How Trump's victory will change your health care

President-elect Donald Trump's return to the White House is poised to have a major impact on consumer health care.

Experts say there are few legislative obstacles to the goal of reforming U.S. health care after Republicans maintained a narrow majority in the House of Representatives, flipped the Senate and took control of both Congress and the presidency. Experts said it may not be possible.

Health policy experts say households with health insurance through Medicaid or Affordable Care Act marketplace plans could be hit the hardest by reforms sought by Trump and Republican lawmakers. It is said that there is.

These reforms could free up federal funds that could be used to pay for other Republican policy priorities, such as tax cuts.

Just under 8% of the U.S. population is currently uninsured, the lowest uninsured rate in U.S. history, said Michael Sparler, professor and dean of the School of Health Policy and Management at Columbia University. When the Affordable Care Act was enacted more than a decade ago, that number was 17%.

“Those rates are going to start going up again,” Sparler said.

President Trump announced on November 14 that he would nominate Robert F. Kennedy Jr. to head the Department of Health and Human Services, which includes the Centers for Medicare and Medicaid Services. CMS administers the Affordable Care Act Marketplace and the Children's Health Insurance Program (CHIP), among other initiatives.

Kennedy, a vaccine skeptic who has been accused of spreading conspiracy theories, has vowed to make major changes to the U.S. health care system.

A spokesperson for Trump's transition team did not respond to a request for comment from CNBC about the president-elect's health policy plans.

Here's how health care could change for consumers under the incoming Trump administration, according to experts.

“Bet” premium subsidy expires

Given the election results, the Affordable Care Act's enhanced subsidies may not be renewed once they expire at the end of 2025, said Cynthia Cox, vice president and ACA program director at KFF, a health policy research organization. He said it was highly sexual.

“If you're going to bet on this, you're much more comfortable betting on it expiring,” Cox said.

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This government-backed aid was originally passed during the pandemic under the 2021 American Rescue Plan, which significantly lowered the cost of coverage for people purchasing health insurance plans in the ACA marketplaces. These customers include students, self-employed consumers, unemployed people, and others who do not have access to a workplace plan.

According to a rough estimate provided by Cox, monthly premiums for an individual earning $60,000 a year are now $425, compared to $539 before the enhanced subsidies. Meanwhile, a family of four earning about $120,000 a year now pays $850 a month instead of $1,649.

The Congressional Budget Office estimates that permanently extending enhanced ACA subsidies could cost about $335 billion over the next 10 years.

“They're concerned about costs and will probably cut taxes next year,” Cox said of Republicans.

Still, not buying health insurance is a 'big' gamble

The Congressional Budget Office estimates that about 3.8 million people would lose health insurance if the subsidies expire. Those who maintain coverage may pay higher premiums.

“The bottom line is uncertainty,” said Sabrina Corlett, co-director of the Center on Health Insurance Reform at Georgetown University's McCourt School of Public Policy.

“The good news for marketplace consumers is that the enhanced (subsidy) will be available until 2025, so no immediate changes need to occur,” Corlett added.

Experts say it's important to continue to enroll if possible, even if the subsidy runs out and you have to sacrifice coverage to keep costs within your budget.

Carolyn McClanahan, a physician and certified financial planner based in Jacksonville, Fla., says that having a plan, even an inexpensive plan with a high annual deductible, can help protect you from unforeseen medical conditions such as surgery. He said it could be an important hedge against the huge costs of such needs.

“I can't stress enough how high the stakes are to live without health insurance,” said McClanahan, founder of Life Planning Partners and member of the CNBC Financial Advisors Council. .

For someone without insurance, “one heart attack can easily cost $100,000,” she says. “Do you have anything to pay for it?”

'Pretty big goal' for lawmakers

Medicaid is the third-largest program in the federal budget, accounting for $616 billion in spending in 2023, according to the Congressional Budget Office. Mr. Trump campaigned on a promise not to cut the two largest programs, Social Security and Medicare.

