Republicans are seeking a major rollback of ObamaCare coverage under the House-passed megabill that would result in millions of people losing insurance coverage to help pay for President Trump’s tax cut extension.
The changes, which echo some of the debate surrounding the 2017 effort to repeal the health care law, have largely flown under the radar amid the heated debate over the bill’s billions of dollars in Medicaid cuts.
Democrats want to change that, arguing the bill is an ObamaCare repeal, even if Republicans aren’t branding it as such.
“They just don’t want to admit it. And the reality is, they use very clever code in order to cut benefits,” Sen. Ron Wyden (D-Ore.) told reporters during a briefing Monday. “Senate Republicans need to know that cutting health care is a death sentence for their constituents, and we’re going to be making that case across the land.”
Wyden, along with Senate Minority Leader Chuck Schumer (D-N.Y.), led a briefing Tuesday with 50 hospitals, health care providers, insurance companies, labor unions, and patient and consumer advocacy groups to discuss a strategy for combating cuts to health care coverage.
According to a person familiar with the meeting, Senate Democrats emphasized that now is the time to speak out and stop the largest cut to Medicaid in American history and a dismantling of the Affordable Care Act (ACA), which could cause health care insurance costs to go up for tens of millions of Americans.
Medicaid is a politically difficult program for Republicans to target, as their base is increasingly composed of low-income voters who would be impacted the most.
A bloc of Senate Republicans has signaled that they are uncomfortable with Medicaid reductions and won’t support the bill without changes.
Sen. Josh Hawley (R-Mo.), for instance, has repeatedly said he is not in favor of any provision that cuts Medicaid benefits for people who need it.
“I’m concerned about people who are here legally, residents of my state, citizens of my state, who are working and would lose health care coverage,” Hawley said Tuesday.
But the changes to the Affordable Care Act — which the Congressional Budget Office said could result in at least 3 million people losing health insurance — are not as concerning, he said.
“There are hosts of concerns, but Medicaid is the big kahuna. That’s where I’m training my focus on, my fire,” Hawley said.
Similarly, Sen. Jim Justice (R-W.Va.) said he is specifically concerned about a freeze on provider taxes, which many states use to finance their Medicaid programs.
But when asked about the ACA, Justice indicated a desire to pass the legislation.
“There’s concerns all over the place, on everything, and it’s going to be an adjustment,” he said. “At the end of the day, if we don’t do anything, we’re going to cannibalize ourselves. You’ve got a president that’s trying to move us forward … and I want to be really supportive of the president.”
The changes envisioned under the bill are not as sweeping as the failed repeal effort, which would have made 30 million people uninsured. They won’t end Medicaid expansion, eliminate the exchanges or target the law’s protections for people with preexisting conditions.
The changes are technical, but the overall effect would make it harder for people to enroll in coverage, likely reversing a trend of immense growth for the exchanges.
The bill would end automatic reenrollment in ACA plans for people receiving subsidies and shut off the ability for people to provisionally receive ACA subsidies in instances where they need additional verification.
It would shorten the open-enrollment period and end certain special enrollment periods that made it easier for people to sign up for coverage.
The legislation could also cut off some legal migrants from health coverage.
Under current law, U.S. citizens and lawfully present immigrants are eligible to enroll in ACA plan coverage and receive premium subsidies.
But the bill would limit eligibility for subsidized coverage to “lawful permanent residents” or green card holders, excluding people granted asylum, Temporary Protected Status and those in their five-year waiting period to be eligible for Medicaid.
Enrollment in the exchanges reached a record high for a fourth year in a row, at 24.3 million people in 2025, according to KFF. Much of that growth has been in red states.
According to the bill’s supporters, the growth is from fraudulent enrollment that’s driving higher spending. They argue people have been misstating their incomes so they can be eligible for higher subsidies that reduce their premiums.
Brian Blase, president of the conservative think tank Paragon Health Institute, estimated that 4 to 5 million people were fraudulently enrolled in ACA exchange plans with no premiums.
Blase has argued that Republicans are merely trying to shrink the health law back to what it was when it first took effect.