leaving behind an enrollee base that is on average somewhat sicker and more expensive to cover. For 2026, this dynamic was estimated to drive rates an average of four percentage points higher than they otherwise would have been, and insurers are now building 2027 rates on top of that adjusted, less-healthy risk pool—compounding the effect into next year’s premiums as well.
Leslie Dach, chair of the advocacy group Protect Our Care, said in a statement Wednesday that the analysis underscores "just the latest hit on hard-working families struggling to get by after Republicans ripped away the tax credits that helped millions of Americans afford coverage."
"Every day the consequences of GOP healthcare cuts get worse," said Dach. "This was a deliberate choice by Republicans who took away affordable coverage from millions of people to help fund tax breaks for billionaires and big corporations. The damage is already being felt at kitchen tables across America, and these new premium hikes show the worst is still ahead. And Republicans will pay the political price. Healthcare is already the driving issue leading up to the elections, and as the consequences mount, it will only mobilize voters further.”
Since the start of President Donald Trump's second White House term, ACA enrollment has declined by more than 5 million people as a growing number of Americans are priced out of coverage by surging premiums.
For 2027, at least 20 insurers across states that have submitted rate filings so far have proposed premium increases exceeding 20%, according to the KFF-Peterson Center analysis.
Kendall Witmer, the Democratic National Committee's rapid response director, said in a statement Wednesday that "healthcare is unaffordable for millions of Americans because Donald Trump and Republicans sold them out to give billionaires even bigger tax cuts."
"Working families are already grappling with sky-high prices for groceries and gas, and growing medical bills are putting them over the edge," said Witmer. "Healthcare for Americans has never been more expensive—and Trump and Republicans are squarely to blame."
Leor Tal, campaign director for the advocacy group Unrig Our Ecnomy, echoed those arguments and called for GOP lawmakers, who still control the House and the Senate, to act.
“Millions have already lost access to health insurance, and these planned premium hikes will only escalate this crisis," said Tal.
"We need Republicans in Congress to restore the health care tax credits they took away from millions. Otherwise, when their premiums rise again, Americans will know who is at fault.”
"They didn’t cheat their way in. They simply can’t afford to stay in the program."
President Donald Trump's administration has tried spinning government data showing millions of people have dropped their health insurance coverage under the Affordable Care Act by claiming these people were defrauding the program.
However, an analysis published Tuesday by Public Citizen refutes this claim, finding that most people who lost their ACA coverage did so because they could not afford to keep it after congressional Republicans let enhanced health insurance subsidies expire last year.
Data released last month showed that nationwide ACA enrollment fell from 22.3 million people in 2025 to just 17.5 million in 2026, a drop of nearly five million people over the span of just a year.
US Health and Human Services Director Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services Administrator Mehmet Oz have both said this drop is due to the administration's efforts to root out fraud, with Oz even saying that current enrollment in the program is at "too high of a number."
The Public Citizen report, however, finds that "the decline in... enrollment this year has nothing to do with removing deceitful enrollees," as what "the numbers show is that American families are being priced out of coverage."
According to Public Citizen's analysis, the best way for a fraudster to game the system created by the ACA would be to falsely claim to have an income right around the poverty line, which would ensure the fraudulent enrollee would get a higher subsidy to purchase coverage.
In other words, if the administration were really pursuing fraud on a mass scale, it would likely mean a drop in enrollees who are claiming incomes near the poverty line.
"But that’s not what is happening," the report explains. "The people losing coverage are concentrated at incomes well above the poverty line. They are low- and middle-income families whose premiums doubled after subsidies were cut. They didn’t cheat their way in. They simply can’t afford to stay in the program."
In fact, the report finds that enrollment is actually growing among people who claim income right at the poverty line, which could suggest there is more prospective fraud in the program than before.
However, the report authors do not think that this increase is due to fraud, but rather to "people living just below the poverty line in states that refused to expand Medicaid" and whose income is not low enough to qualify for Medicaid, but too high to qualify for ACA subsidies.
