Except for some limited drug price deals, the Trump Administration has not tried to make healthcare more affordable. Instead, it is restricting healthcare access for Americans of modest means and is allowing the number of uninsured to rise in an effort to lower government spending.
Although President Trump and his Republican allies failed to kill Obamacare in his first term, they’re aiming to do it now through a campaign to reduce Affordable Care Act coverage and make it harder to enroll in ACA plans.
In the One Big Beautiful Bill of 2025, the Commonwealth Fund notes, Congress not only failed to extend Obamacare subsidies, but it also made millions of legal immigrants ineligible for ACA plans and imposed new income verification requirements on other enrollees. The HHS marketplace rule for 2026 increased out of pocket costs, eliminated special-enrollment periods for the poor, and placed other new restrictions on enrollments.
But the 2027 marketplace rule, proposed in February, takes the administration’s war against healthcare much further. In this work of senseless cruelty, people too poor to be eligible for market subsidies in states that have not expanded Medicaid are offered “catastrophic plans.” These skinny plans cover only catastrophic costs, leaving the insured on the hook for medical services costing up to $15,000—about what a single person living below the poverty level earns annually.
More broadly, the proposal would discontinue standardized plan options in the federally facilitated marketplace, allowing insurers to offer a wide range of plans at different price points, including those that would sharply limit coverage. The proposed rule would also expand access to catastrophic plans for enrollees who are ineligible for advance premium tax credits or cost-sharing reductions.
In addition, HHS wants to loosen physician network requirements for ACA health plans, and it proposes that insurers be allowed to offer “non-network plans.” Instead of having the companies negotiate rates with providers, as they do now, these plans would pay a set amount, and enrollees would have to pay the difference between that and what providers charge them.
While no-network plans—like the catastrophic plans—would cost consumers less than current ACA coverage, there’s no guarantee that these plans would have an adequate number of providers willing to agree to their rates, notes Axios. As a result, enrollees would have less access to care than they do now. In addition, this scheme would weaken the ACA marketplaces and could set off a race to the bottom on price among competing insurers.
With everything else going on right now, the HHS regulatory proposal is not the most important thing on the national agenda. Nevertheless, the Trump administration’s continuing, relentless effort to reduce the access of less affluent people to healthcare may have a significant long-term impact on their health.
Because HHS allowed only 30 days for comments to be submitted, the deadline is nearly upon us, and it’s too late to resist this awful mess in the rulemaking process. Nevertheless, we can hope that public-interest lawyers will sue the government, making the strong case that these actions violate the spirit and the letter of the ACA.
Physician-Led Healthcare Reform 