Trump’s plans to overhaul health care could reduce insurance costs for some low-income Americans and retirees

• Trump said he plans to change the Affordable Care Act, which provides health care to 45 million Americans.

• His past actions include ACA opposition. He has reversed cuts to Medicaid and Medicare.

• Potential changes could affect drug prices, reproductive care and insurance regulations across the country.

Donald Trump’s return to the Oval Office could mean changes to America’s health care coverage, based on his past comments and actions during his presidency.

During his recent campaign, Trump promised to make changes to the Affordable Care Act, commonly called Obamacare, but provided no details.

“If we can come up with a plan that is going to cost our people and our population less money and provide better health care than Obamacare, then I would absolutely do that,” Trump said during the presidential debate in September.

As president, he will also have the power to influence America’s health care landscape, including insurance coverage, drug price negotiations, government health and safety regulations, and access to reproductive health care.

Trump has a mixed record on supporting government health insurance plans such as the ACA, which the Department of Health and Human Services estimates covers 45 million people in health plans such as Medicare and Medicaid. Also at the forefront: the increased federal ACA subsidies, which expire at the end of next year.

If Trump does not extend enhanced subsidy policies that help many low- and middle-income Americans pay for medical care, the Congressional Budget Office estimates that nearly four million people will lose coverage by 2026 because they will be unable to afford it.

Trump’s transition team told Business Insider in a statement that he will “strongly protect” Medicare in his second term — even though he has previously proposed cuts. Any changes to Medicaid and Medicare under Trump could also cause people with ACA insurance to see a reduction in their healthcare options.

Medicare, Medicaid and pre-existing conditions

Trump has not provided any details on his affordable health care policy, other than to say he has “drafts for a plan” during the September debate.

During his first term, Trump supported a rejected Supreme Court case to overturn the Affordable Care Act, which former President Barack Obama passed in 2010, which would have reduced Medicaid coverage for low-income Americans and Medicare coverage for older Americans expanded. ACA’s other major change required insurance companies to cover care for individuals with pre-existing conditions, such as asthma, heart disease and diabetes.

Yunan Ji is an assistant professor and economist at Georgetown University with expertise in healthcare policy. She told BI that reducing or repealing ACA coverage — which Trump proposed during his first term — could harm Americans with pre-existing conditions, who could lose coverage or have to pay more for health care.

“We buy insurance to protect ourselves against future risks,” Ji said. “If we put people in a different risk pool when they need care for a medical condition, it undermines the purpose of insurance.”

Trump has also expressed support for privatizing more 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 health care options.

President Joe Biden’s Inflation Reduction Act also took steps to lower prescription drug costs and limit out-of-pocket costs for Medicare beneficiaries. The legislation requires Trump to continue existing drug price negotiations at least until the end of 2025.

Reproductive and gender-affirming care

Trump has said he would take steps to ban all gender-affirming health care and hormone therapies for minors, which are covered by the ACA in some states.

Project 2025, a policy proposed by Trump allies, calls for significant national restrictions on abortion and contraception. Trump has expressed support for federal enforcement of the Hyde Amendment, a rule that prevents Medicaid from covering abortion pills and procedures. Of the 37 states and DC that do not ban abortion, 17 states and DC currently follow the Hyde Amendment.

Trump has called for federally subsidized in vitro fertilization — a divisive proposal among Republicans.

Insurance regulations and national health policy

Ji said Americans often focus on the sticker price of premiums in their health care plan — how much they are expected to pay out of pocket each month or year. But a Trump presidency would also shape rules and regulations for insurance companies. For example, companies are required to cover a wide range of providers so that someone with a heart condition can find an in-network cardiologist in his or her area.

Ji added that Trump’s Cabinet appointments will provide insight into his second-term health care priorities. His leadership selections will determine federal investments in medical research, health and safety guidelines, insurance company regulations and vaccines. Trump is expected to discourage vaccinations and limit federal health and insurance regulations.

Trump appointed Robert F. Kennedy Jr. on November 14. appointed to lead the Department of Health and Human Services, a decision that requires Senate approval. Kennedy has not outlined any specific plans to increase healthcare affordability, but he would have some influence on the ACA in that role. The former presidential candidate is a vaccine skeptic who Trump hopes will “go crazy” on health, safety and food protocols.

All major changes in health care policy and federal budgets would have to be approved by Congress. Trump will likely receive the support of a Republican-led Senate and House of Representatives.

“The American people re-elected President Trump by a wide margin, giving him a mandate to fulfill the promises he made during the campaign,” Karoline Leavitt, spokesperson for the Trump-Vance transition team, told reporters in a statement. BI. “He will deliver.”

Are you doing anything to prepare your finances or health care plan for Trump’s second term? If so, please contact this reporter at [email protected].

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