Trump's tax cuts vs. healthcare fallout: Will the 'One Big, Beautiful Bill' backfire in 2026 midterms?

Barack Obama had the Affordable Care Act. Joe Biden pushed through the Inflation Reduction Act. Now, President Donald Trump is staking his legacy on sweeping tax cuts.

Like his predecessors’ landmark policies, Trump’s “One Big, Beautiful Bill” is both a signature legislative achievement and a potential electoral liability. While initially celebrated within Republican circles, the bill is under growing scrutiny for provisions that critics say could strip health coverage from low-income Americans and unravel years of climate and energy policy progress.

Trump secured passage of the multitrillion-dollar legislation by rallying Republican lawmakers through a blend of persuasion and pressure tactics. True to his brand-driven approach, he named the bill with characteristic flair and made it a partisan milestone, pushing it through Congress without a single Democratic vote.

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But its political durability faces a crucial test in the 2026 midterm elections. Democrats are preparing to center their campaign narrative around a stark accusation: that Trump has prioritised tax breaks for the wealthy at the cost of health care for the poor.

While Trump and Republican allies insist that vulnerable groups will retain access to health coverage, independent analysts forecast a sharp rise in the uninsured population. At the same time, GOP promises that the bill will deliver an economic boost are being questioned amid economic instability and global trade tensions.

To address criticism that the bill primarily benefits the rich, Trump has highlighted tax relief measures for tipped workers and those earning overtime pay—groups that, while politically symbolic, make up only a fraction of the workforce. Still, whether these offsets will be enough to change public perception remains to be seen as both parties brace for an intense electoral showdown.

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Extending the tax cuts from Trump’s first term that were set to expire if Congress failed to act meant he could also argue that millions of people would avoid a tax increase. To enact that and other expensive priorities, Republicans made steep cuts to Medicaid that ultimately belied Trump’s promise that those on government entitlement programs “won’t be affected.”

“The biggest thing is, he’s answering the call of the forgotten people. That’s why his No. 1 request was the no tax on tips, the no tax on overtime, tax relief for seniors,” said Rep. Jason Smith, R-Mo., chairman of the tax-writing House Ways and Means Committee. “I think that’s going to be the big impact.”

Presidents have seen their signature legislative accomplishments unraveled by their successors or become a significant political liability for their party in subsequent elections.

A central case for Biden’s reelection was that the public would reward the Democrat for his legislative accomplishments. That never bore fruit as he struggled to improve his poll numbers driven down by concerns about his age and stubborn inflation.

Since taking office in January, Trump has acted to gut tax breaks meant to boost clean energy initiatives that were part of Biden’s landmark health care-and-climate bill.

Obama’s health overhaul, which the Democrat signed into law in March 2010, led to a political bloodbath in the midterms that fall. Its popularity only became potent when Republicans tried to repeal it in 2017.

Whatever political boost Trump may have gotten from his first-term tax cuts in 2017 did not help him in the 2018 midterms, when Democrats regained control of the House, or in 2020 when he lost to Biden.

“I don’t think there’s much if any evidence from recent or even not-so-recent history of the president’s party passing a big one-party bill and getting rewarded for it,” said Kyle Kondik, an elections analyst with the nonpartisan University of Virginia’s Center for Politics.

Democrats hope they can translate their policy losses into political gains.

During an Oval Office appearance in January, Trump pledged he would “love and cherish Social Security, Medicare, Medicaid.”

“We’re not going to do anything with that, other than if we can find some abuse or waste, we’ll do something,” Trump said. “But the people won’t be affected. It will only be more effective and better.”

That promise is far removed from what Trump and the Republican Party ultimately chose to do, paring back not only Medicaid but also food assistance for the poor to make the math work on their sweeping bill. It would force 11.8 million more people to become uninsured by 2034, according to the Congressional Budget Office, whose estimates the GOP has dismissed.

“In Trump’s first term, Democrats in Congress prevented bad outcomes. They didn’t repeal the (Affordable Care Act), and we did COVID relief together. This time is different,” said Sen. Brian Schatz, D-Hawaii. “Hospitals will close, people will die, the cost of electricity will go up, and people will go without food.”

Sen. Thom Tillis, R-N.C., repeatedly argued the legislation would lead to drastic coverage losses in his home state and others, leaving them vulnerable to political attacks similar to what Democrats faced after they enacted “Obamacare.” With his warnings unheeded, Tillis announced he would not run for reelection, after he opposed advancing the bill and enduring Trump’s criticism.

“If there is a political dimension to this, it is the extraordinary impact that you’re going to have in states like California, blue states with red districts,” Tillis said. ”The narrative is going to be overwhelmingly negative in states like California, New York, Illinois, and New Jersey.”

Even Sen. Lisa Murkowski, R-Alaska, who eventually became the decisive vote in the Senate that ensured the bill’s passage, said the legislation needed more work and she urged the House to revise it. Lawmakers there did not.

Early polling suggests that Trump’s bill is deeply unpopular, including among independents and a healthy share of Republicans. White House officials said their own research does not reflect that.

So far, it’s only Republicans celebrating the victory. That seems OK with the president.

In a speech in Iowa after the bill passed, he said Democrats only opposed it because they “hated Trump.” That didn’t bother him, he said, “because I hate them, too.”

With inputs from agencies