How a Trump win could change your health care

President-elect Donald Trump's return to the White House is expected to have major impacts on consumer healthcare.

Republicans may face few legislative hurdles in the way of their goals of reshaping health insurance in the United States, experts said, after the party retained its slim majority in the House of Representatives and flipped the Senate, giving it control of Congress and the presidency.

Families who get health insurance from Medicaid or the Affordable Care Act marketplace plan may see some of the biggest disruptions, due to reforms sought by Trump and Republican lawmakers, according to health policy experts.

Such reforms, they said, would free up federal money that could be used to help pay for other Republican policy priorities such as tax cuts.

Just under 8% of the U.S. population is currently uninsured, the lowest rate in American history, said Michael Sparer, a professor at Columbia University and chair of its Department of Health Policy and Management. That number was 17% when the Affordable Care Act was passed more than a decade ago, he said.

“This rate will start to rise again,” Sparer said.

Trump announced on November 14 that he wanted to appoint Robert F. Kennedy Jr. to run the Department of Health and Human Services, which includes the Centers for Medicare and Medicaid Services. CMS, in turn, administers the Affordable Care Act's marketplace and the Children's Health Insurance Program, or CHIP, among other endeavors.

Kennedy, a vaccine skeptic accused of spreading conspiracy theories, pledged to make major changes to the US health care system.

A spokesperson for Trump's transition team did not respond to a request from CNBC for comment on the president-elect's health policy plans.

Here's how consumer health care could change during the incoming Trump administration, according to experts.

Premium “betting” subsidies will end.

Based on how the election went, enhanced support for the Affordable Care Act likely won't be renewed once it expires at the end of 2025, said Cynthia Cox, vice president and director of the ACA program at KFF, a health policy research organization.

“If I were to bet on this, I would be more comfortable betting that it will expire,” Cox said.

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This government-backed aid, originally passed during the pandemic under the American Rescue Plan in 2021, has dramatically lowered coverage costs for people who buy health insurance plans in the ACA marketplace. These clients include anyone who does not have access to a workplace plan, such as students, self-employed consumers and the unemployed, among others.

An individual who earns $60,000 a year now gets a monthly premium of $425, compared to $539 before the enhanced benefits, according to a rough estimate provided by Cox. Meanwhile, a family of four with an income of about $120,000 currently pays $850 a month instead of $1,649.

Permanently extending the ACA's enhanced support could cost about $335 billion over the next 10 years, according to a Congressional Budget Office estimate.

“They're concerned about the cost, and they'll likely cut taxes next year,” Cox said of Republicans.

However, foregoing health insurance is a “big” gamble.

The Congressional Budget Office estimates that about 3.8 million people would lose their health insurance if subsidies end. Those who maintain their coverage are likely to pay higher premiums.

“The bottom line is uncertainty,” said Sabrina Corlett, co-director of the Center on Health Insurance Reforms at Georgetown University's McCourt School of Public Policy.

“The good news for market consumers is that the enhanced (support) will be available until 2025, so there will be no immediate changes,” Corlett added.

Even if subsidies disappear, experts say it's important to stay enrolled if you can, even if you have to make trade-offs on coverage to keep costs within budget.

Enrolling in a plan, even a cheaper plan with a high annual deductible, can provide an important hedge against huge costs from unexpected medical needs like surgery, said Carolyn McClanahan, a physician and certified financial planner based in Jacksonville, Florida.

“I can't stress enough how big of a gamble it is without health insurance,” McClanahan, founder of Life Planning Partners and a member of the Board of Financial Advisors, told CNBC.

“One heart attack easily costs $100,000” out of the pocket of someone without insurance, she said. “Do you have this to pay?”

'Very big goal' for lawmakers

Medicaid is the third-largest program in the federal budget, accounting for $616 billion in spending in 2023, according to the Congressional Budget Office. Trump campaigned on a promise not to make cuts to the two largest programs: Social Security and Medicare.

That makes Medicaid the “obvious place” for Republicans to raise revenue to fund their agenda, said Larry Levitt, executive vice president for health policy at KFF.

“Medicaid will have a very big target on its back,” Leavitt said.

Levitt said the cuts will inevitably mean fewer families will receive benefits. Medicaid recipients tend to be low-income families, people with disabilities and seniors in nursing homes, he said.

The Medicaid cuts were a big part of the push among Trump and other Republican lawmakers to repeal and replace the Affordable Care Act, also known as Obamacare, in 2017, Levitt said.

These efforts were ultimately unsuccessful.

How can Medicaid be cut?

New cuts to Medicaid could take many forms, according to experts, who cite previous proposals and notes from the Trump administration, Republican lawmakers and the conservative policy outline of Project 2025.

For example, the Trump administration might try to add work requirements for Medicaid beneficiaries, as it did during his first term, Columbia University's Sparer said.

In addition, experts said Republicans may try to cap federal Medicaid spending allocated to states.

The federal government matches a portion — generally 50% or more — of states' Medicaid spending. This dollar amount is not specified.

Republicans might try to cover Medicaid with a block grant, where a fixed amount of money is provided annually to each state, or a per capita cap, where benefits are limited to each Medicaid enrollee, Leavitt said.

Lawmakers may also try to roll back the Medicaid expansion under the Affordable Care Act, which expanded the pool of people eligible for coverage, experts said.

They could do this by cutting federal funding to the 40 states, plus the District of Columbia, that have expanded Medicaid eligibility. That would shift “tremendous financial risk to states, and as a result many states would abandon Medicaid expansion,” Levitt said.

Under the previous Trump administration, consumers saw an increase in the availability of non-ACA-compliant health insurance options, including short-term plans, experts say. The same thing is likely to happen over the next four years.

Short-term health insurance plans provide coverage for limited periods of time, usually for fewer medical services than comprehensive coverage.

Proponents of these plans say they allow insurers to offer lower monthly premiums to consumers because they are not required to cover as many services. At the same time, plans are able to turn away people with pre-existing conditions or charge them more. While Trump was in office, enrollment in short-term plans rose.

“The previous Trump administration and many members of the GOP have called for expanding the marketing and sale of short-term plans and other insurance products that do not have to meet the ACA’s pre-existing condition standards and other consumer protections,” Georgetown’s Corlett said. .

Consumers can be attracted to plans because of their low costs, but they often learn too late how poor coverage is, she said.

Experts said it's unclear whether lawmakers will keep drug policies as they are. Trump signed executive orders in 2020 aimed at lowering prescription drug costs, for example.

“It is not at all clear that Trump will be a friend of the pharmaceutical industry,” Sparer said.

For example, the Inflation Control Act gave the federal government, for the first time, the authority to negotiate prices with drug companies for certain drugs covered by Medicare.

The provision is scheduled to begin for 10 drugs — some of the “most expensive and widely used” drugs in Medicare, which treat a variety of ailments such as heart disease, diabetes, arthritis and cancer — in 2026, according to the Centers for Medicare & Medicaid Services. .

The measure will save patients $1.5 billion in out-of-pocket costs in 2026, according to CMS estimates. The federal government will expand the list of drugs in the following years.

The Inflation Control Act also capped Medicare copayments for insulin at $35 per month. They were unrestrained before. A Medicare Part D insulin user would have paid $54 out of pocket per month per insulin prescription in 2020, according to KFF.

The law also caps out-of-pocket costs at $2,000 per year for prescription drugs covered by Medicare, starting in 2025. There was previously no cap.

KFF found that about 1.4 million Medicare Part D enrollees paid more than $2,000 out of pocket for drugs in 2020. These costs averaged $3,355 per person.