The link between affordability and healthcare coverage is one that Democrats have thought important enough to stake a good portion of their 2026 midterm platform. The affordability issue was broadly tested in the 2025 elections across the country, with great success for Democratic candidates, particularly in New York City, New Jersey, and Virginia.
The Trump Administration’s sweeping attacks on national healthcare access and the often illogical opinions coming from HHS Secretary RFK, Jr., have created an issues-oriented stash for future Democratic candidates to draw from. The GOP’s lockstep adherence to the Trump Administration policy and the Republican Party's inability to come up with any alternative to “Obamacare” provide an opening for a coming Blue Wave next year. The Republicans’ problem, so far, is twofold: the widespread acceptance of the Affordable Care Act passed in 2010, and the unpopularity of policies enacted by Trump and his appointees that have severely weakened the nation’s healthcare system, exploiting its infrastructure to carry out larger attacks on human rights at home.
The Agency for Healthcare Research and Quality (AHRQ), which plays an important role in data collection and research to improve healthcare cost and quality, has been threatened with 80–90 percent cuts and lost over half its staff.9 Destruction of research capacity affects health system cost by reducing access to new technologies, which might actually reduce costs, but also by reducing AHRQ's health services research, which often promotes cost containment.
The administration has reversed desegregation and gender equality regulations, taking special aim at transgender people. Researchers whose work is defined as addressing “diversity, equity and inclusion,” including descriptors like “Black,” “disability,” “transgender,” or “women,”10 have had funding cut11 and publications censored.12 Experts removed from NIH panels have been disproportionately people of color and women.13 NIH announced it would not fund research at universities operating “any programs that advance or promote [Diversity, Equity, Inclusion and Accessibility] or discriminatory equity ideology,” replacing older civil rights rules focused on avoiding racial discrimination.11 The Women’s Health Initiative, an enormous, vital study conducted over more than thirty years, was abruptly terminated only to have its restoration announced after public opposition; as with so much, its actual status remains unclear.14
America's inclusion in global health research networks has been damaged, with funding drastically reduced,15 international researchers and students threatened, and visiting scholars cancelling trips to the US citing fear of harassment.16 The administration has strategically employed the goal of “battling antisemitism” to block research grants to universities “refusing to deal, cutting commercial relations, or otherwise limiting commercial relations specifically with Israeli companies.”11
Shocks to specialist research communities cause rapid attrition, with scientists exiting the workforce and even the country after as little as a month of disrupted funding, and resources diverted from high-quality basic research to privately assigned, less-impactful work.17,18 They may also increase hesitancy around research participation, particularly for groups that are already under-represented in health research. One estimate suggests that the administration's proposed NIH cuts, over 25 years, will save $500bn and cost the country $8.2 trillion in lost health-a cost more than 16 times greater than the savings, even excluding lost economic benefits from health research.19
— Greer, S. L., Jarman, H., Kulikoff, R., & Yaver, M. (2025). Trump's second presidency begins: Evaluating effects on the US health system. Lancet Regional Health - Americas, 48, 101173. https://doi.org/10.1016/j.lana.2025.101173
In effect, the administration’s healthcare policy is an attack on more than the healthcare system. Healthcare has become a microcosm of the Trump Administration's anti-democratic assaults on race, immigrants, LGBTQ+, DEI, and academia.
Republicans have chosen to add to the general affordability issue by refusing to extend funding for Medicaid expansion, which was part of the 2010 ACA legislation. Failure to extend the benefit will undermine the Affordable Care Act by hindering access to the legislation’s features, according to statistics released by the NIH:
- Cutting Medicaid funding creates healthcare deserts in rural areas of the country.
- Negatively impacts the quality of healthcare available to minorities.
- Increases the burden on healthcare professionals and facilities that serve these populations.