That makes Medicaid an “obvious place” for Republicans to raise revenue to fund policies, said Larry Levitt, KFF's executive vice president for health policy.

“Medicaid is going to have a pretty big target on its back,” Levitt said.

Mr Levitt said the cuts would “inevitably” mean fewer households receiving benefits. Medicaid recipients tend to be from low-income households, people with disabilities and seniors in nursing homes, he said.

Levitt said the Medicaid cuts were a big part of Trump and other Republicans' push to repeal and replace the Affordable Care Act, also known as Obamacare, in 2017. It is said that he was

Those efforts ultimately failed.

How will Medicaid be cut?

Experts say new Medicaid cuts could take a variety of forms, citing past proposals and statements from the Trump administration, Republican lawmakers and the conservative Project 2025 policy blueprint.

For example, the Trump administration could try to add work requirements for Medicaid recipients, as it did during his first term, Columbia University's Spearer said.

In addition, Republicans may seek to cap federal Medicaid spending allocated to states, experts say.

The federal government accounts for a portion (usually more than 50%) of each state's Medicaid spending. There is no upper limit to that amount.

Levitt said Republicans could either convert Medicaid into a block grant, giving each state a set amount each year, or create a per capita cap, limiting benefits to each Medicaid enrollee. .

Lawmakers also could try to repeal the Affordable Care Act's Medicaid expansion, which widened the pool of people eligible for coverage, experts said.

It would do this by reducing federal funding to the 40 states and the District of Columbia that have expanded Medicaid eligibility. That would “transfer a tremendous amount of fiscal risk to the states, which would result in many states canceling Medicaid expansion,” Levitt said.

Experts say that under the former Trump administration, consumers saw an increase in non-ACA-compliant health insurance options, including short-term plans. Something similar could happen over the next four years.

Short-term health insurance plans provide coverage for a limited period of time and typically provide fewer medical services than comprehensive coverage.

Proponents of these plans argue that insurance companies can offer consumers lower monthly premiums because they don't have to cover as many services. At the same time, the plan can also turn away people with pre-existing conditions or charge them extra. Enrollment in short-term plans has skyrocketed during President Trump's tenure.

“The former Trump administration and many Republican lawmakers called for expanded marketing and sales of short-term plans and other insurance products that do not have to meet the ACA's pre-existing condition standards or other consumer protections,” Georgetown University's Corlett said. I've come,'' he said. .

He said consumers are sometimes attracted to low-cost plans, but often find out how little coverage they have until it's too late.

Experts say it's unclear whether lawmakers will keep drug policies in place. In 2020, President Trump signed executive orders aimed at reducing prescription drug costs, among other things.

“It's not at all clear that Mr. Trump will be a friend of the pharmaceutical industry,” Sperler said.

For example, the Inflation Control Act gave the federal government for the first time the power to negotiate prices with drug companies for some drugs covered by Medicare.

According to the Centers for Medicare and Medicaid Services, this provision will increase the number of drugs in 10 types of medicine (Medicare's “most expensive and most used” drugs that treat a variety of diseases, including heart disease, diabetes, arthritis, and cancer) by 2026. It is said that this will be applied to some of the .

CMS estimates that this measure will save patients $1.5 billion in out-of-pocket costs by 2026. The federal government would expand the list of drugs in subsequent years.

The Inflation Control Act also capped Medicare copayments for insulin at $35 per month. Previously there was no upper limit. According to KFF, the average Medicare Part D insulin user paid $54 per month out of pocket for each insulin prescription in 2020.

The law also capped out-of-pocket costs for Medicare-covered prescription drugs at $2,000 per year starting in 2025. Previously there was no upper limit.

Approximately 1.4 million Medicare Part D members paid more than $2,000 out-of-pocket for medications in 2020, according to KFF. These costs averaged $3,355 per person.