"To escape the coverage gap, some have reported incomes just above the poverty line," states the report, "enough to be eligible for the ACA marketplace."
The ACA isn't the only federal healthcare program under pressure from Trump administration and GOP policies, as cuts to Medicaid included in Republicans' 2025 budget law are projected by the Congressional Budget Office to leave more than 10 million fewer people enrolled in the program by 2034.
"As working families continue to get squeezed left and right by GOP-driven healthcare cost hikes and bureaucratic red tape, millions more Americans will lose the care they rely on to stay alive and healthy."
On the heels of data revealing that millions of people have lost health insurance coverage during US President Donald Trump's second term amid a series of GOP attacks on access to care, polling published Monday shows that a majority of Americans support eliminating private insurers.
The 1,606 adult US citizens surveyed by The Economist/YouGov June 26-29 were asked: "Do you support or oppose a national health plan in which all Americans get their health insurance from the federal government and private health insurance companies are eliminated?"
Fifty-two percent expressed support, and the proposal was even more popular than that among respondents under age 45 as well as registered Democrats and Independents. Just 30% of those polled were opposed, while the rest said that they were "not sure."

The polling follows the administration's quiet release of data showing that 4.2 million lost Affordable Care Act (ACA) coverage as of February. Trump and his Republican allies in Congress have come under fire for letting ACA subsidies expire at the end of last year—as well as for enacting the so-called One Big Beautiful Bill Act, which is expected to leave more working-class Americans uninsured over the next decade. Already, Protect Our Care estimates that 3.8 million people have lost coverage under Medicaid and the Children's Health Insurance Program, bringing the total for Trump's term to around 8 million.
"A mind-boggling number of Americans have found themselves joining the ranks of the uninsured," Protect Our Care president Brad Woodhouse said in a Tuesday statement. "And this is just the beginning. As working families continue to get squeezed left and right by GOP-driven healthcare cost hikes and bureaucratic red tape, millions more Americans will lose the care they rely on to stay alive and healthy."
"These are diabetic patients rationing insulin and parents skipping cancer screenings," he continued. "These are small business owners and farmers shutting down their life's work because they can no longer afford to buy insurance on their own. These are moms, veterans, and seniors. These are the millions who will hand Trump and Republicans in Congress a withering rebuke at the ballot box in November for making healthcare unaffordable so they could make billionaires and big corporations richer."
As premiums soar and Americans begin to endure the consequences of the national Republican healthcare agenda, a sweeping coalition of groups that support a universal single-payer system declared earlier this month that "now is the time for Medicare for All."
Sen. Bernie Sanders (I-Vt.) and Reps. Pramila Jayapal (D-Wash.) and Debbie Dingell (D-Mich.) have repeatedly introduced the Medicare for All Act in Congress, and support for it has grown among elected Democrats and the US public—as suggested by the new polling.
In a statement about the healthcare findings, the pollsters explained:
While eliminating insurance companies may sound like a radical change to healthcare, the share of Americans who want to replace private insurance with a government health plan (52%) is larger than the share who want to expand the existing Obamacare (the health coverage system established by the Affordable Care Act) (38%). The share who favor repealing Obamacare (28%) is about as large as the share who oppose replacing private insurance with a government plan (30%).
Americans who support a national healthcare plan do not universally see expanding Obamacare as a step in the right direction. Only a little more than half (56%) of the Americans who support creating a national health plan also support expanding Obamacare. On the other hand, most Americans who support expanding Obamacare would also support a national health plan that replaces private insurance (77%).
Although "only 8% of Americans would describe themselves as socialists," which is "smaller than the shares who describe themselves with several other ideological adjectives offered in a poll question, including progressive (17%), liberal (23%), and conservative (34%)," the pollsters also noted, "many policy proposals championed by democratic socialists draw significant support from Americans."
For example, majorities of respondents endorsed the government covering the cost of college tuition for all students (55%) and building public housing (57%).
