Document Type

Article

Publication Date

2026

Abstract

The past six years have seen two dramatic shifts in federal health and benefits policy. First, during the COVID pandemic, the government dramatically expanded public benefits. These expansions had incredibly positive effects, and recipients were largely satisfied with them. But after a relatively short time, Congress rolled back nearly all of the expansion. Worse, the immediate pullback set the stage for even more significant retrenchments in the second Trump Administration. Where in 2023 the United States came closest to universal health care in its history—with a record low uninsured rate of 7.7%—the Trump Administration’s Medicaid cuts and failure to extend enhanced marketplace subsidies will have wiped out essentially all gains made since adoption of the Affordable Care Act. That is not what drafters of the COVID era expansions expected. They thought people would rely on and appreciate the new benefits, resist rollbacks, and lead Congress to make the expansions permanent. These ideas, informed by political science literature on the durability of benefits expansions, have shaped Democratic domestic policy priorities for years. From the COVID experience, we learned that universal benefits are not as politically durable as many believe, particularly in their early years. Because universal benefits give workers more bargaining power vis à vis employers, employers have strong incentives to fight against such expansions. Opponents recognized that whether benefits programs are understood as universal is a matter of social meaning. They successfully reframed the programs not as universal protections but as compassionate aid for the deserving poor—arguing that extending them stretched programs beyond their purpose. The COVID experience raises serious questions about whether benefits expansions can be durable without first attending to imbalances of political power.

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© 2026 Houston Law Review. Reproduced with permission.

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