On Thursday, in a 51-48 vote, the Senate rejected a Democratic plan to extend Affordable Care Act enhanced tax credits, as well as a Republican alternative that boosted a health savings account model. It is now all but certain that the credits, which began under the Biden administration, will expire at the end of the year. As I previously reported, that expiration will lead, for millions of Americans, to the greatest single rise in health care premiums ever. In a video recorded after the votes, Sen. Elizabeth Warren (D-Mass.) expressed her anger towards Republican colleagues. “They voted to increase health care costs across the board, and now millions of Americans are left with the impossible decision of choosing between paying for health insurance or paying their rent,” Warren said. “They’ve all fallen in line behind Donald Trump and left American families in the dirt.” On New Year’s Day, the Urban Institute estimates, at least four million ACA marketplace users will become uninsured. People seeking ACA insurance will have until Monday to select a plan in order to be covered on January 1. Some of those people may now choose plans that are less comprehensive because it’s what they can afford, said University of Pittsburgh assistant professor Miranda Yaver, who focuses on health policy. That would leave an even greater number of Americans underinsured. “The average American cannot accommodate an unexpected $1,000 emergency medical expense,” Yaver said. “It is not exactly hard to run up a thousand-dollar tab in the American health care system, and having a good health insurance plan can insulate us from that cost.” American Public Health Association executive director Georges C. Benjamin said in a press release that Congress had failed its duty to safeguard the health of Americans. “Rather than addressing a serious issue that has been on our radar for years, Congress, earlier this year, rejected the opportunity to extend the enhanced tax credits,” Benjamin said, “and instead passed legislation to gut the Medicaid program and make additional changes to the ACA that will result in 16 million Americans losing their health coverage.” “We’re probably going to see more and more people forgoing coverage and care, which is only going to exacerbate existing health conditions,” said Marilyn Cabrera, the nonprofit Young Invincibles‘ health care policy and advocacy manager. Yaver is also skeptical of the health savings account model being pushed by Republicans as an alternative. They are not practical, she says, for the low and middle-income people that the Affordable Care Act is supposed to help. “You have to have the means to put a lot of money into your health savings account, and if you’re barely scraping by and living paycheck to paycheck, it’s just not going to happen,” Yaver said. Among some people whose health insurance is now in jeopardy, there is anger at Congress on both sides of the aisle. Some Democrats, Yaver said, are willing to “sort of allow a certain amount of harm in the next plan year, not wanting to bail Republicans out from their unwillingness to extend the marketplace subsidies,” ahead of elections. And for Republican politicians, Yaver said, “there is a real lack of connection to everyday Americans’ struggles with accessing health care, which is not a luxury item. It is basic survival for a lot of people.”

In a wide-ranging Sunday night interview on CBS News’s “60 Minutes,” President Donald Trump put his desire for unchecked power on full display. He bragged to correspondent Norah O’Donnell that, thanks to the Insurrection Act of 1792, he can invade your city whenever he wants. He said immigration raids—including acts of police violence such as using tear gas in residential neighborhoods, throwing people to the ground, and breaking car windows—”haven’t gone far enough.” And he said the government shutdown will last until Democrats in Congress bend to his will—or until Senate Majority Leader John Thune (R-S.D.) agrees to eliminate the filibuster, which Thune, so far, has rejected. Here are some of the biggest takeaways from Trump’s comments on domestic policy: Trump blamed the shutdown on the Democrats As the federal government shutdown enters its fifth week—on pace to be the second-longest in history after the one that stretched from December 2018 into January 2019—O’Donnell had a straightforward question for Trump: “What are you doing as president to end the shutdown?” His answer? Blaming the Democrats. “The Republicans are voting almost unanimously to end it, and the Democrats keep voting against ending it,” Trump said. “They’ve lost their way,” he added. “They become crazed lunatics.” Senate Democrats have said they will vote to reopen the government if the legislation includes an extension of Obamacare subsidies; without those, the health policy think tank KFF has estimated, average monthly premiums on people who get their insurance through the ACA marketplace would more than double. Trump also claimed Obamacare is “terrible,” adding, “We can make it much less expensive for people and give them much better health care.” But, yet again, he failed to outline his alternative. (Remember his “concepts of a plan“?) > What is President Trump doing to end the government shutdown? > > “What we're doing is we keep voting. I