In a rare public statement, former President Barack Obama has criticized efforts in Congress that could lead to significant reductions in healthcare access, warning that millions of Americans are at risk as Republicans push forward with a bill that would dramatically scale back key elements of the Affordable Care Act.
“Congressional Republicans are trying to weaken the Affordable Care Act and put millions of people at risk of losing their health care,” Obama posted on social media. “Call your Senators and tell them we can’t let that happen.”
The legislation, which was approved by the House last month and is now under consideration in the Senate, would result in the loss of healthcare coverage for an estimated 10.7 million Americans over the next ten years, according to projections from the Congressional Budget Office (CBO). This would mark the most significant reduction in healthcare access since the GOP’s unsuccessful attempt to repeal the Affordable Care Act in 2017. Unlike that previous effort, Republicans are not presenting this as a repeal of Obamacare, instead embedding the proposed cuts within a broader bill aimed at extending former President Donald Trump’s tax breaks.
The CBO estimates that 7.6 million people would lose access to Medicaid, while an additional 3.1 million would be forced off ACA marketplace insurance plans. Over the next decade, the proposed changes would reduce federal healthcare spending by more than $800 billion, helping to offset the cost of continuing tax cuts enacted under the Trump administration.
Among the most controversial aspects of the bill are new administrative burdens that states would be required to implement. These include verifying Medicaid eligibility every six months—rather than annually—imposing a requirement that recipients work at least 80 hours per month, and shortening enrollment periods. Health policy experts warn that such changes could strain administrative systems and make it harder for eligible recipients to maintain coverage.
Research from the Kaiser Family Foundation (KFF) indicates that the majority of Medicaid recipients already work, with only 8% of healthy working-age adults neither employed nor engaged in education or caregiving. Still, the proposed work requirements alone are expected to account for roughly one-third of all projected coverage losses.
Even some Republicans have expressed concern about the bill’s implications. Senator Josh Hawley of Missouri wrote in a New York Times op-ed in mid-May that the proposed healthcare cuts are “morally wrong and politically suicidal.”
Further complicating matters, the legislation includes a provision to reinstate federal subsidies to insurers that reduce out-of-pocket costs for low-income enrollees—but only if those insurers do not cover abortion services. This requirement could disrupt the insurance markets in the 12 states and Washington, D.C., where abortion coverage is mandated. AHIP, the nation’s largest health insurance trade association, warned Politico that the proposal could trigger “immediate instability,” especially when combined with the scheduled expiration of pandemic-era subsidies that currently assist approximately 4 million Americans.
The drive to reduce healthcare spending comes as Republicans push to renew Trump-era tax breaks. Since 2017, enrollment in government-supported healthcare programs—including Medicaid, the Children’s Health Insurance Program (CHIP), and ACA marketplaces—has grown from approximately 85 million to over 100 million people. Correspondingly, annual federal spending on these programs has surged from about $550 billion to more than $900 billion.
While Republican lawmakers maintain that their primary goal is to address inefficiencies and eliminate abuse within the system, critics note that the legislation does not allocate new funding to fraud prevention units. Trump, however, defended the proposal in a comment to NBC, stating, “They’re looking at fraud, waste and abuse. And nobody minds that.”
