President Trump has said he plans to revise the Affordable Care Act, which provides health care to 45 million Americans. His past actions include opposing the ACA. He reversed cuts to Medicaid and Medicare. The potential changes could impact drug prices, reproductive health care, and insurance regulations across the country.
Donald Trump's return to the Oval Office could mean changes to health insurance coverage for Americans based on his past statements and actions as president.
During his recent campaign, Trump promised to reform the Affordable Care Act, colloquially known as Obamacare, but did not go into details.
“If I can come up with a plan that lowers the burden on people and makes our health care system better than Obamacare, I absolutely will do it,” Trump said during a presidential debate in September.
As president, he would also have the power to influence the nation's health care landscape, including insurance coverage, drug price negotiations, government health and safety regulations, and access to reproductive health care.
President Trump has a mixed record of supporting government health insurance policies like the ACA, but the Department of Health and Human Services estimates that 45 million people are covered by health insurance plans such as Medicare and Medicaid. Also of note is the strengthening of federal ACA subsidies, which are set to expire at the end of next year.
If President Trump does not extend subsidies that help many low- and middle-income Americans pay for health care, nearly 4 million people will be unable to pay their health care costs by 2026. The Congressional Budget Office estimates that it will lose . I can afford it.
Trump's transition team told Business Insider in a statement that Trump will “strongly protect” Medicare in his second term, although the president has previously hinted at cuts. Changes to Medicaid and Medicare under the Trump administration could also reduce care options for people with ACA insurance.
Medicare, Medicaid, and pre-existing conditions
President Trump has not provided specifics about his affordable health care policy, other than saying in a September debate that he had a “vision of a plan.”
During his first term, President Trump supported a rejected Supreme Court case that overturned the Affordable Care Act, passed by former President Barack Obama in 2010, and expanded Medicaid coverage for low-income Americans. Expanded coverage and Medicare coverage for older Americans. Another major change in the ACA required insurance companies to cover the care of individuals with pre-existing conditions such as asthma, heart disease, and diabetes.
Yunan Ji is an assistant professor and economist at Georgetown University, specializing in health policy. She told BI that reducing or eliminating ACA coverage, as proposed by Trump during his first term, could disadvantage Americans with pre-existing conditions, causing them to lose coverage or face higher medical costs. He said he may have to pay more.
“We buy insurance to protect against future risks,” Ji says. “If you move people into another risk pool when they need care for some medical condition, that defeats the purpose of insurance.”
President Trump also expressed support for further privatization of the health care sector. This could mean that some Americans with ACA plans could face higher out-of-pocket costs and fewer in-network care options.
President Joe Biden's Inflation Control Act also took steps to lower prescription drug prices and limit out-of-pocket costs for Medicare recipients. The bill requires President Trump to continue existing drug price negotiations through at least the end of 2025.
Reproductive and gender-affirming care
President Trump said he would take action to ban all gender-affirming medical care and hormone therapy for minors, a plan covered by the ACA in some states.
Project 2025, a policy plan proposed by Trump's allies, calls for significant national restrictions on abortion and contraception. President Trump has expressed support for federal enforcement of the Hyde Amendment, a rule that prevents Medicaid from covering abortion drugs and procedures. Of the 37 states and D.C. that do not ban abortion, 17 currently follow the Hyde Amendment.
President Trump has called for federally subsidized in vitro fertilization, a proposal that is divisive within the Republican Party.
Insurance regulations and national health insurance
Gee said Americans often focus on the list price of a health insurance plan's premiums, or how much they are expected to pay out-of-pocket each month or year. However, a Trump presidency will also shape the rules and regulations for insurance companies. For example, companies need to cover a wide range of health care providers so that people with heart disease can find a cardiologist in their local network.
Ji added that President Trump's Cabinet appointments will provide insight into his health care priorities in his second term. His leadership choices will determine federal investment in medical research, health and safety guidelines, insurance company regulation and vaccines. President Trump is expected to block vaccinations and limit federal health and insurance regulations.
President Trump nominated Robert F. Kennedy Jr. to lead the Department of Health and Human Services on November 14, a decision that requires Senate confirmation. Although Kennedy has not announced specific plans to improve health care affordability, he will have some influence over the ACA in his role. The former presidential candidate is a vaccine skeptic and expects Trump to “go wild” on health, safety and food protocols.
Any major changes to health care policy or the federal budget require Congressional approval. Trump is likely to have support in the Republican-led Senate and House of Representatives.
“The American people re-elected President Trump by a landslide and gave him the authority to deliver on the promises he made during his campaign,” Caroline Leavitt, a spokeswoman for the Trump-Vance transition team, said in a statement. “He'll deliver.”
Are you working on anything to prepare a financial or health care plan for President Trump's second term? If so, please contact this reporter at allisonkelly@businessinsider.com.