mean, the Republicans are voting almost > unanimously to end, and the Democrats keep voting against ending it,” says > Trump. pic.twitter.com/f6smwqi8Jn > > — 60 Minutes (@60Minutes) November 3, 2025 He defended Immigration and Customs Enforcement’s violent tactics Citing videos of ICE officers tackling a mother in court, using tear gas in a residential neighborhood in Chicago, and smashing car windows, O’Donnell asked Trump if some of the raids have “gone too far?” Trump gave what may have been his most direct answer of the interview: “No, I think they haven’t gone far enough,” he said. “We’ve been held back by the judges, by the liberal judges that were put in [the federal courts] by Biden and by Obama.” “You’re okay with those tactics?” O’Donnell pressed. “Yeah, because you have to get the people out,” he replied. > "I think they haven't gone far enough," says President Trump, defending ICE > raids. In one case, ICE tackled a young mother and in another tear gas was > used in a residential neighborhood. pic.twitter.com/b7tEYqWyUv > > — 60 Minutes (@60Minutes) November 2, 2025 He bragged that he can send the military into any city, at any time O’Donnell asked Trump what he meant when, at a speech in Japan last week, he said: “If we need more than the National Guard, we’ll send more than the National Guard.” Trump has already sent guard troops into Washington, DC; Los Angeles; Portland, Ore.; Chicago; and Memphis, Tenn. Trump seemed delighted to remind O’Donnell and viewers of what he sees as his vast power: “Well, if you had to send in the Army, or if you had to send in the Marines, I’d do that in a heartbeat. You know you have a thing called the Insurrection Act. You know that, right? Do you know that I could use that immediately, and no judge can even challenge you on that. But I haven’t chosen to do it because I haven’t felt we need it.” > “If you had to send in the Army or if you had to send in the Marines, I'd do > that in a heartbeat,” says President Trump. He has ordered the National Guard > to five major U.S. cities. https://t.co/GAtK4KJNAf pic.twitter.com/Yx0SoiGDFQ > > — 60 Minutes (@60Minutes) November 3, 2025 This is not the first time Trump has threatened to use the Insurrection Act, which allows the president to override federal law that prohibits the military from acting as law enforcement, in order to “suppress rebellion.” But the law has not been used in more than three decades and is widely seen by legal experts as having a frightening potential for abuse. “So you’re going to send the military into American cities?” O’Donnell pressed. “Well, if I wanted to, I could, if I want to use the Insurrection Act,” Trump responded. “The Insurrection Act has been used routinely by presidents, and if I needed it, that would mean I could bring in the Army, the Marines, I could bring in whoever I want, but I haven’t chosen to use it. I hope you give me credit for that.” He claimed he has been “mild-mannered” when it comes to political retribution In only nine months, Trump has made good on his long-running promise to prosecute his political enemies, including former FBI Director James Comey, former National Security Advisor John Bolton, and New York Attorney General Letitia James. “There’s a pattern to these names. They’re all public figures who have publicly denounced you. Is it political retribution?” O’Donnell asked. Trump promptly played the victim: “You know who got indicted? The man you’re looking at,” he replied. “I got indicted and I was innocent, and here I am, because I was able to beat all of the nonsense that was thrown at me.” (He was, indeed, found guilty in New York last year on 34 felony counts in the Stormy Daniels hush-money case.) > “I think I've been very mild-mannered. You're looking at a man who was > indicted many times, and I had to beat the rap,” says President Trump after > the recent indictments of high-profile figures who have publicly denounced > him. https://t.co/XHoIr77Eh1 pic.twitter.com/tLH0fxW2wI > > — 60 Minutes (@60Minutes) November 3, 2025 Despite posting a Truth Social message in September demanding that Attorney General Pam Bondi speed up the prosecutions, just days before Comey was indicted and a couple weeks before Bolton and James were, Trump insisted he did not instruct the Department of Justice to pursue them. “No, you don’t have to instruct them, because they were so dirty, they were so crooked, they were so corrupt,” he said, proceeding to praise the work of Bondi and FBI Director Kash Patel. “I think I’ve been very mild-mannered,” Trump continued. “You’re looking at a man who was indicted many times, and I had to beat the rap, otherwise I couldn’t have run for president.” He think he’s “better looking” than Zohran Mamdani Trump insisted that the frontrunner in New York City’s Tuesday mayoral election, 34-year-old self-described Democratic Socialist Zohran Mamdani, is a “Communist.” When O’Donnell asked Trump what he makes of comparisons between himself and Mamdani—”charismatic, breaking the old rules,” as O’Donnell put it—Trump replied: “I think I’m a much better-looking person than him.” He then reiterated his threat to withhold federal funding from his home city if Mamdani wins over ex-Gov. Andrew Cuomo. “It’s going to be hard for me as the president to give a lot of money to New York, because if you have a Communist running New York, all you’re doing is wasting the money you’re sending there,” Trump said. He claimed that he is “not a fan of Cuomo one way or the other,” but added, “If it’s going to be between a bad Democrat and a Communist, I’m going to pick the bad Democrat all the time, to be honest with you.” > Some have called Zohran Mamdani, the Democratic socialist front-runner for New > York City mayor, a left-wing version of President Trump. > > "I think I'm a much better looking person than him," says Trump, after calling > Mamdani a "communist." pic.twitter.com/p9FDWNcoGs > > — 60 Minutes (@60Minutes) November 2, 2025

