🏥House Speaker targets ACA through budget reconciliation process

Trump eliminates Affordable Care Act effectiveness through regulatory changes, funding cuts, and enforcement reductions that bypass legislative processes. Navigator programs lose funding, enrollment periods shrink, and marketing disappears, causing coverage drops while maintaining the technical claim that ACA remains law.

Regulatory uncertainty and subsidy threats cause insurance companies to exit ACA marketplaces, leaving entire regions without coverage options. Rural areas face particular devastation as insurers retreat to profitable urban markets, creating healthcare deserts for Americans who need individual market insurance the most.

Rather than directly eliminating ACA coverage mandates, the administration allows short-term insurance plans that exclude chronic conditions, cancer treatments, and prescription drugs. Healthy people get cheaper plans while sick Americans lose access to comprehensive coverage, effectively recreating pre-ACA discrimination.

The administration pressures states to impose work requirements, asset tests, and bureaucratic barriers that reduce Medicaid enrollment despite federal matching fund obligations. Red state governors gain cover to cut coverage while blue state expansions face funding uncertainty, creating patchwork healthcare access across America.