Former President Donald Trump’s election victory and imminent return to the White House will likely bring changes that will cut the nation’s public health insurance programs — increasing the uninsured rate while imposing new barriers to abortion and other reproductive care.
The reverberations will be felt far beyond Washington, D.C., and could include an erosion of the Affordable Care Act’s consumer protections, the imposition of work requirements in Medicaid and funding cuts to safety net insurance, and challenges to federal agencies that protect public health. Abortion restrictions may be tightened nationwide with a possible attempt to limit the mail order of abortion drugs.
And with the emergence of vaccine skeptic Robert F. Kennedy Jr. in Trump’s inner circle of advisers, public health interventions backed by rigorous science—whether fluoridating public water supplies or vaccinating children—could come under fire.
Trump defeated Vice President Kamala Harris by 277 Electoral College votes, the Associated Press reported at 5:34 a.m. ET on Wednesday. He won 51 percent of the national vote to Harris’ 47.5 percent, according to the AP.
Trump’s victory will give a much broader platform to skeptics and critics of federal health programs and actions. At worst, public health officials worry that the US could see increases in preventable diseases. undermining public trust in established science; and debunked concepts—such as the link between vaccines and autism—were adopted as policy. Trump said in an interview with NBC News on Nov. 3 that he would “make a decision” about banning certain vaccines, saying he would consult with Kennedy and calling him a “very talented guy.”
While Trump has said he won’t try to repeal the Affordable Care Act again, his administration faces an immediate decision next year on whether to support an extension of enhanced premium subsidies for Obamacare insurance plans. Without the enhanced subsidies, steep premium increases are predicted to cause lower enrollments. The current uninsured rate of about 8% is almost certain to increase.
Policy details haven’t progressed much beyond the “concepts of a plan” Trump said during his conversation with Harris, though Vice President-elect JD Vance later said the administration would seek to introduce more competition to ACA purchases.
Republicans are expected to claim a majority in the Senate, except for the White House, while control of the House was still unresolved early Wednesday.
Polls show the ACA has won public support, including provisions such as pre-existing condition protections and allowing young people to stay in family health plans until they are 26.
Trump supporters and others who have worked in his administration say the former president wants to improve the law in ways that will cut costs. They say he has already shown he will be strong on reducing high health care prices, pointing to efforts during his presidency to pioneer price transparency in medical costs.
“In terms of affordability, I would see him building the first term,” said Brian Blais, who served as Trump’s health adviser from 2017 to 2019. In relation to a Democratic administration, he said, he would there will be “much more focus” “Minimizing fraud and waste”.
Efforts to weaken the ACA could include cutting enrollment outreach funds, allowing consumers to buy more health plans that don’t comply with the ACA’s consumer protections, and allowing insurers to charge patients higher premiums.
Democrats say they expect the worst.
“We know what their agenda is,” said Leslie Dach, executive president of Protect Our Care, a health care policy and advocacy organization in Washington, DC. He worked in the Obama administration helping to implement the ACA. “They will raise costs for millions of Americans and remove coverage from millions while giving tax breaks to rich people.”
Theo Merkel, director of the Private Health Reform Initiative at the right-leaning Paragon Health Institute, which Blase leads, said the enhanced ACA subsidies extended by the 2022 Inflation Reduction Act do nothing to improve plans or reduction of insurance premiums. He said they record the low value of the plans with larger government subsidies.
Other Trump supporters say the president-elect may support keeping Medicare’s power to negotiate drug prices, another provision of the IRA. Trump has championed lowering drug prices and in 2020 promoted a trial model that would link the prices of some Medicare drugs to lower costs abroad, said Merkel, who worked in Trump’s first White House. The pharmaceutical industry successfully sued to block the program.
In Trump circles, a number of names have already surfaced as possible leaders for the Department of Health and Human Services. They include former Louisiana Gov. Bobby Jindal and Seema Verma, who led the Centers for Medicare & Medicaid Services during the Trump administration.
Kennedy, who suspended his independent presidential campaign and endorsed Trump, told supporters that Trump promised him control of HHS. Trump said publicly before Election Day that he would give Kennedy a large role in his administration, but he may struggle to win Senate confirmation for a Cabinet post.
While Trump has promised to protect Medicare and said he supports funding for home care benefits, he has been less specific about his intentions for Medicaid, which provides coverage for lower-income and disabled people. Some health analysts expect the program to be particularly vulnerable to spending cuts, which could help finance the extension of tax breaks that expire at the end of next year.
Possible changes include imposing work requirements on beneficiaries in some states. The administration and Republicans in Congress could also try to revamp how Medicaid is funded. Now, the federal government pays the states a variable percentage of the program’s costs. Conservatives have long sought to limit federal handouts to states, which critics say would lead to draconian cuts.
“Medicaid is going to be a big target in a Trump administration,” said Larry Levitt, executive vice president for health policy at KFF, a nonprofit health information organization that includes KFF Health News.
Less clear is the potential future of reproductive health rights.
Trump said decisions on abortion restrictions should be left up to the states. Thirteen states ban abortion with few exceptions, while another 28 restrict the procedure based on gestational age, according to the Guttmacher Institute, a research and policy organization focused on advancing reproductive rights. Trump had said before the election that he would not sign a national abortion ban.
Measures to protect abortion rights were adopted in four states, including Missouri, which Trump won by about 18 points, according to preliminary AP reports. Abortion rights measures were rejected by voters in Florida and South Dakota.
Trump could limit access to abortion drugs, which are used in more than half of abortions, either by withdrawing FDA approval for the drugs or by enforcing a 19th-century law, the Comstock Act, that abortion opponents say that prohibits their sending. Trump has said he generally would not use the law to ban the mail order of drugs.
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This article was reprinted by khn.orga national newsroom that produces in-depth health journalism and is one of the core operating programs at KFF – the independent source for health policy research, polling and journalism.
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