There are a lot of things wrong with today’s Republican Party. They lie. They lie about how much they lie. They have handed their party and our democracy to a conscienceless kleptocrat, and they adulate him the way Russian Communists once lionized Stalin (massive, Stalinesque banners of Trump now adorn at least two federal office buildings, the Justice Department and the Department of Labor).
But here’s something that’s wrong with them that predates Trump. They have no solutions to anything. As we’re witnessing at the moment, Donald Trump has no idea of anything to do about inflation and gas prices. The last three Republican presidents have left office with the economy in a shambles. On education, the environment, you name it—no solutions. They don’t even bother. Newt Gingrich at least used to bother to pretend, back when he was speaker, with all his New Agey, Tofflerian mumbo-jumbo. In his day, Paul Ryan did terrific cosplay as a wonky “ideas guy.” But now they don’t even do that.
On no issue is this more obvious than on health care. They railed against Obamacare. They spent years vowing to repeal it and replace it with something better. They never could repeal it, despite more than 70 tries. And that’s a good thing for many reasons, but mostly because they never had anything to replace it with. Conservatives once acknowledged that lack of health care coverage in this country was a problem, for which they promoted free-market solutions. But now they don’t even do that. They ostracized Mitt Romney, the last guy who tried. If you don’t have health care, in Republican world, that’s your own lazy fault.
All of which brings us to what’s happening with Obamacare right now. You’ll recall last fall’s government shutdown. That happened in part because expanded Obamacare subsidies signed into law by Joe Biden after the pandemic were set to expire at the end of 2025. Democrats wanted to renew them, and Republicans did not.
Now—you could argue that these subsidies were meant to be temporary, and so ending them was justifiable. It’s not a crazy point. On the other hand, millions of people came to depend on them. They couldn’t afford to buy coverage on the Obamacare exchange without those subsidies—which may mean that the original subsidies weren’t generous enough to persuade people to buy coverage. In any case, many Democrats and health care advocates argued last fall if the subsidies were ended, the cost of premiums would spike, and millions of people would drop their health care coverage.
Well … guess what happened? For openers, I refer you to this Wall Street Journal headline from March 19: “Millions of Americans Are Going Uninsured Following Expiration of ACA Subsidies.” The article reported: “Nearly one in 10 people who had Affordable Care Act plans last year dropped health insurance altogether, after premium costs rose sharply because of the expiration of federal subsidies, according to a new survey.”
Since that article ran, states have been reporting on their exact enrollment numbers for this year. In Georgia, for example, more than half a million people—all of them faced, remember, with higher gas and grocery prices—have decided to forgo coverage. The Georgia Recorder reported on April 20: “The 37% enrollment drop—from 1.5 million Georgians in January 2025 to 950,000 as of April 17, 2026—dwarfs any previous decline in the state since the launch of so-called Obamacare health insurance plans in 2014.”
While some of that drop happened before the subsidies expired, the lion’s share of it came after. It means that if you make more than $64,000 in Georgia, you have to pay full sticker price for health care, which in turn means that “for some Georgians, the cost of premiums more than tripled,” according to the Recorder. And while the numbers are more dramatic in Georgia, this is happening all over the country. It will, in addition, have a lot of knock-on effects. For example, hospitals will have to provide more uncompensated care, which leads to things like less money to invest in equipment and technology, which leads to worse care.
And taking a longer historical view: What has Obamacare done for Georgians? Has it made them feel the crippling weight of the chains of socialism that they are now forced to drag around with them? Well, I suppose some may feel that way. But in point of fact, from 2013 to 2016, the number of uninsured Georgians dropped by 537,000, which was 29 percent. The story was similar in two neighboring states. In Alabama, the uninsured dropped by 32.5 percent, and in Florida, by 34 percent.
In other words, Obamacare, with all its flaws, has done the main thing it promised it would do. It reduced the number of uninsured Americans dramatically. And in contrast, we might ask: What have Trump and the Republicans done with respect to Americans’ health care?
Next to nothing. A number of Republican governors and state legislatures did eventually bow to reality and accept the federal money they received from buying into Obamacare and opening state-run exchanges. Even so, 10 states still refuse to do so. Georgia is one (although it has accepted a partial expansion). Of the others, six are—guess what?—former states of the Confederacy. Then there are Kansas and Wyoming and, oddly, Wisconsin, where the state legislature is run by extremist nutsos.
And the president? His big health care calling card is TrumpRX.com, a website where people can buy certain drugs at a discount. It’s not awful. But as KFF points out in a fact sheet, the website offers discounts on 43 drugs. How many prescription drugs are patented in this country? Around 24,000. Plus, there are already other websites and online pharmacies that offer similar discounts and that list more drugs. So TrumpRX is like paving one pothole on a road littered with them. Meanwhile, Trump is throwing millions of Americans off their insurance plans because they can no longer afford them, while he’s telling them that gas prices are going to be high for a little while because of this pointless war that he started and is losing, and they just have to deal with it.
We tend to assign these actions by Republicans to cruelty. And it’s true. A lot of what they do is just heartless. For example, Texas limits eligibility for Medicaid to families living below 15 percent of the poverty level, meaning that a family of three earning more than—get this—$4,098 annually is not eligible for any benefits. The states that have opted into Obamacare all cap eligibility at 138 percent of the poverty level, and the feds pick up most of that tab. The states that haven’t bought in set their own levels. Texas is the lowest, and it’s just mean.
However, I wonder just how much stupidity factors in here too. These people must be dumb as rocks if they can’t see how this cruelty hurts their states economically. And even those who aren’t that stupid worship a man who pridefully knows nothing about public policy. That’s its own kind of dumb, and it’s arguably more insidious than even Trump’s addled incuriosity. They know better, and they do it anyway.
The end result is that people will go without health care, and some will die. OK—I guess cruelty wins. But man, it’s close.
