Trump’s Return: Implications for the Future of the Affordable Care Act
- President-elect Donald Trump may empower Republicans to weaken or repeal the Affordable Care Act (ACA).
- The potential changes could affect Medicaid expansion, increase the uninsured rate, weaken patient protections, and raise premiums for millions.
- In 2017, despite having control of Congress and the presidency, Republicans failed to repeal the ACA, mainly due to some GOP members' concerns about rising uninsured rates.
Trump’s Impact on the Affordable Care Act
President-elect Donald Trump may empower Republicans to weaken or repeal the Affordable Care Act (ACA). However, significant changes will still face procedural and political challenges. Trump has long opposed the ACA and signaled interest in reform during his campaign. With Republican control over both the House and Senate, revamping the ACA could become a priority. Many Republicans argue the ACA is expensive and represents government overreach.
The potential changes could affect Medicaid expansion, increase the uninsured rate, weaken patient protections, and raise premiums for millions. Sarah Lueck from the Center on Budget and Policy Priorities warns that Republican plans might not explicitly state a repeal, but their policies can lead to similar outcomes.
In 2017, despite having control of Congress and the presidency, Republicans failed to repeal the ACA, mainly due to some GOP members’ concerns about rising uninsured rates. Polls indicate public support for the ACA’s protections, which could stall future repeal efforts.
House Speaker Mike Johnson has stated the ACA needs “massive reform” and plans to prioritize it if Trump wins. Congress could change the ACA using a process called “reconciliation,” but narrow margins in the House and Senate mean a few dissenting votes could derail these efforts.
Possible Changes to the ACA
Some conservative proposals include modifying Medicaid funding or allowing consumers to use ACA subsidies for non-compliant plans. These changes could drive healthier individuals to cheaper plans, resulting in higher premiums for those who need comprehensive coverage. Cynthia Cox from KFF notes these ideas resemble a repeal without officially declaring one.
Trump may also avoid Congress entirely, utilizing executive actions to change Medicaid funding and regulations related to the ACA, similar to his previous term. Chris Edelson, a political professor, believes Trump will act if he believes he can succeed.
Inaction as a Strategy
Republicans could also weaken the ACA by doing nothing. Enhanced subsidies that have helped lower premiums will expire at the end of the next year if Congress does not act. This could double or significantly increase premiums, leading to more uninsured individuals in the coming years.
Some states most affected by premium changes are Republican-led, which may create hesitation among lawmakers to allow subsidies to lapse. Trump could withdraw support from lawsuits challenging the ACA, effectively reducing its protections.
Executive Actions
Trump may start making changes immediately through executive orders. These orders can impact regulations and funding related to the ACA. He could initiate steps that worked against the ACA in his previous term, such as cutting federal outreach funding and modifying insurance regulations.
The Biden administration reversed several Trump-era changes. New regulations could expand short-term plans that lack ACA protections, further complicating insurance availability for consumers with preexisting conditions.
Concerns Among ACA Enrollees
Some ACA enrollees express concerns about potential changes. For example, Dylan Reed, a small-business owner with an autoimmune disease, fears returning to a time when obtaining insurance was difficult. He worries about the future of his coverage without the current protections.
Overall, Trump’s return to power could instigate significant changes to the ACA, affecting millions of Americans and their access to healthcare.