Many people say the American healthcare system is largely broken, or at least facing seemingly intractable problems. But it could get worse, compounded by policies of President Donald Trump’s administration on medical debt and inaction by Congress.

Expiration of tax credits from the Affordable Care Act at 2025’s end restricted who could claim Medicaid assistance. That left those covered by Obamacare increasingly facing difficult choices of sucking up extra expenses — while also covering the basics of life, such as rent and food costs — or even forgoing coverage altogether. All of which compounded an already deep medical debt crisis.