Republican lawmakers on Capitol Hill are evaluating a legislative package that could lead to significant reductions in funding for the Affordable Care Act (ACA), putting millions of Americans at risk of losing their health insurance. This development comes amidst indications that this decision may not sit well with many constituents, as reflected in recent polling data.
According to a new survey conducted by KFF, a nonpartisan organization focused on health policy research, about 45% of adults who are insured through the ACA marketplace affiliate as Republicans. This statistic elevates concerns given that many of these individuals could be adversely affected by potential cuts.
(Notably, a significant majority of those Republican ACA enrollees, over 75%, identify as “MAGA” Republicans, accounting for 31% of ACA purchasers overall.)
On the other hand, 35% of Democrats rely on the ACA for their health insurance, as reported by KFF.
In May, the House of Representatives approved a sweeping tax and spending bill, projected to cut approximately $900 billion from health-related programs, including Medicaid and the ACA, commonly referred to as Obamacare. Currently, Senate Republicans are deliberating on the legislation, which encompasses several domestic policy goals set forth by President Donald Trump. The GOP aims to finalize the passage of this megabill by the upcoming Fourth of July holiday.
Should the legislation be enacted without extending tax credits that currently lower monthly ACA premiums, the Congressional Budget Office suggests that around 15 million individuals could lose their health coverage.
“A substantial portion of Republican users of these programs could face cuts,” remarked Audrey Kearney, a senior survey analyst with KFF’s public opinion and survey research division.
The survey was conducted from May 5 to May 26 among a representative sample of 2,539 U.S. adults, which included 247 individuals who have personally purchased their health coverage.
Many Republicans are self-employed
Health plans available through the ACA marketplaces primarily serve individuals who lack coverage from their employers or public programs like Medicare or Medicaid. Experts have noted that self-employed Americans fall into this demographic gap, contributing to the increased enrollment of Republicans in ACA plans compared to their Democratic counterparts.
“Republicans tend to be more entrepreneurial than Democrats,” Kearney noted, referencing a 2023 study from researchers at Columbia University, the University of California, San Diego, and the University of Alberta, which indicates that about 5.5% of Republicans venture into entrepreneurship, in contrast to 3.7% of Democrats.
Medicaid expansion varies by state
The Affordable Care Act also sought to broaden Medicaid eligibility for additional households. Nevertheless, ten states have yet to adopt this expansion: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming—states that all supported Trump in the 2024 presidential election.
According to John Graves, a health policy and medicine professor at Vanderbilt University School of Medicine, Republicans are “more likely to reside in non-expansion states.”
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This discrepancy is crucial for ACA enrollment, as “people in non-expansion states show a larger population that qualifies for tax credits,” remarked Carolyn McClanahan, a physician and certified financial planner based in Jacksonville, Florida. She is a member of the Finance Newso Financial Advisor Council.
In states that expanded Medicaid, the eligibility threshold for Medicaid coverage encompasses nearly all adults with incomes up to 138% of the federal poverty line (approximately $22,000 for a single-person household in 2025).
Conversely, in states that have not expanded Medicaid, more individuals qualify for subsidies that lower the cost of ACA health plans, according to Graves. These subsidized exchanges are available for those with incomes between 100% and 138% of the federal poverty line, among other criteria.
“Given the substantial subsidies available in that income range and the significant number of uninsured individuals, it stands to reason that a higher concentration of low-income GOP-identifying individuals would opt for the (subsidized) exchange route,” Graves pointed out.
The Affordable Care Act has faced criticism from Republicans since its inception during President Barack Obama’s administration. However, certain features of the law, such as the establishment of ACA marketplaces, protections for individuals with pre-existing conditions, and the option for young adults to remain on their parents’ health plan until age 26, enjoy widespread support, according to Kearney.
As of 2023, nearly 1 in 7 U.S. residents has enrolled in an ACA marketplace plan at some point since its launch in 2014, according to a 2024 report from the U.S. Department of the Treasury.
“Polls over the years indicate that while Republicans generally view the ACA unfavorably, the individual provisions within it are quite popular, including among Republican constituents,” Kearney noted.