When asked, "Do you think Donald Trump has had the right priorities or hasn’t paid enough attention to the country's most important problems?" 60% of respondents said the president "hasn't paid attention to the most important problems."
The polling comes just over four months away from the November midterm elections, in which Democrats hope to reclaim majorities in both chambers of Congress. Some Democratic candidates, including US Senate hopefuls Graham Platner in Maine and Abdul El-Sayed in Michigan, are explicitly running on support for Medicare for All.
After multiple progressives running to represent various New York districts in the US House of Representatives won their primaries last week, Sanders called their victories proof that Americans "are sick and tired of status quo politics," while Jayapal similarly celebrated that "bold, people-powered candidates took on the Democratic establishment and won."
"They ran on Medicare for All. On a public option for housing. On a foreign policy that centers human dignity over political convenience. And they won," Jayapal said. "This is what happens when movements build power. People-powered movements win."
"This coverage collapse was a choice that Congress made. As a result, millions more will end up uninsured, living sicker, dying younger, and being one emergency away from financial ruin."
The Trump administration quietly released data last week showing a sharp decline in the number of Americans enrolled in health insurance on the Affordable Care Act exchanges, a widely predicted outcome caused by congressional Republicans' refusal to extend subsidies that helped people buy coverage.
The new data, published Friday on the Department of Health and Human Services' website, shows that 19.2 million people were enrolled in ACA marketplace plans as of February—a decline of more than 5 million since the start of President Donald Trump's second term.
Last year, Republicans repeatedly blocked Democratic efforts to enact a temporary extension of the enhanced ACA tax credits, whose expiration at the start of 2026 led insurers to jack up premiums, pricing many out of coverage entirely. In focus groups, some Americans facing premium spikes said they would be forced to cut back on groceries or ration their medications to afford coverage.
“This dramatic decrease of millions of Americans losing health insurance is the result of deliberate decisions by the president and congressional leaders—it is what we feared but expected, given the end of the enhanced tax credit and other policies that make it harder to get on and stay on coverage," said Anthony Wright, executive director of the advocacy group Families USA. "As a result, millions more will end up uninsured, living sicker, dying younger, and being one emergency away from financial ruin."
Wright dismissed the Trump administration's attempt to explain away the coverage losses by claiming the numbers show a decline in "phantom" enrollment and fraud, calling that narrative "an insult to every person who became uninsured or underinsured."
"These results are real for the millions who faced premiums doubling, paying hundreds of thousands of dollars for coverage. The resulting price spikes and coverage losses are real for all who buy coverage as individuals, including gig workers, small business owners, young adults, seniors not quite of Medicare age, and many others," said Wright. "The consequences are now undeniable: millions dropped from the rolls, and yet another year of double-digit premium increases."
The lapse of enhanced ACA subsidies—which were established in 2021 during the Biden administration—alongside the roughly $900 billion in Medicaid cuts included in the Republican budget package that Trump signed into law last summer amounts to what analysts, advocates, and Democratic lawmakers say is the largest assault on federal healthcare programs in US history.
"We weren’t being hysterical. We knew this would happen," said Rep. Sara Jacobs (D-Calif.) in response to the new enrollment figures. "When Republicans passed the Big Ugly Bill and cut funding for healthcare, they literally signed away millions of Americans’ ability to afford health insurance. And now it’s happening."
According to the Congressional Budget Office, around 16 million people across the US could lose health coverage by 2034 due to the Trump-GOP law, and millions of children have lost coverage since last year.
“Trump and Republicans are engineering the most devastating assault on healthcare in history, and today’s numbers prove it," Leslie Dach, chair of the advocacy group Protect Our Care, said on Friday. "They ripped away the tax credits that helped millions afford coverage, gutted funding to help people enroll, and sabotaged the ACA at every turn. They knew exactly what would happen, they chose to do it anyway, and it’s going to get worse."
