Bulwark Takes: Yes, They’re Coming for Obamacare (AGAIN!)

Release Date: May 28, 2025

In the episode titled "Yes, They’re Coming for Obamacare (AGAIN!)" from Bulwark Takes, hosts Jonathan Cohn and Andrew Egger delve deep into recent developments in U.S. healthcare policy. They explore the aggressive maneuvers by the Trump administration and congressional Republicans to undermine the Affordable Care Act (Obamacare) while simultaneously highlighting internal disruptions within the Department of Health and Human Services (HHS).

1. Robert F. Kennedy Jr.'s Influence on Vaccine Policy ([00:15] - [08:55])

The discussion kicks off with a critical analysis of Robert F. Kennedy Jr.'s (RFK Jr.) role within the HHS and his longstanding anti-vaccine stance. Jonathan Cohn elaborates on RFK Jr.'s history, noting that his skepticism towards vaccines—particularly the debunked claim linking childhood vaccinations to autism—has been a consistent theme in his political endeavors.

Key Points:

• RFK Jr.'s Anti-Vaccine Agenda: Cohn explains RFK Jr.'s efforts to undermine vaccine safety, including his claims about insufficient testing and alleged links to vaccine injuries. He highlights the resignations of top vaccine officials from the FDA and CDC under RFK Jr.'s watch, indicating internal resistance to his agenda.

• Recent Policy Changes: The hosts discuss the recent removal of FDA authorization for COVID-19 booster shots for most healthy adults under 65 ([07:10]). This decision eliminates access to annual booster shots previously available to maintain immunity.

• Impact on Specific Groups: Furthermore, RFK Jr. announced the removal of COVID-19 vaccines from the recommended schedule for healthy pregnant women and young children ([08:00]). He frames these changes as steps "toward making America healthy again," a statement that the hosts find alarming given the vaccine's role in saving millions of lives.

Notable Quote: Andrew Egger observes, “[08:55] RFK is essentially monkeying with the pediatric vaccine schedule here a little bit at a time. … You can see in his mind, this being kind of like a trial balloon.”

2. Procedural Irregularities and Leadership Concerns ([08:55] - [17:33])

Jonathan Cohn and Andrew Egger express deep concerns about the haphazard and non-transparent manner in which RFK Jr. is implementing vaccine policy changes.

Key Points:

• Lack of Traditional Channels: Cohn points out the absence of comprehensive guidance from HHS and the CDC, with changes being announced through social media videos rather than official documents ([11:00]). This bypasses the usual consultation with advisory committees like the CDC's Advisory Committee on Immunization Practices.

• Comparison with Elon Musk's Approach: Cohn draws a parallel between RFK Jr.'s strategy and Elon Musk’s disruptive management style, noting that while Musk's "move fast and break things" approach led to significant backlash, RFK Jr. is adopting a more calculated method that may prove equally, if not more, detrimental ([16:00]).

• Potential Backlash and Long-term Implications: The hosts speculate on the public and political backlash that may ensue as RFK Jr. continues to challenge established vaccine protocols, raising fears about the future of public health initiatives under his leadership ([17:33]).

Notable Quote: Jonathan Cohn remarks, “[14:19] … RFK is sort of whipping the tablecloth off of his anti-vaccine project here a little bit at a time.”

3. Republican Healthcare Bill and Its Impacts on Obamacare ([17:34] - [35:51])

Shifting focus, the conversation turns to the recent Republican-led healthcare bill, scrutinizing its multifaceted attack on the Affordable Care Act and Medicaid.

Key Points:

• Overview of the Bill: Egger outlines the bill as a combination of massive tax cuts paired with significant cuts to social programs, particularly Medicaid and the ACA marketplaces ([21:49]). The tax cuts are deemed unsustainable, likely increasing the federal deficit.

• Medicaid Cuts: The bill proposes reductions that could strip coverage from over 10 million low-income Americans, potentially increasing the uninsured population by 7 million ([21:49]).

• Subtle Assault on Obamacare: Unlike previous attempts to repeal Obamacare outright, Republicans are now implementing incremental changes. These include:

  • Eliminating Subsidies for Legal Immigrants: Removing financial assistance for legal immigrants purchasing insurance through ACA marketplaces.
  • Introducing Procedural Barriers: Implementing complex enrollment processes referred to as "sludge," designed to deter individuals from signing up for insurance ([29:02]).
  • Reducing Financial Assistance and Benefits: Capping subsidies and diminishing the actuarial value of plans, leading to higher premiums and out-of-pocket costs.

• Impact on Insurance Pools: Egger explains how these changes could disrupt the insurance risk pool by driving healthy individuals away, thereby increasing premiums and creating a cycle that favors only those with chronic illnesses ([33:31]).

Notable Quotes:

• Egger states, “[21:49] … Republicans are looking to cut spending primarily on social programs, primarily on health care.”
• Jonathan Cohn adds, “[30:43] … the whole principle of insurance is that you're spreading medical expenses among a broad group of people.”

4. The Cumulative Effect and Public Health Concerns ([35:28] - [35:51])

In their concluding remarks, Cohn and Egger emphasize the dire implications of these policy shifts on the American healthcare landscape.

Key Points:

• Erosion of Healthcare Access: The combined effect of Medicaid cuts and ACA modifications threatens to leave millions without essential health coverage, exacerbating health disparities and financial instability for vulnerable populations.

• Underreported Crisis: Despite the monumental changes, the hosts note a surprising lack of public discourse and media coverage, underscoring the need for greater awareness and advocacy ([35:28]).

• Future Outlook: Cohn and Egger express concern over the Trump administration's handling of the pandemic under RFK Jr., fearing that mismanagement could lead to future health crises without effective leadership ([35:51]).

Notable Quote: Jonathan Cohn concludes, “[35:51] … Hope you head to thebulwark.com and subscribe. Subscribe to the YouTube channel. Thanks for all.”

Conclusion

In "Yes, They’re Coming for Obamacare (AGAIN!)," Jonathan Cohn and Andrew Egger present a comprehensive and alarming examination of the current threats to the U.S. healthcare system. From the internal dismantling of vaccine policies under RFK Jr. to the broader legislative attacks on Medicaid and the ACA, the episode underscores a concerted effort to undermine public health infrastructure. The hosts call for heightened vigilance and proactive measures to safeguard healthcare access and prevent further erosion of essential services.

For a more in-depth analysis, listeners are encouraged to visit thebulwark.com and subscribe to the podcast.