Making the Marketplaces Great Again?

“They’re not just dismantling the ACA. They’re dismantling the truth—and hoping you won’t notice until the bill comes due.” - Mary Coughlin

When the Cruelty is the Policy, and the Silence is the Strategy

It’s a headline that should stop us cold:

Nearly half of the people enrolled in the ACA Marketplaces are MAGA voters or Republicans.
And they are about to lose their health insurance.

Not because of market failure.
Not because of inflation.
But because the very people they voted for are gutting the system that sustains them.

According to a recent analysis by Drew Altman at KFF, around 10 million Americans—nearly half of all Marketplace and individual insurance enrollees—are MAGA-aligned or Republican voters. These are working people. Families. Cancer survivors. Folks with chronic illness. Parents. Gig workers. People doing their best in an increasingly brutal system.

And now? They're in the crosshairs of that same system.

The Cruelty is Not Accidental. It’s the Point.

The reconciliation bill currently being pushed through Congress includes changes that would:

• Make it harder to qualify for Marketplace insurance,

• Cut off financial help for millions, and

• Allow enhanced ACA tax credits to expire, which would raise premiums by over 75% on average.

The result? Over 4 million people are projected to lose coverage.
Red states—especially those that didn’t expand Medicaid—will be hit the hardest.

Let that sink in. Florida, Texas, the Carolinas. Places where people already struggle with access to care.
People who cheered for repeal.
People who believed they were safe.
They are now the collateral damage of their party’s political agenda.

And the silence? It’s deafening.
Almost no national outrage.
No Republican acknowledgment.
No mainstream headlines screaming, “MAGA voters about to lose their insurance because of MAGA lawmakers.”

Trauma-Informed Truth: This is Psychological Warfare

As someone who has worked in trauma-informed care for decades, I recognize the pattern.
This isn’t just policy violence—it’s trauma by design.

Confuse the public.
Complicate the language.
Divide blame.
Create despair.
Then do harm while people are too overwhelmed to resist.

This is institutional betrayal on a mass scale.
And it’s happening in plain sight.

People are being gaslit into thinking their suffering is a failure of government, not the deliberate erosion of public health by those in power. And they will blame the system, the health plans, the bureaucracy—everyone but the actual perpetrators.

This is how authoritarian regimes operate.
They destabilize. Then disappear. Then deny.

But This Is Not a Lost Cause

There is still time.
But time alone will not protect us. Truth will. Action will. Collective resistance will.

What’s needed now:

• Clear messaging: Say the quiet part out loud—these cuts are coming from Republicans.

• Moral clarity: Healthcare is not a partisan issue. It is a human one.

• Accountability: Governors, state leaders, and Marketplace directors must name who is behind the cost hikes.

• Solidarity: Regardless of political affiliation, no one deserves to be thrown under the bus for the sake of ideology.

And above all, storytelling. We must humanize the harm.

A Closing Reflection

We live in a nation where some cheer for the destruction of systems they rely on.
Where cruelty is cloaked in patriotism.
Where millions may lose coverage and still not know who pulled the plug.

If the enhanced tax credits expire, people will suffer.
If Marketplace reforms go unchallenged, more will fall through the cracks.
And if we keep staying silent—if we don’t name the betrayal for what it is—then we are complicit, too.

This is not just about economics.
This is about truth, dignity, and the soul of our democracy.

They call it “making the Marketplaces great again.”
But what they really mean is making them smaller, meaner, and easier to destroy.

We can choose another way.

We can reimagine a system that cares.
We can call out cruelty in every form it takes.
And we can protect one another from a future where access to care depends on politics, not humanity.

Because the Marketplaces may have been built by Democrats…
But they now belong to all of us.
And no one deserves to be left behind.

I write this not with despair, but with defiant hope.
Because the truth is still ours.
And we are still worth fighting for.

With fire in my belly and love in my bones,

Mary