“Among the three million who have lost coverage are parents skipping cancer screenings, patients rationing insulin, and families who are now one medical emergency away from financial ruin," said Dach. "Republicans created this crisis on purpose, and while Americans pay for it with their health and their lives, billionaires are cashing their tax cut checks."
According to a new report, the crisis is "only going to get worse."
Not even a year after President Donald Trump signed the largest healthcare cuts in US history into law, around five million Americans have lost insurance coverage, according to a report out Monday from Protect Our Care, which predicted that the crisis was "only going to get worse."
The massive budget and tax legislation passed by Republicans last July, known as the One Big Beautiful Bill Act, slashed nearly $1 trillion from Medicaid and the Children's Health Insurance Program (CHIP) over the next decade while introducing tax breaks that are expected to hand an additional $1 trillion to the richest 1% of Americans.
“Five million and counting. That’s the human toll of the spiraling Republican healthcare affordability crisis,” said Protect Our Care president Brad Woodhouse. “Just one year after Trump and congressional Republicans made the largest cuts to healthcare in history to fund tax breaks for billionaires and big corporations on Wall Street, millions have lost the care they depended on to stay alive and healthy."
Citing the most recent data from the Centers for Medicare and Medicaid Services (CMS) and state agencies, the report found that the number of Americans enrolled in Medicaid and CHIP had fallen to just 76.9 million, down from 80.8 million a year before—a decline of more than 3.8 million people.
Another 1.2 million are also estimated to have lost coverage due to the massive spike in premiums after Republicans voted not to renew tax credits for consumers under the Affordable Care Act (ACA) that lowered costs for Americans who purchased coverage through ACA marketplaces.
During open enrollment in 2025, 24.3 million Americans selected insurance plans through the ACA. This year, as the average premium was projected to more than double on average, the number of Americans enrolled through the ACA fell to just 23.1 million—a drop of nearly 1.2 million.
The millions of other families still enrolled in insurance through the ACA exchanges saw an average increase of $780, and according to KFF, it's only been that low because many families have opted to switch to cheaper, less comprehensive plans.
The loss of insurance coverage "is only a small piece of the puzzle," Woodhouse said.
"Millions more are making impossible choices every day to keep their coverage, including skipping rent or cutting back on groceries so they can see a doctor," he said. "Their pain and suffering are incalculable."
The report said the coverage losses over the first year are "just the beginning" and that "millions more will lose coverage once deeper cuts go into effect."
The full slate of changes to Medicaid from the GOP bill has not yet been enacted. Next year, many adult recipients will be required to submit proof that they are doing at least 80 hours of work or other qualifying activity each month in order to maintain benefits, which the nonpartisan Congressional Budget Office (CBO) estimated could increase the uninsured population by 5.3 million by 2034.
Another paperwork hurdle, the requirement that certain Medicaid expansion enrollees prove their eligibility every six months, is expected to result in another 700,000 people becoming uninsured by 2034.
In total, CBO analyses estimate that over the next decade, roughly 15 million Americans would lose their insurance coverage as a result of the legislation.
"These are our neighbors, our friends, our loved ones. These are small business owners and farmers. These are seniors. Veterans. Moms," Woodhouse said. "These are millions of working people now scrambling to find insulin pumps, taking thousands out of retirement just to see a doctor for that cough that’s not getting better, or, worse, not getting care at all."
With healthcare costs now a top concern among voters—66% of whom said they were worried about affording it, according to a KFF poll in January—cuts to healthcare spending appear to be a glaring liability for Republicans entering the midterm elections.
Another KFF poll from April found that 37% of voters said they trusted Democrats to address healthcare costs, while just 26% said they trusted Republicans. Meanwhile, 67% of voters said they disapproved of the Trump administration's handling of healthcare costs.
"Every single day, the affordability crisis mounts, and more Americans will find themselves joining the five million struggling to keep up with skyrocketing healthcare costs," Woodhouse said. "The American people won’t forget this betrayal in November.”
