The ACA scapegoat: How coverage of “Obamacare cuts” distorts the full picture of the $1.1 Trillion in cuts to health care

The radical MAGA NAZI budget ACA cut is perhaps only 35% of the cuts.

The ACA scapegoat: How coverage of “Obamacare cuts” distorts the full picture of the $1.1 Trillion in cuts to health care by the radical MAGA NAZI budget. ACA is perhaps only 35% of the cuts.

Introduction

You’ve probably seen headlines screaming that “Obamacare will be gutted under the new budget.” Politicians and news outlets frequently frame the health-care fight as an existential assault on the Affordable Care Act. But that framing is misleading: the ACA/Marketplace part is only a slice of what’s being cut. Most of the burden falls on Medicaid — and that reality often gets obscured.

The real breakdown

• The MAGA reconciliation package now being debated would cut federal health care spending (Medicaid + ACA markets) by around $1.1 trillion over 10 years (after accounting for overlaps). Center For Children and Families+1

• Within that total, Medicaid and CHIP (Children’s Health Insurance Program) provisions account for ~$990 billion in gross cuts. Center For Children and Families+1

• ACA Marketplace provisions (subsidies, eligibility) make up $213 billion of gross cuts. Center For Children and Families+1

• After coverage losses are tallied, ~65 % of the projected increase in the uninsured comes via Medicaid cuts, vs ~35 % from ACA/Marketplace changes. Center on Budget and Policy Priorities+2KFF+2

So yes, ACA does take hits — but it’s misleading to treat that as the main battleground the health care debate when Medicaid is absorbing the lion’s share.

Why the ACA-centric narrative dominates

1. Simplicity and branding
   “Repeal Obamacare” is a powerful slogan. It’s easier for media and politicians to discuss the ACA rather than navigate the complexity of Medicaid’s rules, state matching, provider taxes, etc.

2. Emotional appeal & visibility
   People see ACA subsidies on their bills or marketplace statements. That gives a visceral hook. Medicaid cuts operate more behind the scenes — fewer direct, sensational headlines.

3. Political theater
   Democrats and some media lean into the ACA narrative because it allows framing the cuts as attacks on a flagship program. Opponents paint MAGA moves as “gutting Obamacare” even when much of their damage is in Medicaid policy rules.

4. Confusion over overlapping programs
   Because ACA expansion sits inside Medicaid in many states, the lines blur. Some cuts that appear as “ACA expansion” are actually implemented via Medicaid rules. That helps sustain the narrative.

5. Recall how many times MAGA NAZI Mike Johnson has criticized ACA expansion.

He simply doesn’t like the Extension. Why? It raises the ceiling on income that qualifies for Medicaid from 40% to 60% of the FPL (Federal Poverty Level) depending on the State to 139% of the FPL and other expansions. MAGA NAZI Mike Johnson doesn’t like this or the other changes. How many times has he said government should not be shut down over policy disputes? And yet here we are.

But he is not alone among the MAGA NAZIs. These States have refused the ACA expansion: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. What do these States have in common? They are all MAGA.

CBO projects that, by 2034, 7.8 million people would lose coverage through Medicaid cuts, and another 4.2 million would lose ACA Marketplace coverage due to the expiration of enhanced tax credits (and related Marketplace changes) under the proposal. Center on Budget and Policy Priorities+3Center on Budget and Policy Priorities+3KFF+3

That means roughly 65 % of coverage loss is from Medicaid, and 35 % from ACA/Marketplace changes. Center on Budget and Policy Priorities+2KFF+2

Why this distortion matters

• Misdirected outrage: If public energy focuses only on “saving the ACA,” the deeper cuts to Medicaid might pass with less scrutiny.

• Policy blind spots: Medicaid policies — provider rates, eligibility redeterminations, matching rules — are less understood, thus more vulnerable to “surprise” changes.

• Operational havoc: States may be forced to make cuts in Medicaid benefits, hospital reimbursements, or provider networks — which cascades into destabilizing care, especially for low-income and vulnerable populations.

• Undermining accountability: Politicians can deflect criticism by claiming “we’re not cutting Obamacare,” even though the overall system is being weakened.

How to reorient the debate

• Call out the full accounting: Whenever someone says “Obamacare will be destroyed,” demand they include Medicaid in the math.

• Show the larger Medicaid cuts: Use charts or graphics to show the disproportionate share of cuts landing there.

• Humanize Medicaid stories: Share narratives of people on Medicaid (children, elderly, disabled) whose care may be threatened.

