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Republicans’ refusal to extend Affordable Care Act (ACA) subsidies last week is Step 8 in the autocrat’s playbook in action: intentionally weakening the government so concentrated power becomes easier to exercise. Shatter trust in what people should expect from democracy, and they learn to expect nothing.
Authoritarian movements rarely begin by abolishing popular programs outright. They do something quieter and more effective, something that feels inevitable. After years of complaining about how government doesn’t work (often by undermining and underfunding it), they force programs to fail in visible, painful ways, then use that failure as evidence that public institutions can’t be trusted. Case in point: allowing health care premiums to spike for more than 20 million Americans is a strategic withdrawal of responsibility.
Congress knows exactly what will happen when these subsidies expire at the end of the month.
Even the most conservative, anti-ACA Republican can tell you the sequence: first, premiums will rise, then coverage will shrink, forcing families to absorb the cost. After that, everyone else will have to pay for “uncompensated care”—the bills hospitals still have to cover even if patients can’t. Insurance companies won’t be on the hook because they hedged their bets by spiking premiums.
The sham plan Republicans put forward in response was an insult dressed up as policy, shifting responsibility from the state to the individual, then calling it “choice.” Health Savings Accounts that can’t pay for insurance, and account caps that leave users with chronic conditions or cancer on the hook and in debt. Junk insurance comes to fill in the gaps, and a weakened system finally collapses.
This is how the government is broken on purpose. People are left to navigate crises alone, told to be grateful for crumbs while systems that protect insurance company shareholders, pad billionaire wealth, and aggregate power remain untouched. But the strategy of breaking trust only works if Republicans avoid owning the damage. They’re betting voters will blame “the government” or “Washington” in the abstract—or better yet, Democrats—rather than the specific party that blocked the fix. Sabotage is only good politics if someone else takes the fall.
Donald Trump doesn’t need to dismantle the Affordable Care Act himself.
He benefits from a Republican Congress that has already learned how to retreat, how to let programs and agencies collapse without accountability, and how to outsource suffering. Worse, they fund their cruelty with high deductible plans on low-income families, while every members of Congress and the Trump administration enjoy gold-plated insurance and healthy returns on their investments. That’s how authoritarian power consolidates: not through dramatic decrees, but through repeated acts of abdication.
This is a feature of the authoritarian playbook—a design that has reaped benefits for autocrats around the world. When people experience government as unreliable or hostile, they disengage. They stop expecting help. Civic participation becomes a mockery, further isolating those who need the benefits of a social contract the most. Instead, in a time of fragility, our communities become more vulnerable to authoritarian appeals. Speeches that promise relief without pesky institutions. Snake-oil solutions that swear less is more. And those who’ve created the most harm shouting for greater accountability.
The consequences of this strategy show up most clearly in the South, where the test run of failed healthcare has proven effective. Administrative burdens, underfunded resources and shoddy politics compound into years of deliberate neglect. Ten states, including Georgia, still refuse to expand Medicaid, leaving millions in a coverage gap and shuttering dozens of hospitals. Millions more are “dual enrolled” in Medicare and Medicaid yet still can’t access consistent care. That reality is at the center of Dual: The True Cost of Care, a new multi-part docuseries from New Disabled South, documenting what happens when coverage exists on paper but accountability disappears in practice. You can watch the first episode below.
This preview of what awaits us all is why the Senate’s ACA vote is not separate from the broader authoritarian assault we’ve experienced over the past year. It is part of it. Breaking the government makes it easier to argue that only the most powerful can fix it. Or that we’ve never deserved help in the first place. The House still has a chance to take action, but we must compel them to remember their jobs—and to understand the consequences of inaction.
The danger isn’t just higher health care costs. It’s a political system being trained to accept failure as normal, cruelty as efficiency, and abandonment as reform. Once that becomes routine, democracy doesn’t need to be overthrown. It simply stops functioning, and we accept our condition and our fate.
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