Democrats have seized on Monday's report as part of their election pitch, including Rep. Greg Landsman, who faces a competitive reelection fight in Ohio's 1st Congressional District.
He wrote on social media Tuesday that Republicans "cut healthcare by nearly a trillion to pay for tax cuts for the super wealthy... five million people no longer have healthcare."
"The healthcare crisis in America is dominating the lives of millions, and will soon dominate all of our lives," he said. "We need a new Congress to restore people’s healthcare and to end this crisis. There is no other way."
With eligibility verification and fees, the rule was projected to force 2 million people to drop their insurance, said cities and advocacy groups that sued the administration.
Officials in several cities joined advocacy groups in celebrating a federal court ruling Friday that blocked the Trump administration's rule which, they argued in a lawsuit, illegally imposed new fees and created barriers "that would make it harder—and in some cases impossible—for people to get and keep affordable health insurance."
The cities of Columbus, Ohio; Baltimore; and Chicago were among the plaintiffs in a case filed last week in the US District Court of Maryland against Health and Human Services Secretary Robert F. Kennedy and other Trump officials, arguing that the so-called "Marketplace Integrity and Affordability" rule would destabilize the insurance market and penalize vulnerable families, "rather than promoting affordability."
The rule was introduced in May, months after Affordable Care Act subsidies that had made ACA insurance premiums more affordable for millions of people were allowed to expire by Republicans in Congress. More than 1 million fewer Americans signed up for coverage in ACA exchanges after the tax credits expired, and the Trump administration claimed that the new rule's provision of more "catastrophic" insurance plans would give more "choice" to people who couldn't afford plans that cover more healthcare needs.
The rule also required additional verification for low-income households before they enroll in ACA plans, with Centers for Medicare and Medicaid Services Administrator Mehmet Oz claiming the new requirement "strengthens eligibility checks, cracks down on abuse, and gives insurers more flexibility to offer affordable, consumer-focused coverage options."
“Cloaked in the pretense of government efficiency and fraud prevention, the 2026 rule creates numerous barriers to affordable insurance coverage."
The verification requirements and new fees could cause as many as 2 million people to drop their coverage, said Democracy Forward, which represented the plaintiffs, as well as raising annual costs by about $700 for families.
“Cloaked in the pretense of government efficiency and fraud prevention, the 2026 rule creates numerous barriers to affordable insurance coverage, negating the ACA’s goal of extending affordable health coverage to all Americans, and instead increasing the population of underinsured and uninsured Americans,” the plaintiffs said in the lawsuit.
In the ruling on Friday, US District Judge Brendan Hurson vacated several provisions of the rule, including ones that revoked guaranteed insurance coverage for people with past-due premiums; required eligibility verification for the special ACA enrollment period; and imposed a $5 premium penalty on people who automatically reenrolled in their plans.
Columbus City Attorney Zach Klein said the rule's provisions were among "the Trump-Vance administration’s illegal attempts to undermine the Affordable Care Act."
“This ruling is a significant win for millions of Americans, including thousands in Ohio, who would have been denied coverage or seen their out-of-pocket costs skyrocket due to this president and his administration," said Klein. "We will continue to fight to protect healthcare coverage for all Americans whenever it’s threatened.”
Richard Trent, executive director of Main Street Alliance, a small business advocacy group that also joined the lawsuit, said that "the Trump-Vance administration’s unlawful attempt to undermine the Affordable Care Act would have increased costs, created unnecessary barriers to coverage, and made it harder for entrepreneurs and workers to get the care they need."
"Small business owners cannot grow their businesses when healthcare becomes more expensive and less accessible," said Trent. "We are grateful that the court has protected these critical safeguards and reaffirmed that affordable healthcare remains essential to a strong economy and thriving Main Streets across the country."
Baltimore Mayor Brandon Scott also applauded the ruling, but emphasized that healthcare advocates' "work is not over."
