The fight is not only about foreign policy. It is also about whether Washington treats health coverage as optional when military spending expands.
A July 30, 2026 USA TODAY opinion column argues that Donald Trump wasted billions on Iran and that money could have kept Americans insured in the United States. The piece says, in plain terms, this was a tradeoff between war spending and health care: Defense Secretary Pete Hegseth told Congress on July 21 that five months of fighting Iran had cost $37.5 billion, while seeking another $67 billion.
That comparison is landing because Affordable Care Act subsidies have expired, enrollment has dropped, and many households are facing higher premiums. The core question is not just whether Trump “blew billions,” but what Washington chooses to protect first when money is suddenly available for war.
The numbers behind the argument
The USA TODAY column centers on a stark budget contrast. Hegseth’s cited figure — $37.5 billion for five months of war with Iran — is roughly the same annual scale as the cost of extending enhanced Affordable Care Act subsidies, based on a Congressional Budget Office estimate cited in the column.

The CBO estimate said keeping those subsidies in place would increase the deficit by about $350 billion over 10 years, or about $35 billion a year. It also projected that the policy would add 3.8 million people to Obamacare enrollment.
The column’s argument is simple and intentionally blunt: if the government could spend $37.5 billion in five months on Iran, it could have found comparable money to keep millions of people connected to health insurance for a year.
That is an opinionated framing, not a formal budget transfer. Defense appropriations and health subsidies do not move through Washington like cash between checking accounts. Still, the comparison is politically potent because federal budgets are statements of priority, not just spreadsheets.
ACA coverage is already shrinking
The health care side of the argument rests on real movement in enrollment. The U.S. Department of Health and Human Services recently reported, according to the column, that Obamacare enrollment fell from 24.2 million in 2025 to 19.2 million in February.
KFF, the health policy nonprofit, had warned that the expiration of enhanced subsidies would sharply raise costs for people buying coverage through Affordable Care Act marketplaces. The column cites KFF’s September projection that premiums for Obamacare enrollees would rise by 114% after the subsidies lapsed.
KFF also reported July 28 that every state except New Mexico saw a year-over-year enrollment drop. That matters because the ACA marketplaces are not abstract policy machinery; they are where self-employed workers, early retirees, gig workers and people without employer coverage often shop for insurance.
Premium shocks do not always show up as dramatic public moments. They show up when families quietly choose a cheaper plan, take on a higher deductible, or go uninsured because the monthly bill no longer fits.
Why Iran spending became the foil
Iran spending became the comparison point because military costs often appear in Washington with a different sense of urgency than domestic benefits. A war request can be framed as national security. A health subsidy is more likely to be framed as a cost, a deficit driver or a partisan program.
Trump’s defenders would argue that national security obligations cannot be measured against domestic programs dollar for dollar. If Iran posed a threat to U.S. interests, they would say, the government had to respond regardless of what was happening in the ACA marketplaces.
Critics counter that this is exactly how expensive wars escape scrutiny. Once fighting starts, the price tag can become secondary to the politics of appearing strong. Health coverage, by contrast, must repeatedly justify its existence, even when millions rely on it.
That is the tension the column exploits. It does not need readers to believe a perfect one-to-one swap was sitting on the table. It asks why one expense was treated as necessary while another was allowed to lapse.
Trump’s health care pitch remains thin
The column also takes aim at Trump’s broader health care posture. It notes that Trump campaigned in 2024 on making health care more affordable, then aligned with Republicans as enhanced ACA subsidies expired at the end of 2025.
Trump has continued to criticize Obamacare and has referred in speeches to a “great health care plan.” But the details described in the column sound more like a collection of narrower proposals than a full replacement or rescue plan for people losing marketplace affordability.
A White House official, according to the USA TODAY piece, pointed to several bills involving health care price transparency, prescription costs and access to some over-the-counter medications. Those ideas may affect parts of the system, but they do not directly answer the premium spike created by the subsidy expiration.
That gap is politically risky. Voters can disagree about the ACA as a brand and still be deeply sensitive to insurance bills. KFF polling cited in the column found that 61% of Americans had a favorable view of the Affordable Care Act in March, compared with 38% unfavorable.
The politics cut both ways
The column argues that Trump and Republicans own the consequences because they let subsidies expire while funding war. That is the cleanest political attack line, especially with health care costs rising and midterm pressure building.
Republicans can respond that the ACA subsidies were expensive, temporary and deficit-increasing. They can also argue that Democrats are using military spending as a rhetorical device while ignoring the long-term cost of open-ended health commitments.
There is some truth in the complexity. The federal government borrows, reallocates, delays and bundles spending decisions in ways that make any single comparison imperfect. A war bill does not automatically cancel an insurance subsidy, and an insurance subsidy does not automatically prevent military action.
But political accountability is not only about accounting categories. When leaders approve large sums for one priority and reject large sums for another, voters are entitled to judge the choice.
The unresolved question
The biggest unanswered question is whether the health coverage losses are the beginning of a longer slide or a temporary reset after subsidy changes. If premiums remain high and enrollment continues to fall, the argument that Washington knowingly priced people out of coverage will gain force.
The other question is whether Trump will offer a health care plan substantial enough to compete with the ACA rather than simply attacking it. Price transparency and prescription proposals may be popular, but they do not by themselves replace subsidies that made monthly premiums affordable.
The Iran comparison gives the debate a sharper edge because it turns an abstract deficit fight into a household question: who gets protected when federal money is tight, and who is told to wait?
That is why the column is resonating. It is not only an attack on Trump’s Iran policy. It is a reminder that every billion dollars Washington spends carries an opportunity cost — and for millions of Americans, that cost may now be showing up as an insurance bill they cannot pay.
















