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Republicans Are More Dependent on Obamacare Than You Might Think

A surprising new poll from the Kaiser Family Foundation (KFF) reveals that 45% of adults enrolled in Affordable Care Act (ACA) marketplace plans identify as Republicans, outpacing the 35% who identify as Democrats. This data exposes a stark contradiction as Republican lawmakers in the House push for sweeping cuts to the ACA—threatening millions of Americans' health insurance.

The GOP’s Legislative Push Could Put Millions at Risk

In May, the Republican-controlled House passed a massive tax and spending bill estimated to slash around $900 billion from health programs, including Medicaid and ACA subsidies. If enacted without modifications—especially without extending ACA premium tax credits—the Congressional Budget Office warns that up to 15 million people could lose their health coverage.

Many of these affected individuals are, in fact, Republican voters. Among GOP ACA users, over three-quarters identify as “MAGA” Republicans, who represent roughly 31% of all ACA marketplace purchasers, according to the KFF survey conducted from May 5 to 26 among a nationally representative sample of 2,539 adults.

Audrey Kearney, senior survey analyst at KFF, emphasized this potential political fallout: “A large constituency of Republicans using these programs could face significant losses if these cuts go through.”

Why Are More Republicans Enrolled in ACA Plans?

Experts point to the self-employed demographic, which tends to lean conservative, as a key reason behind the Republican presence in ACA marketplaces. Unlike traditional employer-based insurance, ACA plans serve those without workplace coverage.

Research from 2023 by Columbia University, UC San Diego, and the University of Alberta found that 5.5% of Republicans are entrepreneurs, compared to 3.7% of Democrats. This entrepreneurial segment often relies on ACA plans to secure health insurance independently.

The Medicaid Expansion Gap Deepens Political Divides

Another major factor is Medicaid expansion—or the lack thereof—in many Republican-led states. Ten states, including Alabama, Florida, Texas, and Wisconsin, have not expanded Medicaid under the ACA. These states also largely supported Donald Trump in the 2024 presidential election.

As Vanderbilt University’s John Graves explains, “Republicans are more likely to live in non-expansion states,” which creates a unique dynamic:

• In Medicaid expansion states, adults earning up to 138% of the federal poverty level (about $22,000 for an individual in 2025) qualify for Medicaid directly.
• In non-expansion states, people in this income bracket often qualify for ACA marketplace subsidies instead, broadening eligibility for premium tax credits and driving more Republican enrollees to the marketplace.

Carolyn McClanahan, a physician and certified financial planner, adds that the “wider population eligible for subsidies in these states” partly explains the higher ACA marketplace enrollment among conservatives.

The Paradox of Republican Views on the ACA

Though Republicans have consistently criticized the ACA since its inception during President Obama’s administration, many provisions of the law enjoy bipartisan support. Features such as:

• Coverage for pre-existing conditions
• The ability for young adults to stay on their parents’ plans until age 26
• The establishment of ACA marketplaces

are broadly popular across the political spectrum, including among Republicans.

According to Kearney, “While Republicans often express unfavorable opinions about the ACA as a whole, many actually support its core benefits.”

ACA’s Growing Role in American Healthcare

Since its rollout in 2014, the ACA marketplace has steadily expanded its reach. A 2024 U.S. Department of the Treasury report states that nearly 1 in 7 Americans have enrolled in an ACA plan at some point since its inception.

This growing reliance on the ACA marketplace by a significant portion of Republican voters adds complexity to GOP efforts to cut its funding—raising important questions about the political and human costs of such moves.

What This Means Going Forward

As Senate Republicans weigh the House’s bill, the potential for widespread insurance losses among GOP constituents could complicate party unity on healthcare reforms. The data underscores the importance of considering the diverse needs of voters within each party—particularly when it comes to essential services like health insurance.