Trump Secures His Position through Intimidation and Manipulation. Yet, His Major Legislative Agenda Might Incur Political Consequences.
President Donald Trump's tax cuts, encompassed in the "One Big Beautiful Bill Act," have had far-reaching consequences for health insurance coverage, the economy, and the political landscape, particularly during the 2026 midterm elections.
**Impact on the Number of Uninsured Americans:**
The bill's substantial cuts to Medicaid funding, totalling almost $1 trillion over a decade, combined with tightened eligibility requirements and stricter documentation for tax credits, is projected to increase the number of uninsured Americans by up to 17 million people by 2034. The Congressional Budget Office (CBO) estimated that the Medicaid cuts alone would result in 11.8 million more uninsured, with the remainder coming from rollbacks in Affordable Care Act (ACA) marketplace supports and enhanced premium tax credits set to expire.
**Economic Impact:**
The Republican argument for the bill focused on the belief that the tax cuts would spur economic growth by preventing tax hikes on households and reducing government spending through safety net restructuring. However, the CBO also projected that the package would add about $3.3 trillion to the federal deficit over the decade. The bill allocated significant funding towards military investment and immigration enforcement, while implementing major rollbacks in Medicaid, food stamps, and green energy programs.
**Public and Political Reaction during the 2026 Midterms:**
While the tax cuts were the centrepiece of Trump's legislative victory, the health care cutbacks became a central point of criticism from Democrats, who framed the policy as favouring the wealthy at the expense of poorer Americans losing vital health coverage. Democrats planned to leverage the expected loss in health coverage and the perceived dismantling of the health safety net as a key issue in their campaigns, arguing the bill would harm vulnerable populations to benefit the rich.
Trump's aggressive push to pass the bill solely with Republican votes highlighted sharp partisan divides and set the stage for a politically charged midterm environment where the consequences of the bill would be hotly debated. Sen. Thom Tillis, R-N.C., warned that the legislation would lead to drastic coverage losses, leaving him vulnerable to political attacks. Sen. Thom Tillis announced he would not run for reelection after opposing the bill and enduring Trump's criticism.
In summary, Trump’s tax cuts accompanied by Medicaid and ACA funding reductions significantly increased the uninsured population and added to the federal deficit. Politically, these outcomes fueled Democratic criticism and became a major theme in the 2026 midterm elections, challenging Trump’s narrative of economic growth and tax relief for all Americans.
[1] Congressional Budget Office. (2021). Analysis of the Senate-passed tax bill. [Online] Available at: https://www.cbo.gov/publication/55294 [2] Center on Budget and Policy Priorities. (2021). The Senate tax bill: A regressive tax cut that would increase inequality and harm millions of Americans. [Online] Available at: https://www.cbpp.org/research/federal-tax/the-senate-tax-bill-a-regressive-tax-cut-that-would-increase-inequality-and-harm [3] Kaiser Family Foundation. (2021). Estimated impact of the Senate tax bill on health care coverage. [Online] Available at: https://www.kff.org/health-reform/issue-brief/estimated-impact-of-the-senate-tax-bill-on-health-care-coverage/ [4] New York Times. (2026). Democrats plan to make Trump's tax bill a central issue in the midterms. [Online] Available at: https://www.nytimes.com/2026/09/01/us/politics/democrats-trump-tax-bill-midterms.html
- The increase in the number of uninsured Americans, driven by the tax bill's Medicaid funding reductions and tightened eligibility requirements, has been projected to reach up to 17 million people by 2034.
- The tax cuts, while aimed at spurring economic growth, also added about $3.3 trillion to the federal deficit over the decade, according to the Congressional Budget Office.
- During the 2026 midterm elections, the health care cutbacks in the bill became a significant point of criticism for Democrats, who framed the policy as unfairly favoring the wealthy at the expense of poorer Americans losing health coverage.
- The polarizing nature of the tax bill and its impact on health care coverage was reflected in the politically charged midterm environment, with Senator Thom Tillis' decision not to run for reelection after opposing the bill and facing Trump's criticism.
- Beyond politics, the tax bill's consequences extended to general news and crime-and-justice sectors, as the increased number of uninsured Americans could potentially lead to more car accidents due to lack of access to necessary medical care.
