The Affordable Care Act, also known as Obamacare, remains popular with the public, with support from 54% of American adults, according to a recently released Gallup poll. But experts say that may not prevent potential changes to the federal health care program, as President-elect Donald Trump and his fellow Republicans aim to renew the $4 trillion health care plan. states. Expired tax relief.
Many provisions of the Tax Cuts and Jobs Act of 2017 (TCJA), the signature law passed during President Trump’s first term, are scheduled to be repealed at the end of 2025. Republican leaders are currently strategizing on how to extend the tax cuts, but the president-elect also promised to lower corporate taxes and eliminate taxes on workers’ tips and overtime pay. .
But according to the Committee for a Responsible Federal Budget, an advocacy group focused on reducing the nation’s debt, simply renewing the TCJA tax cuts without reducing federal spending could raise the nation’s budget deficit by $4 trillion by 2035. It is said that the number will increase soon.
President Trump has already exempted two major government programs, Social Security and Medicare, from cuts. Larry Levitt, executive vice president for health policy at KFF (formerly the Kaiser Family Foundation), wrote in a recent JAMA article that cuts to defense spending also seem unlikely, with nearly half of federal spending said that it would be protected.
As a result, “Medicaid and the ACA, the next largest sources of federal spending, will be the primary targets for spending cuts. This calculation is inevitable,” Levitt said.
Will President Trump repeal the ACA?
In contrast, the ACA is unlikely to be completely repealed. President Trump continues to criticize the health care expansion plan, but he has backed away from his previous promise to completely repeal the ACA.
“President Trump will make permanent his highly successful tax cuts and deliver on his promise to ease the financial burden on families across the country. He will also deliver on his promise to ease the financial burden on families across the country. He will also deliver on his promise to end the depleted health care system that our nation relies on. “It will ensure that we can continue to take care of Americans who are in need of Medicaid, Medicare, and Social Security,” Trump-Vance transition press secretary Anna Kelly told CBS News.
Support for the ACA reached a record high of 55% in 2017, marking the first time a majority of Americans approved of the health care law since Gallup began asking questions about it in 2012. This high watermark was reached a month after efforts by then-President Trump and the U.S. government failed. Republicans would repeal and replace the law.
“The Affordable Care Act remains politically divisive, but overall it has more public support than ever before,” Levitt told CBS MoneyWatch. “While it is unlikely that Republicans will try to repeal the ACA again, cuts to the ACA and Medicaid are very possible if Republicans are looking to pay for tax cuts.”
Brad Ellis, senior director at Fitch Ratings, said President Trump and Republican lawmakers are considering how the ACA will be administered, including the introduction of high-risk participant pools and possible cuts to subsidies for public exchange businesses. He pointed out that he is interested in the change. Such changes could have a negative impact on enrollment, he said in a recent report.
During his presidential campaign, Trump said he had a “vision for a plan” to replace the ACA.
“Obamacare stinks,” President Trump recently said on NBC News’ “Meet the Press,” adding, “If I come up with a better answer, I’m going to present that answer to the Democrats and everyone else and give them a We will take some action about it.”
Make large cuts without moving your fingers
Republicans can make significant cuts to the ACA by simply enduring it. This is due to the strengthening of ACA premium subsidies enacted after President Biden was elected and Democrats took control of Congress. Scheduled to expire According to KFF’s analysis, the decline in financial aid ACA enrollment would increase out-of-pocket premiums by an average of $705 a year, or 79%.
The Congressional Budget Office projects that allowing additional ACA subsidies to expire would reduce the federal deficit by $335 billion over 10 years compared to extending them permanently.
After the enhanced subsidies went into effect, ACA enrollment nearly doubled to 21 million. CBO estimates that without the subsidy, 6.9 million fewer people would enroll in ACA Marketplace plans and an additional 3.4 million people would become uninsured.
The impact will be felt nationwide, but especially Southern states that have not expanded Medicaid Levitt said the five states with the fastest growth in ACA enrollment since 2020 are Georgia, Mississippi, South Carolina, Tennessee and Texas.
“Health care wasn’t a big topic during the campaign, so I can imagine voters would be surprised to see cuts to Medicaid and the ACA that they didn’t know about during the campaign,” Levitt said. “People are worried about disrupting the status quo, just as people are dissatisfied with the status quo of health insurance.”
Is Medicaid subject to cuts?
According to KFF, Medicaid accounts for more than $600 billion annually in federal spending and covers 81 million people.
“There are signs that support for Medicaid will decline under the new administration, suggesting a decline in enrollment and revenue for the program,” Fitch’s Ellis said.
Although President Trump remained silent on Medicaid during his 2024 campaign, his budget proposal during his first administration included a plan to cap federal spending on Medicaid. The Project 2025 plan, created by the Heritage Foundation and a coalition of conservative groups, recommends changes to Medicaid, including limits on federal spending.
“The centerpiece of several prominent plans, including Project 2025, the 2025 Republican Review Committee (RSC) Budget, and the 2025 House Republican Budget Resolution, is to cap and significantly reduce federal Medicaid funding.” , said research professor Edwin Park. The Center for Children and Families at Georgetown University’s McCourt School of Public Policy pointed out this in September.
President Trump called for distancing. Himself in Project 2025 In the months leading up to the election, he criticized some of his policy proposals as “terrible.”
But Levitt said the ACA and Medicaid could still face cuts as Republicans, who control the White House and both chambers of Congress, rush to implement a fiscal plan after President-elect Trump takes office.
“A lot depends on whether there is pressure to pay for tax cuts along with spending cuts,” Levitt said. “If Republicans are willing to cut taxes and increase the deficit, we may not see major cuts to the ACA or Medicaid. ” he said. “Some Republicans may argue for spending cuts to offset the tax cuts. If that happens, the ACA and Medicaid could very well be on the brink.”
