Americans Won’t “Get Over” Losing Health Insurance

Senator Mitch McConnell recently told his fellow Republicans not to feel bad about voting for a budget that takes away health insurance from 16,000,000 Americans. He said, “They’ll get over it.”

They’re about to do it to us, folks, so if you aren’t calling your senators then shame on you. And get ready to turn your focus on the House when the bill is sent back to them, so the House and the Senate versions of the bill are reconciled. They want us to go bankrupt or die, depending on whether or not we can afford any healthcare on our own right now. If not, there’ll be flies on Frank.¹

I wanted to see whether Trump wrote an EO regarding religious or ethnic freedom—or the denial of it, as current deportations demonstrate—and I found one that led me to a Page 404. Through a little detective work, I traced the EO as a policy now integrated into a larger policy called Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS). It represents a final rule that he signed on May 1. It takes effect on June 25.

This rule will be part of “DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Parts 147, 155, and 156 [CMS-9884-F] RIN 0938-AV61.”

It represents the destruction of the Affordable Care Act, or at least the parts that make healthcare possible for so many of us. Its basis is Trump’s memorandum entitled “Delivering Emergency Price Relief for American Families and Defeating the Cost-of-Living Crisis.” It purports to address the delivery of emergency price relief for Americans and to increase workers’ prosperity.

On the bottom of page 2, this final rule reads:

Based on our review of enrollment data and our experience fielding consumer complaints, the Department believes the temporary expansion of ACA premium subsidies resulted in conditions that were exploited to improperly gain access to fully subsidized coverage. As we detailed in the 2025 Marketplace Integrity and Affordability proposed rule and reiterate in this final rule, the widespread availability of $0 premium plans created the incentive and opportunity for fraudulent and improper enrollments at scale, either by the enrollee’s own doing or by a third party without the enrollee’s knowledge, including consumers who were enticed to respond to misleading advertisements promising cash or gift cards, and provided enough personal information for the agent, broker, and web-broker to enroll the consumer in a qualified health plan (QHP). Exchange eligibility verification policies in effect at the time enhanced subsidies became available, as well as those adopted and implemented since that time, were not sufficient to protect against this consumer harm and fraud, waste, and abuse of Federal funds. [this writer’s emphasis]

Trump (or whoever wrote this for him) goes on to wring his hands with worry that Americans will be liable to pay fines because they were enrolled improperly and therefore cannot rightfully claim their tax credits. He also states that people will lament falling victim to horrible, unscrupulous insurance brokers who enroll people without knowing they are breaking government rules in one of many instances of waste, fraud, and abuse. Wait, where have we heard that phrase before? Ah, yes, DOGE.

But this EO or final rule, whatever it’s called, doesn’t stop there. It is 478 pages long. I haven’t finished reading it, but here are a few more important takeaways:

This final rule says that improper enrollment caused by fraudulent brokers will disqualify Americans from eligibility, and so there will be no credits payable. Then, this paragraph caught my attention:

Because Federal law limits the amount that enrollees with lower household incomes must repay when they reconcile advance payments of the premium tax credit (APTC) received, these improper enrollments ended up costing Federal taxpayers billions of dollars. One analysis of improper enrollments estimated the Federal Government may have spent up to $26 billion on improper enrollments in 2024, before reconciling enrollment data. The policies being finalized in this rule aim to address these imminent program integrity problems while recognizing these problems are an outgrowth of temporary policy in order to deliver a streamlined enrollment and eligibility determination process for individual market consumers.

Whoever wrote this then had the temerity to suggest that the function of the Marketplace using the Exchange to buy a Quality Health Plan (QHP) and receive a premium tax credit (PTC), which is an advanced PTC or APTC when it’s received before tax time, not only costs the government money but also causes integrity problems. This rule also states that the ACA puts the onus on healthcare providers to treat people with chronic health conditions, thus blocking treatment options for healthy people. And this is just on page 5!

The rule goes on to state that care related to transgender issues would certainly be covered. Aren’t you glad you don’t have to worry about that! And then it states that fortunately the government will protect employers who issue group health insurance plans without understanding transgender issues. There’s a great deal of mishigas there, but it boils down to unwillingness to pay for services that are not understood by an employer who offers benefits to his employees. And the impulsiveness of the religious insured person is also attacked, rendering them too unreasonable to understand what their coverage is. Look for this garbage available starting on page 294.

We are suckers, people, if we do not do our best to protect the structures of the legislation we’ve had in place in recent years, good policies created by past presidents like Bill Clinton, Barack Obama, and Joe Biden. When we turn Congress blue in 2026—that’s both the House and the Senate—we must be ready with our old policies ready and prepared for reinstatement or updated if need be. Trump’s handlers had him fully prepared for his takeover on January 20, 2025, with all of his EOs prewritten and ready for his signature. We must emulate their efficiency.

1. A saying based on the title of John Lennon’s poem, No Flies on Frank