In the run-up to November's midterm elections, the Trump administration has removed more than 750,000 enrollees from Affordable Care Act (ACA) health insurance marketplaces, a move that appears to be a calculated political strategy targeting low-income Americans.
President Donald Trump has been scrambling to show voters he can address economic pressures, offering to lower beef import barriers to curb meat prices, only to reconsider under pressure from the cow lobby. He also proposed halting diesel exports, but oil companies showed no interest. In early October, he began mailing $500 checks to nearly a million people, touting his healthcare "wins," and promised adult Americans a $5,000 check if Republicans retain control of Congress.
Administration's fiscal claims undercut by deficit projections
The administration frames the ACA ejections as part of a commitment to fiscal discipline. However, Treasury Secretary Scott Bessent's pledge to trim the budget deficit to 3% of US gross domestic product was never more than a rhetorical feint. The savings from the ACA maneuver, estimated at $2.2bn per year, are minimal compared to the One Big Beautiful Bill Act from 2025, expected to add $4.1tn to budget deficits over the next decade, largely due to tax cuts for the most affluent Americans.
The budget deficit is projected to rise to some $2tn in fiscal year 2026, roughly 6% of GDP and 18% more than in fiscal 2024, the last year of the Biden administration. Beyond the 3 million Americans who dropped health insurance after the administration cancelled Biden-era subsidies, the new ejections appear to spread further misery.
Strategy mirrors Doge playbook and targets 'bad' constituencies
The effort follows the playbook of Elon Musk's Doge, which promised to rid the government of "waste" and "fraud." That approach likely caused deaths of millions of children in the developing world after the dismantling of USAID, but proved largely irrelevant to saving money. It may serve as a masterclass in trolling, but it is not a vote-winner.
Trump's strategy appears to revolve around punishing people he can define as "bad," particularly immigrants and low-income people. ICE is doubling down, announcing it will hire another 5,000 agents by the end of the year.
Base support and political calculus
Surveys from the Pew Research Center show about two-thirds of Republicans believe giving more aid to the poor does more harm than good. Only 19% of Republicans think the Trump administration is doing too much to deport immigrants illegally in the country. The most radical rightwing voters support federal deportations and don't think the federal government should ensure Americans' healthcare.
Doubling down on policies to please the most ardent fanatics in his base ultimately reveals the weakness of Trump's position. Punishing the poor and the foreign, alongside an unlikely $5,000 Hail Mary pass, is all he has left.
