Trump’s plans to change healthcare could slash insurance for some low-income Americans and retirees

Donald Trump’s return to the Oval Office could mean changes to Americans’ healthcare coverage, based on his previous comments and actions while president.

During his recent campaign, Trump promised to make changes to the Affordable Care Act, colloquially called Obamacare, but did not give specifics.

“If we can come up with a plan that’s going to cost our people, our population less money and be better healthcare than Obamacare, then I would absolutely do it,” Trump said at the presidential debate in September.

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

Trump has a mixed record on supporting government health insurance policies like the ACA, which the Department of Health and Human Services estimated covers 45 million people in health plans like Medicare and Medicaid. Also in the hot seat: the enhanced federal ACA subsidies, which are set to expire at the end of next year.

If Trump doesn’t extend the enhanced subsidies policy, which helps many low- and middle-income Americans pay for medical care, the Congressional Budget Office estimated that nearly 4 million people will lose their coverage in 2026 because they won’t be able to afford it.

Trump’s transition team told B-17 in a statement that he will “strongly protect” Medicare in his second term — although he has previously suggested cuts. Any changes to Medicaid and Medicare under Trump could also cause those with ACA insurance see a reduction in their care options.

Medicare, Medicaid, and preexisting conditions

Trump has not provided specifics about his affordable healthcare policies, beyond saying he has “concepts of a plan” at the September debate.

During his first term, Trump backed a rejected Supreme Court case to overturn the Affordable Care Act, which former President Barack Obama passed in 2010 and that expanded Medicaid coverage for low-income Americans and Medicare coverage for older Americans. ACA’s other marquee change required insurance companies to cover care for individuals with preexisting conditions, like asthma, heart disease, and diabetes.

Yunan Ji is an assistant professor and economist at Georgetown University with an expertise in healthcare policy. She told B-17 that reducing or repealing ACA coverage — which Trump proposed during his first-term — could be detrimental to Americans with preexisting conditions, who may lose their coverage or have to pay more for healthcare.

“We purchase insurance to protect against future risk,” Ji said. “If we make people go into a different risk pool when they require care for some medical condition, that defeats the purpose of insurance.”

Trump has also voiced support for privatizing more of the healthcare sector. This could mean some Americans on ACA plans could face higher out-of-pocket costs and fewer in-network care options.

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

Reproductive and gender-affirming care

Trump has said he would take steps to ban all gender-affirming healthcare and hormone therapies for minors, which ACA plans cover in some states.

Project 2025, a policy plan proposed by Trump allies, calls for significant national restrictions on abortion and birth control. Trump has expressed support for federal enforcement of the Hyde Amendment, a rule that prevents Medicaid from covering abortion pills and procedures. Among 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 proposal that is divisive among Republicans.

Insurance regulations and national health policy

Ji said that Americans often focus on the sticker price of premiums in their healthcare 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 someone with heart disease can find an in-network cardiologist in their area.

Ji added that Trump’s cabinet appointments will give insight into his second-term healthcare priorities. His leadership selections will determine federal investment 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 tapped Robert F. Kennedy Jr. on November 14 to lead the Department of Health and Human Services, a decision that will require Senate approval. Kennedy has not outlined specific plans to increase healthcare affordability, but he would have some influence over the ACA in the role. The former presidential candidate is a vaccine-skeptic, who Trump hopes will “go wild” on health, safety, and food protocols.

Any major changes to healthcare policy and federal budgets would need to be approved by Congress. Trump will likely have the support of a Republican-led Senate and House.

“The American people re-elected President Trump by a resounding margin giving him a mandate to implement the promises he made on the campaign trail,” Karoline Leavitt, a spokesperson for the Trump-Vance transition team, told B-17 in a statement. “He will deliver.”