• Push media coverage beyond slogans: Encourage reporters to explain provider tax restrictions, eligibility redetermination, work requirements, and state impact — not just “ACA slashes.”

• Frame the fight around coverage and care, not brand names: The question isn’t “Can we save Obamacare?” but “Can we prevent deep damage to America’s health safety net?”

Before the Affordable Care Act (ACA), Medicaid was mainly limited to specific categories of low-income people:

• Children in poor families

• Pregnant women

• People with disabilities

• Some very low-income parents

• Low-income elderly in nursing homes

In most states, childless adults — even if living in deep poverty — were not eligible at all. Each state also set its own income limits, often well below the poverty line (e.g. 40–60% of the federal poverty level, or FPL).

So Medicaid was categorical and restrictive, not truly “universal” for the poor.

What the ACA expansion did

The ACA (2010) created an optional expansion category that states could adopt starting in 2014. It opened Medicaid to:

All adults under age 65 with incomes up to 138% of the federal poverty level (FPL) — roughly $20,800 for a single person in 2025.

That meant:

• Childless adults could finally qualify. (These are the ones the MAGA NAZIs really hate.)

• Working poor adults just above traditional cutoffs were included.

• States that expanded saw huge coverage gains, especially among low-wage workers, early retirees, and rural residents.

When you hear MAGA NAZI Mike Johnson say, as he repeatedly says, “that it is not what Medicaid was intended for,” what he is really saying is that he disapproves of Obamacare. Like some old Confederate loyalist, he will not accept defeat.

1. Absolute number & percentage of U.S. population with no health insurance

• In 2023, about 25.3 million people ages 0–64 were uninsured — which corresponds to 9.5 % of that age group. KFF+1

• Across all ages, more broadly, estimates place the uninsured count at around 26 million people, or about 8 % of the U.S. population. Health Affairs+2Census.gov+2

• In 2024, the CDC reports 8.2 %, or 27.2 million Americans of all ages, lacked health insurance. CDC

So a reasonable current estimate is: ~ 25–27 million uninsured, ~ 8–9 % of the population.

2. Number & share of people who have insurance but are “underinsured” (i.e. they can’t afford deductibles, co-payments, or forego care because of costs)

• From the Commonwealth Fund’s 2024 survey, 23 % of U.S. adults had underinsurance — i.e. they were insured all year, but the coverage did not provide affordable access to care (because of high out-of-pocket costs). Commonwealth Fund

• In that same survey, among those underinsured:
   • 66 % had employer plans
   • 14 % were in Marketplace / individual plans
   • 16 % in Medicaid or Medicare Commonwealth Fund

• The survey doesn’t give a total absolute number of underinsured people (for all ages) in that source, but we can approximate: if ~ 23 % of adults are underinsured, and assuming ~ 250 million adults (just as a rough base), that is ~ 57.5 million people (very rough).

3. Number & share of Americans projected to lose their health coverage if the MAGA budget eliminates the ACA expansion (or more broadly, under the current reconciliation / budget proposals) and cuts Medicaid

• Under the House-passed reconciliation package, CBO estimates ~ 10.9 million people would lose health insurance (on top of baseline losses) over time. Medicare Rights Center+3Brookings+3STAT+3

• In one breakdown, analysts say that ~ 11 million Americans would lose Medicaid and ~ 5 million would lose ACA / Marketplace coverage under the proposals. Medicare Rights Center

• Also, KFF (Kaiser Family Foundation) notes that, under the reconciliation package, in total 11.8 million additional people could be uninsured by 2034 compared to current law. KFF

In terms of the share of the U.S. population:

• If ~ 10–12 million people lose coverage, that’s roughly 3–4 % of the total U.S. population (assuming ~ 330 million people).

• Among non-elderly adults or the “insured market,” the share would be higher.

About 27 million Americans—around 8 percent of the population—already have no health insurance. The MAGA budget now before Congress would add roughly 11 million more uninsured, mostly through Medicaid cuts (about 65 percent) rather than ACA changes (about 35 percent).

That would bring the total to about 38 million people without any coverage at all.

Add the 44 million insured adults the Commonwealth Fund says are underinsured—people who can’t afford to use their plans because of deductibles and copays—and about 82 million Americans, nearly one quarter of the country, would effectively have no usable healthcare.

Other advanced democracies keep their uninsured rates below 2 percent and rarely have anyone underinsured. Under the MAGA NAZIs we would be the worst among Nations. (Sources: CDC 2025; KFF 2025; CBPP 2025; Commonwealth Fund 2024; OECD 2024.)