Senate Majority Leader John Thune (R-South Dakota), Sen. John Barrasso (R-Wyoming), and Senator Mike Crapo (R-Idaho) were seen exiting the West Wing of the White House on June 4, 2025. The Senate had commenced deliberations on President Donald Trump’s controversial “Big Beautiful Bill,” which narrowly passed the House on May 22. Several Republican senators have expressed concerns about the bill’s cost and its proposed cuts to Medicaid and clean energy tax credits.
According to a recent survey conducted by KFF, a nonpartisan health policy research group, nearly half (45%) of adults enrolled in a health plan through the ACA insurance marketplace identify as Republicans. Interestingly, more than three-quarters of these Republican ACA users align themselves with the “MAGA” Republican faction. On the other hand, 35% of Democrats receive their health insurance through the ACA.
The House of Representatives passed a multitrillion-dollar tax and spending package in May, which is estimated to cut approximately $900 billion from health programs like Medicaid and the ACA. Senate Republicans are now evaluating the bill, which encompasses many of President Trump’s domestic policy priorities. The GOP is aiming to pass the bill by the Fourth of July.
If the legislation is enacted as is and the tax credits that lower monthly ACA health premiums are not extended, an estimated 15 million people could lose their health insurance, as per the Congressional Budget Office. Audrey Kearney, a senior survey analyst at KFF, highlighted that a significant number of Republicans who utilize these programs could potentially face cuts.
The survey, conducted from May 5 to 26 among a nationally representative sample of 2,539 U.S. adults, sheds light on the impact of the proposed legislation on individuals who have purchased their own health coverage.
Health plans offered through the ACA exchanges primarily cater to Americans who do not have coverage through their employers or public programs like Medicare or Medicaid. Self-employed individuals often fall into this coverage gap, and as per Kearney, self-employed Americans tend to lean towards the right politically. This inclination could explain why more Republicans are enrolled in ACA health plans compared to Democrats.
Additionally, the Affordable Care Act expanded Medicaid coverage to more households, but 10 states, including Alabama, Florida, and Texas, have not adopted this expansion. These states, which all voted for Trump in the 2024 presidential election, are more likely to be home to Republicans who could benefit from the tax credits available in the non-expansion states.
Despite the criticisms leveled against the Affordable Care Act by Republicans, certain provisions within the law, such as coverage for pre-existing conditions and the ability to stay on parents’ health plans until the age of 26, have garnered widespread support. Kearney emphasized that while Republicans may view the ACA unfavorably as a whole, specific provisions are actually quite popular, even among Republican individuals.
The ACA has seen significant enrollment numbers since its inception in 2014, with nearly 1 in 7 U.S. residents enrolling in an ACA marketplace plan at some point. This indicates that the ACA has had a substantial impact on the healthcare landscape in the country, despite the ongoing political debates surrounding its implementation.
