House speaker targets the ACA through budget reconciliation

House Speaker Mike Johnson announced a strategy to effectively repeal major Affordable Care Act provisions by embedding Medicaid work requirements, cost-sharing expansions, and subsidy cliffs into the reconciliation bill, bypassing the 60-vote Senate threshold. The approach followed the 2017 playbook but used budget scoring to characterize coverage losses as secondary effects rather than direct repeals. CBO estimated 13 to 17 million people would lose coverage under the proposed changes.