As Common Dreams reported Friday, tied up in the Trump administration's push for more Americans to use high-deductible catastrophic insurance—which is likely to present families with high out-of-pocket costs—is a plan to push households into more medical debt by allowing them to take out loans directly from their health insurance companies.
“We will continue to fight back against any attempts by this administration to slash protections under the ACA," said Scott, "and will not stop fighting until every person in this nation has access to the affordable, quality healthcare they deserve.”
"This could ruin people's finances, while creating a financial incentive for insurers to deny coverage," said one Democratic congresswoman.
After the Republican Party's decision to terminate subsidies that had significantly reduced healthcare costs under the Affordable Care Act for 22 million people, the White House is considering a new way to—officials claim—"help" Americans who face massive medical bills, either due to high-deductible plans that don't cover routine costs or because of emergency expenses.
The proposal, though, could just shift "who [the patients] owe the debt to," as one doctor and researcher told The New York Times, which reported Thursday on the Trump administration's proposal to allow people to take out loans directly from their health insurance companies when they can't afford to pay a hospital or doctor's office out of pocket—and then pay the insurance company back, likely with interest.
"Hard to top this level of dystopia," said one writer in response to the Times report. "Have health insurance through the ACA? The Trump administration is going to turn your health insurer into a loan shark you borrow money from if you can't afford to pay your portion of medical procedures."
As the newspaper was reported, the provision is buried in a 1,121-page final rule issued last month regarding how the ACA will be regulated next year.
The Trump administration is planning to significantly expand the number of Americans who are eligible for high-deductible "catastrophic" health insurance plans that provide no coverage for day-to-day medical expenses.
"We note that multiyear and 1-year catastrophic plans may be able to offer relief from the high deductible and maximum annual limitation on cost sharing through other mechanisms," reads the final rule. "For example, issuers of catastrophic plans could consider financing the deductible by providing enrollees a loan."
Currently, the average annual deductible for people insured under the ACA is nearly $4,000, and about 40% of enrollees this year have "Bronze" plans, which have an out-of-pocket maximum that's over $10,000 for an individual, likely leaving many people having to pay thousands of dollars in medical expenses despite having coverage.
By 2028, as Common Dreams reported earlier this year, catastrophic plans with lower premiums could have deductibles as high as $31,000 for families.
The plan to shift more people onto expensive plans that provide less coverage for day-to-day medical care—and to push patients to take out loans from their insurers—comes as about one-third of Americans, even those with insurance, report skipping meals or cutting back on other expenses to afford their medical bills.
The Times reported that at least one major health insurer—UnitedHealthcare, the nation's largest—is already equipped to start lending patients money to cover unexpected medical bills. The company operates a bank that administers loans to doctors and offers health savings accounts.
Rep. Shontel Brown (D-Ohio) said the latest proposal from the White House shows that President Donald Trump "is destroying healthcare from all sides."
The advocacy group Protect Our Care said the "suggestion" buried in the Centers for Medicare & Medicaid Services' final rule "is not only out of touch, it is cruel—accruing medical debt only adds to families’ financial burdens."
“While working families drown in the high cost of living, the Trump administration’s answer to the healthcare affordability crisis they created is to throw people an anchor made of medical debt and call it relief," said Leslie Dach, chair of Protect Our Care. "Trump and Republicans had a simple, popular fix sitting right in front of their faces—extending the ACA tax credits—but they killed it anyway, triggering premiums to double, triple, or even quadruple for millions of working families, all to make billionaires and big corporations even richer."
"Americans are being bankrupted by crushing medical debt, and this administration isn’t lifting a finger to help—it’s busy shoveling more people into that hole," said Dach. "Voters will remember this foolishness at the ballot box in November, just you wait.”
Melanie D'Arrigo, executive director of the Campaign for New York Health, which advocates for a universal, single-payer healthcare system for New York state, suggested the proposal makes the latest case for a federal, government-funded healthcare program similar to those in other wealthy countries, which would end the healthcare profit motive by expanding the existing Medicare system to the entire US population.