For over a decade, Americans with private health insurance have enjoyed free access to dozens of types of preventive healthcare: cholesterol medication, prenatal care, and many types of cancer screenings, as well as pre-exposure prophylaxis (PrEP), the “miracle drug” that prevents HIV infection. But on Monday, the US Supreme Court heard oral arguments in a case that could gut the part of the Affordable Care Act that requires insurers to cover these services at zero cost to patients.  Kennedy v. Braidwood Management is at least the eighth time the Supreme Court has weighed in on a major element of the ACA since the health law was passed during the Obama administration in 2010. The lawsuit—filed by a group of Christian businesses and individuals who object to PrEP on religious grounds and Obamacare on ideological ones—takes aim at the US Preventive Services Task Force, a panel of independent, volunteer experts who rate the effectiveness of different types of preventive care. The ACA requires insurers to fully cover services rated “A” or “B” by the task force. Currently, members of the task force are appointed by the Secretary of Health and Human Services. But the case being heard by the Supreme Court argues that the Constitution requires officials who wield that level of power to be nominated by the president and confirmed by the Senate. The legal argument is highly technical, and oral arguments on Monday barely touched on the case’s potentially vast consequences for public health. If the justices agree with the plaintiffs, the task force and its recommendations for the last 15 years could be thrown out, and insurers could start denying coverage or imposing out-of-pocket costs on dozens of currently free preventive screenings and services—meaning many fewer patients would choose to get them. “The people who are going to be hurt most are the people who can’t just pull out a credit card and pay full cost for a service, or pay a $50 co-pay or an $80 co-pay,” says Wayne Turner, senior attorney at the National Health Law Program. “It is a literal lifesaver for people to be able to have some early detection.”  > “The people who are going to be hurt most are the people who can’t just pull > out a credit card and pay full cost for a service, or pay a $50 co-pay or an > $80 co-pay.” Among the threatened services are free HIV screenings for all, and PrEP for those at increased risk of contracting the virus. While HIV has become much less deadly since the mid-1990s, when more than 40,000 people in the United States were dying of related causes annually, there are still nearly 32,000 new infections and 8,000 HIV-linked deaths in the US every year, according to the health policy think tank KFF. PrEP—first approved by the FDA as a daily pill in 2012—lowers the risk of acquiring HIV through sex by 99 percent, and through injection drug use by 74 percent.  But the drug can cost up to $1,800 per month, so when the Preventive Services Task Force gave it an “A” rating in 2019, making it 100% covered by insurance, use of the drug appears to have soared. In 2015, 3 percent of people recommended for a PrEP prescription got one; in 2022, 31 percent did, according to the HIV and Hepatitis Policy Institute. Kennedy v. Braidwood threatens to reverse this progress. At the center of the lawsuit are a trio of Texans who have become conservative heroes in the culture wars against LGBTQ and reproductive rights: A powerful anti-LGBTQ activist, a lawyer known for masterminding Texas’ abortion vigilante law, and the judge they like to bring their cases to. The lead plaintiff, Braidwood Management, is owned by 74-year-old doctor Steven Hotze, a Houston-area alternative medicine guru, conservative powerbroker, far-right activist, and Republican megadonor. As my Mother Jones colleague Tim Murphy has written, Hotze—a former anti-abortion lobbyist—has a history of being very publicly anti-gay going back to at least the 1980s, when he campaigned to make it legal to discriminate against queer people in housing and employment.  