President-elect Donald Trump’s return to the White House may embolden Republicans who want to weaken or repeal the Affordable Care Act, but there are procedural and political challenges to enacting such sweeping changes. need to overcome hurdles.
Trump, a longtime opponent of the ACA, expressed interest in reforming the health law during his campaign. Additionally, some Republican leaders, who will now control both the House and Senate, say revising the landmark 2010 bill known as Obamacare will be a priority. They argue that the law is too costly and represents government overreach.
These three policies set the stage for significant changes that could curb the expansion of Medicaid laws, raise uninsured rates, weaken patient protections, and increase premiums for millions of people. It will be.
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“The Republican plan does not say they will repeal the ACA, but their package of policies could be as good or better,” said Sarah, vice president for health policy at the Center on Budget and Policy Priorities. Lueck said. , Research Policy Research Institute. “It can happen through laws and regulations. We’re on guard against everything. It can take many forms.”
Congressional Republicans have voted dozens of times over the years to repeal the law. After Trump took office in 2017, despite holding both houses of Congress and the White House, he was unable to do so primarily because some Republicans argued that it would cause a significant increase in the uninsured rate. Because he didn’t support the bill.
Similar opposition to changing the law could emerge again, especially since public opinion polls show the ACA’s protections are popular.
Neither Mr. Trump nor his Republican allies have provided details on what changes they would make, but House Speaker Mike Johnson said last month that the ACA requires “major reform” and that if Mr. Trump wins, his party’s He said it would be a topic of discussion.
In theory, Congress could change the ACA without a single Democratic vote using a process known as “reconciliation.” But Republicans’ narrow control of both houses of Congress means just a few “no” votes could defeat that effort.
Many of the more ambitious goals will require Congress. Some conservatives have called for changes to the funding formula for Medicaid, the federal health insurance program for people with low incomes and disabilities. The idea would be to use budget reconciliation to win approval from lawmakers to reduce the federal government’s share of the growing population. The most affected groups are primarily comprised of high-income adults and adults without children, rather than “traditional” Medicaid recipients such as pregnant women, children, and people with disabilities.
A conservative proposal to allow individuals to take advantage of ACA subsidies for plans on exchanges that do not comply with the health law would likely require Congress. That could push up premiums for older and sicker consumers who need more comprehensive coverage, as healthier people take advantage of subsidies to buy cheaper, more modest plans. .
“This is similar to the ACA repeal plan,” said Cynthia Cox, vice president and director of the Affordable Care Act program at KFF, a health information nonprofit that includes KFF Health News. “It will be renamed and abolished.”
Congress would likely need to pass a proposal that would move a portion of consumers’ ACA subsidies into health savings accounts to cover eligible medical expenses.
Trump may also choose to bypass Congress. During his previous term, he asked states to apply for waivers to change how the Department of Health and Human Services pays for the Medicaid program, capping federal funding in exchange for giving states more flexibility in running the program. . When it comes to making other changes to Medicaid, waivers are popular in both blue and red states.
“Trump will do whatever he thinks he can get away with,” said Chris Edelson, an assistant professor of government at American University. “If he wanted to do something, he’d just do it.”
Republicans have another option to weaken the ACA. It’s just doing nothing. The temporary, enhanced subsidies that lowered premium costs and contributed to the lowest uninsured rates in the nation’s history are set to expire at the end of next year without action from Congress. On average, subsidized consumers in 12 states who enroll through the federal ACA exchanges more than double their premiums, according to KFF data.
That means fewer people will be able to afford ACA exchange coverage. Additionally, federal estimates predict that 1.7 million more people will be uninsured from 2024 to 2033, although the number of people covered by employer plans is likely to increase. Masu.
Many of the hardest-hit states, such as Texas and Florida, are represented by Republicans in Congress, and some lawmakers may be hesitant to allow the subsidies to expire.
The Trump administration may choose to stop defending the law against lawsuits seeking to overturn parts of it. One of the most notable cases challenges the ACA’s requirement that insurance companies cover some preventive services, such as cancer screenings and alcohol counseling, for free. Approximately 150 million people currently benefit from the coverage requirements.
If the Justice Department withdraws the petition after President Trump takes office, plaintiffs would no longer have to comply with applicable requirements, but similar challenges could be triggered and could have broader implications. Zachary Barron, director of Georgetown University’s Center for Health Policy and Law, said the recent Supreme Court decision leaves the door open to legal challenges by other employers and insurance companies seeking similar relief. He said that it has become.
Meanwhile, President Trump could initiate change through executive orders, which are legally enforceable orders, from his first day in the Oval Office.
“Early executive orders will tell us what policies the administration plans to pursue,” said Alison Orris, senior fellow at the Center on Budget and Policy Priorities. “Signaling early through an executive order will send a message about what guidelines, regulations, and policies will be followed.”
In fact, President Trump relied heavily on these orders during his previous term. The October 2017 order directed federal agencies to begin amending the ACA, ultimately increasing consumer access to noncompliant health plans. He could issue a similar order early in his new term, starting a process of mandatory law reform, including increased oversight of potential wrongdoing.
The administration could take other steps early on that could work against the ACA, such as cutting federal funding for aid or helping to sign ACA plans. Both measures suppressed enrollment during the previous Trump administration.
President Trump could also use the regulations to implement other conservative proposals, such as increasing access to health insurance plans that do not comply with the ACA’s consumer protections.
The Biden administration is reversing President Trump’s effort to expand what is called short-term health insurance, which may not cover certain benefits and limit coverage for people with pre-existing health conditions. They disparaged the plan as “junk” insurance because coverage could be denied.
The Trump administration is expected to use regulations to reverse Biden’s reversal and allow consumers to keep and renew their plans for longer periods.
But drafting regulations has become much more complex following the Supreme Court’s ruling that federal courts no longer have to defer to federal agencies facing legal challenges to their authority. If a Trump-era Department of Health and Human Services rule is enacted in response, it could prompt further efforts to block it in court.
Some ACA planners say they are concerned. Dylan Reed, 43, a small business owner from Loveland, Colorado, remembers a time before the ACA and doesn’t want to go back to the days when he couldn’t afford insurance.
In addition to attention-deficit/hyperactivity disorder and anxiety, he has scleroderma, an autoimmune disease that causes joint pain and numbness in his extremities. Even with an ACA plan, he estimates he pays about $1,000 a month just for drugs.
He worries that without the protections of the ACA, it will be difficult to find insurance to cover his pre-existing conditions.
“It’s definitely a scary idea,” Reed said. “I’ll probably survive. I’ll just be in so much pain.”
KFF Health NewsFormerly known as Kaiser Health News (KHN), we are a national newsroom producing in-depth journalism on health issues and one of our core operating programs on health issues. KFF — An independent source for health policy research, polling, and journalism.