"Letting Americans take out loans to afford healthcare forces Americans deeper into debt and drives up profits for the health insurance industry," said D'Arrigo. "Abolish the health insurance industry. Demand Medicare for All."
The shortcomings of US healthcare are painfully apparent throughout Rep. Casten’s district, so why won't he co-sponsor the Medicare for All Act?
Ten years ago, when reflecting on his signature legislative achievement, President Barack Obama famously encouraged Americans to think of the Affordable Care Act as a “starter home.” For as much good as the ACA did—expanding coverage to millions, offering policies to people with “preexisting” conditions—it is clear that the foundation of this starter home is starting to crack.
As an emergency medicine physician who has practiced throughout the Chicagoland area for nearly 50 years, I have seen these fault lines up close. Health insurance corporations like Blue Cross Blue Shield and UnitedHealthcare have strayed far from their nonprofit roots, and now routinely delay and deny care for everyday Americans. Put simply, these insurers have an incentive—and even a duty—to skim hundreds of billions of dollars off the top.
Earlier this year, the Chicago City Council recognized this dynamic when it passed a resolution calling for a single-payer national health program, also known as “Medicare for All.”
The resolution passed without objection from any of the city’s 50 aldermen, and concluded by saying council members “enthusiastically support the Medicare for All Act of 2025 and call on our federal legislators to work toward its swift enactment.”
Under a single-payer national health program, Americans would no longer need to worry about what treatments their insurance would cover, what doctors they would be allowed to see, and how much they would be charged out of pocket.
Every representative whose district includes Chicago has already co-sponsored the Medicare for All Act in the US House, and every likely replacement for retiring members of Congress has promised to do the same, with one exception. Rep. Sean Casten (D-Ill.), whose district includes parts of the Garfield Ridge and Clearing neighborhoods west of Midway Airport, has committed to staying in the “starter home,” even though it is coming apart at the seams.
The shortcomings of US healthcare are painfully apparent throughout Rep. Casten’s district, where more than 40,000 of his constituents lacked health insurance before the expiration of enhanced ACA subsidies and the implementation of federal Medicaid cuts. That’s to say nothing of his constituents with sky-high deductibles and limited provider networks who cannot afford to use the coverage they do have.
During my years in the emergency department, I have seen the awful impacts of delayed care. When I practiced at Michael Reese Hospital many years ago, it was distressingly common for me to treat young men with kidney failure. Why? Because their high blood pressure went untreated due to a lack of health coverage to pay for doctor visits and simple medications. They waited until their health issues became unbearable—and much more expensive to treat.
We can do so much better than this, and growing numbers of Americans—including 90% of Democrats in a recent Gallup poll—are starting to demand that we replace our “starter home” with a much more durable healthcare system.
Under a single-payer national health program, Americans would no longer need to worry about what treatments their insurance would cover, what doctors they would be allowed to see, and how much they would be charged out of pocket. I enjoyed a glimpse of this during my 20 years at the Captain James A. Lovell Federal Health Care Center in North Chicago, where I was able to care for veterans, active-duty members of the US military, and their families—without worrying about what their insurance would cover or whether they could afford to pursue treatment.
As Dr. Claudia Fegan, who recently retired as the chief medical officer of Cook County Health, testified before the Chicago City Council, a system like Medicare for All is well within our grasp.
“We already spend enough money on healthcare in this country,” Dr. Fegan said, “we just allow too many people who do none of the work of delivering healthcare to take profit from it. By eliminating the waste and greed of private insurance, we can afford to cover everyone in our country for all necessary care, and end the scourges of surprise bills, skipped medications, and medical bankruptcy.”
Rep. Casten has declined to co-sponsor the Medicare for All Act during his four terms in office, but his position has become increasingly lonely within the Democratic Party, the Illinois Congressional Delegation, and the US medical profession.
Thankfully, it is never too late to do the right thing.