Former President Donald Trump’s election victory and looming return to the White House are likely to bring changes that scale back the nation’s public health care programs — increasing the rate of uninsured people while erecting new barriers to abortion and other reproductive care.
The reverberations will be felt far beyond Washington DC and could include an erosion of the Affordable Care Act’s consumer protections, the imposition of work requirements in Medicaid and cuts to safety net insurance, and challenges to federal agencies that protect public health. Abortion restrictions could become stricter nationwide, with a possible effort to limit the shipment of abortion drugs.
And with vaccine skeptic Robert F. Kennedy Jr. being elevated to Trump’s inner circle of advisers, public health interventions with rigorous scientific backing — 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 said at 5:34 a.m. ET on Wednesday. He won 51% of the vote nationally to Harris’ 47.5%, the AP predicted.
Trump’s victory will provide a much broader platform to skeptics and critics of federal health programs and actions. In a worst-case scenario, public health authorities worry, the U.S. could see an increase in preventable diseases; a weakening of public confidence in established science; and debunked concepts – such as a link between vaccines and autism – that have been adopted as policy. Trump said inside an NBC News interview on Nov. 3 that he would “make a decision” on banning some vaccines, saying he would consult with Kennedy and calling him “a very talented man.”
Although Trump has said he will not try again to repeal the Affordable Care Act, his administration will have to make an immediate decision next year on whether to support an extension of increased premium subsidies for Obamacare insurance plans. Without the increased subsidies sharp premium increases which means a lower number of registrations is expected. The current uninsured rate, about 8%would almost certainly rise.
The policy details haven’t gone much beyond the “concepts of a plan” Trump said he had during his debate with Harris, though newly elected Vice President J.D. Vance later said the administration would try to inject more competition into the ACA marketplaces .
Republicans, in addition to the White House, would claim a majority in the Senate, with control of the House still unresolved as of Wednesday.
Polls show the ACA has done just that received public supportincluding provisions such as protecting pre-existing conditions and allowing young people to continue on family health insurance until age 26.
Trump supporters and others who worked in his administration say the former president wants to improve the law in ways that reduce costs. They say he has already shown he will be forceful when it comes to lowering 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 on the first term,” said Brian Blase, who was Trump’s health adviser from 2017 to 2019. Relative to a democratic government, there will be “much more attention,” he said. “minimize fraud and waste.”
Efforts to weaken the ACA could include cutting funds for enrollment activities, allowing consumers to buy more health insurance plans that do not comply with ACA consumer protections, and allowing insurers to charge sick people higher premiums.
Democrats say they expect the worst.
“We know what their agenda is,” said Leslie Dach, executive chairman of Protect Our Care, a health care policy and advocacy organization in Washington, DC. He worked in the Obama administration and helped implement the ACA. “They’re going to raise costs for millions of Americans and take away coverage from millions of Americans, all the while giving tax breaks to rich people.”
Theo Merkel, director of the Private Health Reform Initiative at the right-wing Paragon Health Institute, which Blase heads, said the increased ACA subsidies provided by the Inflation Reduction Act in 2022 do nothing to improve plans or reduce premiums. He said they are covering up the low value of the plans with larger government subsidies.
Other Trump supporters say the president-elect could support preserving Medicare’s authority to negotiate drug prices, another provision of the IRA. Trump is in favor of lowering drug prices and put forward a test model in 2020 that would have tied the prices of some drugs in Medicare to lower costs abroad, said Merkel, who worked in Trump’s first White House . The drug industry successfully sued to block the program.
Some names have already been floated within Trump’s circles as possible leaders for the Department of Health and Human Services. They include former Louisiana Governor Bobby Jindal and Seema Verma, who led the Centers for Medicare & Medicaid Services during the Trump administration.
Kennedy, who suspended his independent presidential run and endorsed Trump, has told his supporters that Trump promised him control of HHS. Trump said publicly before Election Day that he would give Kennedy a major role in his administration, but that he might struggle to win Senate confirmation for a Cabinet position.
While Trump has vowed to protect Medicare and said he supports funding home health benefits, he has been less specific about his intentions for Medicaid, which provides coverage to lower-income people and people with disabilities. Some health analysts expect the program will be particularly vulnerable to budget cuts, which could help fund 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 the way Medicaid is funded. Now the federal government pays states a variable percentage of program costs. Conservatives have long sought to limit federal allocations to states, which critics say would lead to draconian cuts.
“Medicaid will 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 has said decisions on abortion restrictions should be left to the states. Thirteen states ban abortion with few exceptions, while 28 others restrict the procedure based on the length of pregnancy. according to the Guttmacher Institutea research and policy organization focused on advancing reproductive rights. Trump said before the election that he would not sign a national abortion ban.
State ballot measures to protect abortion rights were passed 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 take action to restrict access to abortion drugs, which are used in more than half of abortions, either by revoking the FDA’s approval for the drugs or enforcing a 19th century law , the Comstock Act, which abortion opponents say bans its shipment. Trump has said he generally would not use the law to ban mail delivery of the drugs.
This article originally appeared on KFF Health News.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the key operating programs at KFF – an independent source of health policy research, polling and journalism. Learn more about KFF.
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