Republicans more likely to use it
The Senate Majority Leader John Thune (R-South Dakota), along with Senators John Barrasso (R-Wyoming) and Mike Crapo (R-Idaho), recently exited the West Wing of the White House on June 4, 2025. This was in relation to the Senate’s deliberations over President Donald Trump’s massive “Big Beautiful Bill.” The bill had narrowly passed the House on May 22, but now faced scrutiny in the Senate. Several Republican senators were expressing concerns over the bill’s cost, as well as potential cuts to Medicaid and clean energy tax credits.
According to a recent survey by KFF, a nonpartisan health policy research group, nearly half (45%) of adults enrolled in health plans offered through the Affordable Care Act (ACA) marketplace identify as Republicans. This statistic highlights the significant number of Republican constituents who rely on the ACA for their health insurance coverage. Additionally, 35% of Democrats receive their health insurance through the ACA.
The House of Representatives had previously passed a multitrillion-dollar tax and spending package in May, which was estimated to cut approximately $900 billion from health programs, including Medicaid and the ACA. Senate Republicans were now considering this measure, which contained many of President Trump’s domestic policy priorities. The aim was to pass the bill before the Fourth of July.
If the legislation was enacted without extending tax credits that lower monthly ACA health premiums, an estimated 15 million people could lose their health insurance, according to the Congressional Budget Office. This would have a significant impact on the large constituency of Republicans who rely on these programs for their coverage.
The survey conducted by KFF also highlighted that health plans offered through the ACA exchanges primarily cater to Americans who do not have coverage through their jobs or public programs like Medicare or Medicaid. Self-employed individuals often fall into this coverage gap, and as research suggests, self-employed Americans tend to lean more towards the right, which could explain why more Republicans are enrolled in ACA health plans compared to Democrats.
Furthermore, the Affordable Care Act expanded Medicaid coverage to more households, but 10 states, all of which voted for Trump in the 2024 presidential election, have not adopted the expansion. This has implications for ACA enrollment, as states that did not expand Medicaid have a wider population eligible for tax credits to make ACA health plans more affordable.
Despite the ongoing political debate surrounding the ACA, provisions within the law, such as coverage for preexisting conditions and the ability to stay on parents’ health plans until age 26, have broad appeal. While Republicans may view the ACA itself unfavorably, the individual provisions are popular among both Republicans and Democrats alike.
In conclusion, the future of the ACA and its impact on millions of Americans remains uncertain as Senate Republicans continue to deliberate over the “Big Beautiful Bill.” The potential cuts to health programs and the implications for millions of individuals who rely on the ACA for their health insurance underscore the significance of this legislation for both political parties and the American public.
