In the midst of the frenetic start to Donald Trump’s second term, something which has received less attention among the American public is the Republican Party’s budget bill currently working its way through Congress. To many people, just hearing the words “budget bill” is enough to make their eyes glaze over. But at the centre of the debate around the legislation is an issue which could backfire on Republicans if they aren’t careful: healthcare.

US healthcare has long proved a difficult issue for politicians from both parties. Efforts to expand coverage have often been met with charges of socialism, and have created a backlash among the electorate. But once a new benefit is entrenched, taking it away can be even riskier, a political science phenomenon known as voter loss aversion.

We’ve seen this principle at play within recent memory. One of the first major actions undertaken by the Republican-controlled Congress during Trump’s first term was to repeal the Affordable Care Act, better known as Obamacare. Polls routinely showed that Americans had come round to the law seven years after its passage and did not want to see it destroyed; and but for the dramatic “no” vote from John McCain, millions of people likely would have lost their insurance coverage.

The political fallout was impossible to ignore. In the subsequent midterm elections, Democrats experienced a “blue wave”, netting 40 new seats in the House and making extensive gains down the ballot. The AP VoteCast survey from that election found that a plurality of voters identified healthcare as the top issue facing the country, and those who agreed broke overwhelmingly for Democrats over Republicans in House races, 76% to 22%.

However, the clear political risks of cutting healthcare services and coverage have not dissuaded the Republicans from trying again. Their latest budget is likely to include massive cuts to Medicaid — a programme that provides health insurance to low-income Americans — and the codification of Trump’s administrative changes to the ACA insurance exchanges. One estimate from the Kaiser Family Foundation suggested these changes and others in the bill could grow the uninsured US population by as many as 16 million people.

Unsurprisingly, these proposals are highly unpopular. For a start, Medicaid remains highly favoured by Americans of all political persuasions. As of this year, 83% had a positive attitude towards the programme, including 74% of Republicans — whose favourability rose by 11 points since just last year. The public also has strongly favourable views towards the ACA, with 66% approving of it as of this year — the highest share on record — though a majority of Republicans remain critical.

Democrats looking for an issue on which to gain an advantage ahead of next year’s midterms would be wise to zero in on healthcare. At a time when many Americans feel that life is increasingly unstable, the threat of losing their insurance and becoming more exposed to medical bankruptcy is likely to be a real motivator. Party strategists seem to be taking note, advising House candidates to make the GOP’s impending cuts “the defining contrast of the 2026 election cycle” and launching an ad campaign against Republicans in vulnerable districts.

It remains to be seen whether congressional Republicans will follow through with these threatened cuts — and whether Trump, who has explicitly stated he will not slash Medicaid benefits, would sign a budget bill that included them. But as the 2018 midterms showed, it may not matter whether these changes ultimately pass. Just the threat of their doing so could be enough to derail the Republicans next year.

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Michael Baharaeen is chief political analyst at The Liberal Patriot substack.

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