Around 27 million Americans have no health insurance, requiring them to pay for medical care upfront. Pandemic-era subsidies under the Affordable Care Act expired in December, and Obamacare enrolment has since fallen by more than a million people. Republican-backed legislation has cut federal Medicaid spending by more than $900bn over a decade, while insurance premiums and deductibles continue to rise. Many households are now being forced to choose between healthcare and basic necessities such as food and rent. More than 100 rural hospitals have closed over the past decade, with over 700 more now considered at risk.