Trump’s return to the White House could disrupt the health care safety net

Former President Donald Trump’s impending return to the White House is likely to bring changes that will restrict the nation’s public health insurance programs – increasing the number of uninsured people while imposing novel barriers to abortion and other reproductive care.

The reverberations will be felt far beyond Washington and could include the erosion of consumer protections under the Affordable Care Act, the imposition of work requirements in Medicaid and cuts to net insurance funding, as well as challenges to federal agencies that protect public health. Abortion restrictions may be tightened across the country, which could result in reduced shipments of abortion drugs.

And with the elevation of vaccine skeptic Robert F. Kennedy Jr. to Trump’s inner circle of advisers, public health interventions backed by tough science – whether fluoridating public water supplies or vaccinating children – could come under fire.

Trump’s victory will provide a much broader platform for skeptics and critics of federal health programs and actions. Public health authorities fear that, in a worst-case scenario, the U.S. could see an raise in preventable diseases; weakening public trust in recognized science; and debunked concepts – such as the link between vaccines and autism – that had been accepted as policy. Trump said in interview with NBC News On November 3, he stated that he would “make a decision” to ban certain vaccines, consult with Kennedy and call him a “very talented guy.”

Although Trump has said he won’t try to repeal the Affordable Care Act again, his administration will face an immediate decision next year whether to support extending increased premium subsidies for Obamacare insurance plans. No increased subsidies keen increases in contributions are projected to result in lower enrollment numbers. Current uninsured rate, about 8%will almost certainly raise.

The specifics of the policy did not go much beyond the “concepts of the plan,” as Trump stated during the debate with Harris, although Vice President-elect J.D. Vance later said the administration would seek to bring more competition to ACA markets.

Polls show the ACA does gained support among the publicincluding provisions such as protection for pre-existing conditions and allowing youthful people to benefit from family health care plans until they turn 26.

Trump supporters and others in his administration say the former president wants to improve the law in a way that would lower costs. They say he has already shown he will be decisive when it comes to lowering high health care prices, pointing to efforts during his presidency to pioneer price transparency in medical costs.

“On affordability, I see him continuing the work in the first term,” said Brian Blase, who was Trump’s health adviser from 2017 to 2019. Compared to a Democratic administration, he said, there will be a “significantly greater emphasis” on issues of “minimizing fraud and waste.”

Efforts to weaken the ACA could include cutting funding for enrollment assistance, allowing consumers to purchase more health plans that do not comply with ACA consumer protections, and allowing insurers to charge higher premiums to ailing people.

Democrats say they are expecting the worst.

“We know what their agenda is,” said Leslie Dach, executive chairwoman of Protect Our Care, a health care policy and advocacy organization in Washington. He worked in the Obama administration helping to implement the ACA. “They are going to raise costs for millions of Americans and take away insurance from millions, while they provide tax breaks to rich people.”

Theo Merkel, director of the private health care reform initiative at the right-wing Paragon Health Institute, which Blase chairs, said the increased ACA subsidies extended under the Inflation Reduction Act in 2022 do not support improve plans or lower premiums. He said they were hiding the low value of the plans with larger government subsidies.

Other Trump supporters say the president-elect may support preserving Medicare’s authority to negotiate drug prices, another provision of the IRA. Trump favors lowering drug prices, and in 2020 he developed a test model that would link Medicare prices for certain drugs to lower costs abroad, said Merkel, who worked in Trump’s first White House. The pharmaceutical industry successfully sued to block the program.

Names of potential leaders of the Department of Health and Human Services have already been floated in Trump’s circles. They include former Louisiana Gov. Bobby Jindal and Seema Verma, who led the Centers for Medicare and Medicaid Services during the Trump administration.

Kennedy, who suspended his independent presidential campaign and endorsed Trump, told his supporters that Trump had promised him control of HHS. Trump said publicly before Election Day that he would give Kennedy a massive role in his administration, but he may have difficulty winning Senate confirmation for a cabinet position.

While Trump has promised to protect Medicare and has said he supports funding home care services, he has been less specific about his intentions for Medicaid, which provides protections for lower-income people and people with disabilities. Some health analysts expect the program to be particularly vulnerable to spending cuts, which could support finance an extension of tax credits that expire at the end of next year.

Possible changes include requiring beneficiaries to have work-related obligations in some states. The administration and Republicans in Congress may also try to change how Medicaid is funded. Now the federal government pays states a variable percentage of the program’s cost. Conservatives have long sought to limit federal allocations to states, which critics say would lead to draconian cuts.

“Medicaid is going to be a big target in the Trump administration,” said Larry Levitt, executive vice president of health policy at KFF, the nonprofit health information organization that owns KFF Health News.

The potential future of reproductive health rights is less clear.

Trump said decisions on abortion restrictions should be left to states. Thirteen states ban abortion with constrained exceptions, while 28 others restrict the procedure based on the duration of pregnancy. according to the Guttmacher Institutea research and policy organization focused on promoting reproductive rights. Trump said before the election that he would not sign a nationwide abortion ban.

Four states have passed state ballot measures to protect abortion rights, including Missouri, which Trump won by about 18 points, according to preliminary AP reporting. Voters in Florida and South Dakota rejected abortion rights measures.

Trump could take steps to restrict access to abortion drugs, used in more than half of abortions, either by revoking FDA approval for the drugs or by enforcing the 19th-century Comstock Act, which abortion opponents say prohibits their shipment. Trump has said he generally won’t operate the law banning the delivery of drugs by mail.

KFF Health News is a national newsroom dedicated to publishing in-depth journalism on health issues and is one of the website’s main operational programs KFF — an independent source of health policy research, polling and journalism.