In 1985, he endorsed a mayoral candidate who said that the best way to fight the AIDS epidemic was to “shoot the queers.” Years later, Hotze crusaded against same-sex marriage, backing Texas’ statewide ban in 2005 and filing a Supreme Court brief in 2015 arguing that gay marriage was “against the Bible.” (Hotze did not respond to a request for comment.) In 2020, Hotze—who had reportedly become fond of Covid conspiracies and QAnon slogans—allegedly paid a former Houston police captain over $260,000 to conduct a private investigation into voter fraud in Harris County. The investigator pursued the outlandish theory that an air conditioner repairman was using his truck to transport more than 750,000 forged mail ballots signed by undocumented Hispanic children, per a lawsuit filed by the repairman. So the investigator ran the repairman’s truck off the road, then held him at gunpoint while an associate searched the truck, which contained only air conditioner parts. Hotze was charged with aggravated assault with a deadly weapon, among other crimes, for his alleged role in commissioning the private investigation and knowledge of the ex-cop’s plan to confront the repairman. He has pleaded not guilty and says the prosecution is part of a conspiracy against him. Now, he’s at the center of a case that could dismantle a key part of the ACA. Hotze has sued over Obamacare before, challenging the law in 2013 on the grounds that taxation bills must originate in the House, whereas parts of the ACA were first introduced in the Senate. (He also released two techno tracks around that time, with lyrics like: “What would Davey Crockett do? I know what I’m going to do. I’m going to fight Obamacare.”) But lower court judges threw out the case, and in 2016 the Supreme Court declined to hear his appeal. In 2020, Braidwood Management and other plaintiffs sued over the ACA again, this time claiming their religious freedom was being violated by the law’s zero-cost preventive services requirement. Hotze specifically objected to mandatory insurance coverage for PrEP medications, which the lawsuit claimed “facilitate behaviors such as homosexual sodomy, prostitution, and intravenous drug use, which are contrary to Dr. Hotze’s sincere religious beliefs.” > “Our first and most immediate goal is to save this Affordable Care Act > provision, which is so important for so many people.” Representing Hotze and the other plaintiffs was none other than Jonathan Mitchell, the legal strategist and former Texas solicitor general known for crafting Texas’s “bounty hunter” anti-abortion law, SB 8, which cut off most abortion access in his state even before the fall of Roe v. Wade. Last year, Mitchell served as President Donald Trump‘s lawyer in front of the Supreme Court, arguing (successfully) against Colorado’s attempt to exclude Trump from the 2024 ballot. Mitchell has represented Braidwood Management before, in a case claiming that Title VII, the federal law banning discrimination in employment, violated Hotze’s religious beliefs. In both that case, and in the current ACA one, Mitchell filed the lawsuit in the Northern District of Texas, where it was duly assigned to yet another Texas conservative hero, federal Judge Reed O’Connor. In a 2018 ruling involving the constitutionality of the ACA’s individual mandate, O’Connor had already proved willing to strike down the law altogether. The 2018 decision was ultimately overturned by the Supreme Court, which said that O’Connor should have dismissed the case from the get-go. In the Braidwood case, O’Connor handed Mitchell and Hotze a partial win—ruling that the PrEP insurance mandate violated Hotze’s religious freedom, and exempting Braidwood Management from that requirement. Crucially, he also sided with them on an additional, more technical claim that members of the US Preventive Services Task Force are improperly appointed.  It’s that second argument that the Biden administration appealed, and the Supreme Court is now reviewing. Turner, the health policy attorney, says the case comes down to a line in the law that created the task force, declaring it “independent and, to the extent practicable, not subject to political pressure.” Braidwood Management argues that that line makes the task force too unaccountable. (Vaccines and birth control aren’t threatened by this case, since those recommendations are made by other entities—though powerful conservative activists are currently targeting the leading medical group that makes contraception coverage recommendations, as Susan Rinkunas recently reported at Jezebel.) To the surprise of patient advocacy groups, the Trump administration decided earlier this year to fight back against Braidwood’s challenge. Trump, in the past, has tried to repeal the healthcare law. But now, his administration argues that the task force is indeed accountable to Trump’s Senate-confirmed Secretary of Health and Human Services, Robert F. Kennedy Jr. During oral arguments on Monday, the administration’s lawyer claimed the secretary has the power to both appoint and remove members at will, and could use those powers to influence task force recommendations.  Turner says it’s a “real concern” that the Trump administration will eventually attempt to exert greater political control over the task force and its recommendations. “We’ve seen the administration do this in other parts of the federal government and other parts of HHS—purge the current leadership, purge the current members, and fill it with cronies who are going to be rubber stamping,” he says. But says it’s a risk worth taking:  “In my view, our first and most immediate goal is to save this Affordable Care Act provision, which is so important for so many people.” After oral arguments on Monday, court observers predicted that the justices would ultimately reject Hotze and Mitchell’s challenge to Obamacare. The ruling is expected by this summer.