The creation of healthcare “bubbles” and “deserts” throughout the country has the net effect of heightening inequalities among historically disadvantaged Americans based upon their race, color, geographical location, gender, and sexual preferences. Weaponizing healthcare allows the president to weaken the social safety net for the benefit of wealthy conservatives who don’t need one. Trump has taken Ronald Reagan’s disdain for ‘big government’ to a new level by reducing regulatory oversight and diverting funds from programs that benefited the 95% to his wealthy friends in the 5%.
For those of us who need healthcare coverage only have to look back a few years on what transpired during the pandemic and how healthcare was unable to function effectively in the face of an out-of-control virus. Reducing funding, withdrawing support, and limiting access to health insurance is a recipe for most of us with finite means to worry not only about our physical well-being, but also about our financial health. The burden of inequality of care will surely fall on our most disadvantaged and disabled.
Picture, if you will, two gurneys being pushed down a hospital corridor— one with a patient from a large metropolitan area with good health care facilities, the other with a minority child from rural America; one whose parent has great health insurance, the other whose parent is unemployed or underemployed without insurance; one with a woman seeking an abortion in a state without abortion rights legislation, or another carrying a transgender youth. Do any of us not believe that circumstances beyond their control will dictate the access to and quality of their care under Donald Trump’s Republican health care policies? Reflecting on the disparity should challenge our collective conscience.
A thought experiment might be useful here, especially one that can help develop a thoughtful solution to the complex ethical or moral issue at hand. One such experiment was conducted by Australian philosopher Peter Singer in 2009 called “The Life You Can Save”:
Imagine that you are walking down the street and notice a child drowning in a lake. You can swim and are close enough to save her if you act immediately. However, doing so ruins your expensive shoes. Do you still have an obligation to save the child?
Singer says yes, you have a responsibility to save the life of a dying child and price is no object. If you agree with him, it leads to his question.
Question: If you are obligated to save the life of a child in need, is there a fundamental difference between saving a child in front of you and one on the other side of the world?
— Big Think, “7 thought experiments that will make you question everything,”
Singer’s test is timely today. The policies being promoted, which use healthcare as a proxy for conscience, ask our leaders, and those in our nation who have gained great wealth under our system of government, to sacrifice what amounts to a pair of expensive shoes to share the benefits they enjoy as a matter of course. Beyond that, however, is the moral question that haunts our healthcare system. From its inception in 2010, uninsured rates had declined steadily under Democratic governance, but the trend leveled off significantly afterwards. The Republican takeover of government in 2016 began with Trump’s unsuccessful plan to repeal and replace the ACA with his own version. His 2017 plan would have reduced the number of insured while increasing the federal deficit. Republican efforts to repeal the ACA having failed, they turned to killing off its momentum. From 2017 through the end of Trump’s first term, coverage rates fell. Only the pandemic and the efforts of the Biden Administration to combat it would stem the tide:
The coverage gains observed between 2019 and 2023 largely reflect policies adopted during the pandemic to stabilize coverage in Medicaid and enhance subsidies to purchase Marketplace coverage. Coverage gains reflected provisions in the Families First Coronavirus Response Act (FFCRA), enacted at the start of the pandemic that prohibited states from disenrolling people from Medicaid during the Public Health Emergency in exchange for enhanced federal funding.
— KFF, “Health Coverage by Race and Ethnicity, 2010-2023,” by Latoya Hill, Nambi Ndugga, Samantha Artiga, and Anthony Damico
And so, Singer’s little thought experiment can be revised to apply here. If healthcare is so effective for those who can afford it, why wouldn’t it be the same for everyone? For Republicans, the cost is too high because profit, not the general welfare, appeals to their base of donors. So long as the government acts on their behalf, affordability is a non-issue. Affordable healthcare is of little concern because it only interferes with their Trump-era fire sale of government assets.
Hell, they wouldn’t want to ruin their expensive new shoes— or spoil the fun at their next Gatsby soiree— to help ensure healthcare for the rest of us, now would they?
