With the Nov. 3 midterm elections less than three weeks away, healthcare has become a central Democratic campaign issue. An Associated Press analysis of AdImpact data found that healthcare was the most common issue in Democratic House and Senate ads since Sept. 1.
Democrats have made four claims: that Washington spends more on war than on healthcare, that most Americans lack health insurance, that Trump’s Medicaid changes take coverage away from poor Americans, and that socialized medicine provides better care. All four claims are false, as the spending figures, insurance coverage data, Medicaid provisions and international comparisons below demonstrate.
U.S. national health spending reached $5.3 trillion in 2024, or $15,474 per person, according to CMS data. That spending was equal to 18.0 percent of GDP. The federal government paid for 31 percent of total health spending, and state and local governments paid for 16 percent. Combined, government at all levels paid roughly $2.5 trillion.
That figure is nearly double the entire health budget of China, the world’s second-largest economy. According to China’s National Health Commission, China’s total health spending in 2024 was an estimated 9.09 trillion yuan, about $1.27 trillion in public and private spending combined, with the government paying 24.9 percent. Per person, the OECD’s health division head told the Senate Special Committee on Aging that U.S. government health spending per capita was greater than in all other OECD countries.
That spending funds coverage for more than a third of Americans. The Census Bureau found that 92.0 percent of Americans, 310 million people, had health insurance in 2024. Employer coverage was the most common type at 53.8 percent, followed by Medicare at 19.1 percent and Medicaid at 17.6 percent. Overall, 66.1 percent of Americans had private coverage and 35.5 percent had public coverage. Government coverage is concentrated among low-income Americans. Public coverage rates fall as income rises: Census figures show 77.0 percent of children and 50.7 percent of adults in poverty had public coverage, compared with 6.7 percent and 5.7 percent of those at or above 400 percent of the poverty line.
Trump signed the One Big Beautiful Bill Act into law on July 4, 2025, and Democrats have since described its Medicaid provisions as taking healthcare away from vulnerable Americans. In a May 2025 press release, House Democratic Leader Hakeem Jeffries called the bill “the largest healthcare cut in our country’s history” and said millions would lose Medicaid coverage. A statement from Jeffries and House Democratic leaders said the law takes healthcare and food assistance from millions of people to fund tax cuts for the wealthy. Rep. Bobby Scott, ranking member of the House Education and Workforce Committee, said Republicans would strip healthcare from the Americans most in need.
The law does not kick poor people off Medicaid, and it does not raise the income eligibility threshold, which remains 138 percent of the federal poverty line. It simply requires able-bodied adults to work, study or volunteer 80 hours a month.
