In the year since Donald Trump signed the One Big Beautiful Bill Act into law, millions of Americans have already lost their health insurance as a result of that bill and other Republican policies. According to a recent report from health care advocacy group Protect Our Care, the number of enrollees in Medicaid and the Children’s Health Insurance Program (CHIP) has fallen by nearly four million since last July. Last month, data from the Department of Health and Human Services (HHS) revealed an even steeper drop for Obamacare: five million fewer people are now enrolled in Affordable Care Act (ACA) marketplace plans compared to last year.

Part of this slide has a straightforward cause: in January, Republicans blocked the extension of enhanced tax credits for Obamacare, leading to a steep jump in premiums and a predictable drop in ACA enrollment. But the broader decline stems not from a single decision but from a constellation of new policies that have been rolled out over the past year. Some of these measures come directly from the Big Beautiful Bill, but most are simply new rules drafted by Trump officials with the aim of reducing enrollment in programs like Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and Obamacare. In short, the numbers reflect the administration’s wider strategy of weaponizing red tape against low- and middle-income Americans.

This approach has intensified in recent months as administration officials have introduced a wave of new rules that raise barriers to enrolling in or maintaining access to various programs. The finalized rule for the ACA marketplace, published by HHS in May, illustrates this trend. Weighing in at 1,121 pages, the rule introduces a dense array of new regulations and reporting requirements while narrowing the enrollment periods. For enrollees, this means a lot more paperwork and time spent navigating a complex web of “sludge” just to keep coverage they already qualify for. Marketed as fraud‑fighting measures, these new rules are almost certain to drive down enrollment among eligible individuals.