President Donald Trump signed several executive orders on January 20, 2025, that could affect nearly 24 million Americans, including many in Republican states. These orders focus on changes to the Affordable Care Act (ACA), also known as Obamacare, with the goal of reducing federal spending and simplifying the process. However, critics warn that these changes could make health insurance less available for millions, especially in states that did not expand Medicaid.
Why It Matters The new executive orders undo some of the improvements made to the ACA during the Biden administration, which aimed to increase access to health care. This is particularly concerning for states like Texas, Florida, and Georgia, where many people rely on the ACA for insurance. These states have some of the highest enrollment numbers in the ACA marketplace but also have higher rates of people without insurance due to the lack of Medicaid expansion. These changes could lead to higher health care costs and less coverage for those who need it most.
What’s Happening On his first day back in office, President Trump issued these executive orders, which reverse policies that helped more people get health care under the ACA. These changes limit the open enrollment periods and reduce federal subsidies that help people pay for their insurance. While the goal is to cut federal spending, it could make it harder for many Americans to get the health coverage they need, especially those in states that did not expand Medicaid.
Trump’s Plan Trump’s executive orders are part of his effort to reshape the health care system, which some have called “Trumpcare.” By reducing subsidies and shortening enrollment windows, the administration hopes to cut costs. However, these changes might also make it more difficult for people to afford insurance and could lead to fewer people enrolling in ACA plans, particularly those who are facing major life changes, such as losing a job or moving to a new state.
State Impact In 2024, states like Florida, Texas, California, and Georgia had the most people enrolled in ACA plans. These states, especially Florida and Texas, rely heavily on the ACA for health insurance, but because they have not expanded Medicaid, many residents remain uninsured. The new policies could make it harder for these states’ residents to keep their health coverage.
