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Former President Donald Trump’s election victory and his anticipated return to the White House are expected to bring significant changes to the nation’s public health insurance programs, potentially scaling them back and leading to a rise in the uninsured rate. Key to his administration’s agenda will likely be imposing new barriers to abortion and reproductive care, alongside efforts that could weaken the Affordable Care Act (ACA) and increase challenges to federal health agencies.
Trump’s win against Vice President Kamala Harris, confirmed by The Associated Press on November 7, sets the stage for a second term that promises a shift in health policy, with potential fallout across the U.S. health system. According to projections, the ACA’s consumer protections could erode, Medicaid work requirements could be introduced, and funding for safety-net insurance could be cut, amplifying concerns about increased vulnerability for low-income and disabled Americans.
Health experts worry that public health interventions, particularly those supported by rigorous scientific research, could come under fire. This includes efforts related to public water fluoridation, childhood vaccinations, and other established health measures. With Trump’s decision to welcome vaccine skeptic Robert F. Kennedy Jr. into his advisory circle, there are fears that the administration might backtrack on public health measures that have long been considered effective. Trump has already mentioned that he would “make a decision” about banning certain vaccines, after consulting with Kennedy.
Health Care and ACA Under Threat
Despite Trump’s repeated vows not to repeal the ACA, his administration is likely to face decisions about whether to extend enhanced subsidies for Obamacare premiums, set to expire in 2025. Without these subsidies, experts warn of sharp premium hikes that could result in lower enrollment, likely pushing the uninsured rate above the current 8%. However, Trump has said he would focus on making the ACA “more affordable” by driving greater competition in the insurance market, though details of his plan remain vague.
“On affordability, I’d see him building on the first term,” said Brian Blase, a former health adviser to Trump. Blase emphasized that Trump’s administration would focus on reducing health care fraud and waste, contrasting it with Democratic policies.
However, Democratic critics are bracing for what they anticipate will be an assault on health care access. “They’re going to raise costs for millions of Americans and rip coverage away from millions,” warned Leslie Dach, executive chair of Protect Our Care, a leading health advocacy group.
Republicans, including figures like Theo Merkel from the Paragon Health Institute, argue that the ACA’s enhanced subsidies do little to improve the underlying health plans, and that funding cuts to the program could offer a more sustainable approach to controlling costs.
Medicaid at Risk of Cuts and Reform
With a Republican-controlled Senate and the White House, Medicaid—the program that insures low-income individuals—could be a key target. While Trump has promised to protect Medicare, Medicaid faces an uncertain future. Health analysts predict that the Trump administration may push for spending cuts in the program, possibly introducing work requirements for beneficiaries or changing the way Medicaid is funded by capping federal support to states.
“Medicaid will be a big target in a Trump administration,” said Larry Levitt of KFF Health News. The potential changes could shift the program toward state-controlled funding, which critics argue would lead to deep cuts in services for vulnerable populations.
Reproductive Health and Abortion Access
On the reproductive health front, Trump has made it clear that he believes decisions about abortion should be left to individual states. Since the Supreme Court overturned Roe v. Wade, the legal landscape for abortion has become increasingly fragmented, with 13 states enacting near-total bans and 28 others imposing restrictions based on gestational age. Although Trump has said he would not sign a national abortion ban, his administration could move to restrict access to abortion medications, which account for over half of all abortions in the U.S.
Trump has also floated the idea of limiting the distribution of abortion drugs through the mail, possibly reviving 19th-century laws such as the Comstock Act, which anti-abortion activists argue could prohibit the shipment of abortion pills.
Trump’s Health Team and Challenges Ahead
As Trump prepares to take office, speculation is growing about the leaders he might select for key health positions. Former Louisiana Governor Bobby Jindal and Seema Verma, who led the Centers for Medicare & Medicaid Services during Trump’s first term, are among the names mentioned for roles in the Department of Health and Human Services (HHS).
Robert F. Kennedy Jr., who suspended his independent presidential campaign to endorse Trump, is also reportedly vying for a major role, potentially in charge of HHS. However, his confirmation may face significant hurdles in the Senate, given his controversial views on vaccines.
Looking Ahead: Uncertainty for Public Health
While Trump has made several promises to protect Medicare and expand home care benefits, the future of public health programs remains uncertain. With his victory, the U.S. could be poised for an era of significant health care policy changes—ranging from stricter Medicaid rules to increased attacks on the ACA and reproductive health rights. For many Americans, the next few years could see rising costs, reduced access, and a potential erosion of public confidence in health interventions backed by science.
