As Trump Ponders Health Cuts, Obamacare Grows In Red States He Won

Enrollment in individual coverage under the Affordable Care Act, also known as Obamacare, is growing faster in states Donald Trump carried in the last election, according to a new analysis.

Obamacare enrollment, which is at a record more than 24 million, has more than doubled since 2020 “with the fastest growth occurring in states won by President Trump in 2024,” KFF said in a report released this week. The 31 states Trump carried last November accounted for 88% of the increase in enrollment during the last five years, KFF said.

“Since 2020, enrollment grew by an average of 157% in states carried by President Trump but only 36% in states carried by former Vice President Kamala Harris,” KFF’s report said. “Almost all states have seen increases in enrollment since 2020, including six states where enrollment has more than tripled: Texas (up 255%), Mississippi (up 242%), West Virginia (up 234%), Louisiana (up 234%), Georgia (up 227%), and Tennessee (up 221%). Only New York (down 19%), Oregon (down 4%) and the District of Columbia (down 3%) experienced enrollment declines over the past five years.”

The report comes in the wake of massive cuts to the U.S. Department of Health and Human Services at the direction of Trump, his new health secretary Robert F. Kennedy, Jr., and his billionaire donor Elon Musk, according to several reports.

The cuts to HHS, which administers federal health insurance programs including Obamacare, and the threat of more health spending reductions comes ahead of health insurer quarterly earnings reports later this month when companies, including Centene, Oscar Health, Cigna, UnitedHealth Group’s UnitedHealthcare and Blue Cross and Blue Shield plans operated by Elevance Health are expected to report increasing enrollment in individual coverage under the ACA.

Whether such momentum and growth continues after this year is uncertain. When Trump was in office from 2017 to 2021, he and Republicans in Congress tried and failed several times to repeal the ACA, the signature legislative achievement of former President Barack Obama. But once again, Trump and Republicans are looking at cutting health benefits, including those under the ACA, to pay for tax cuts.

Obamacare has come a long way, with millions of Americans gaining such coverage in part due to expanding subsidies that allow more people to afford health insurance. The subsidies, which make health insurance premiums more affordable for individuals, were expanded thanks in part to moves by the Biden administration and the Democratic-controlled Congress, which passed the Inflation Reduction Act of 2022, allowing more Americans to buy coverage.

The subsidies have contributed to record enrollment in individual coverage, which is also more widely available as health insurance companies have pushed into more markets, including Republican-leaning states that have long opposed expanding Medicaid for poor Americans.

“Much of the enrollment growth stems from the enhanced premium aid first made available in 2021 that helped to make Marketplace coverage more affordable for many people,” the KFF report said. “The extra assistance is set to expire at the end of this year unless Congress acts to extend it.”