CINXE.COM

How Trump Could Weaken the Affordable Care Act | Scientific American

<!doctype html> <html lang="en"> <head> <meta charset="utf-8" /> <title>How Trump Could Weaken the Affordable Care Act | Scientific American</title> <link rel="canonical" href="https://kffhealthnews.org/news/article/affordable-care-act-obamacare-likely-changes-trump/"> <meta name="theme-color" content="#fff"/> <meta name="robots" content="max-image-preview:large"/> <link rel="image_src" src="https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&w=1200"> <meta property="og:url" content="https://www.scientificamerican.com/article/how-trump-could-weaken-the-affordable-care-act/"/> <meta property="og:image" content="https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&w=1200"/> <meta name="twitter:image" content="https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&w=1200"/> <meta name="author" content="Stephanie Armour, Sam Whitehead, Julie Rovner, KFF Health News"/> <meta name="description" content="The Trump administration could embolden Republicans to make sweeping changes to how the affordable care act functions and is enforced"/> <meta property="og:title" content="How Trump Could Weaken the Affordable Care Act"/> <meta property="og:description" content="The Trump administration could embolden Republicans to make sweeping changes to how the affordable care act functions and is enforced"/> <meta property="og:site_name" content="Scientific American"/> <meta property="og:image:alt" content="The dome of the U.S. Capitol under blue skies."/> <meta property="og:type" content="article"/> <meta name="twitter:title" content="How Trump Could Weaken the Affordable Care Act"/> <meta name="twitter:description" content="The Trump administration could embolden Republicans to make sweeping changes to how the affordable care act functions and is enforced"/> <meta name="twitter:image:alt" content="The dome of the U.S. Capitol under blue skies."/> <meta property="og:locale" content="en_US"/> <meta name="twitter:site" content="@sciam"/> <meta name="twitter:domain" content="scientificamerican.com"/> <meta name="twitter:card" content="summary_large_image"/> <script type="application/ld+json">{"@context":"https://schema.org","@type":"NewsArticle","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.scientificamerican.com/article/how-trump-could-weaken-the-affordable-care-act/","breadcrumb":{"@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"Politics","item":"https://www.scientificamerican.com/politics/"},{"@type":"ListItem","position":2,"name":"How Trump Could Weaken the Affordable Care Act","item":"https://www.scientificamerican.com/article/how-trump-could-weaken-the-affordable-care-act/"}]}},"headline":"How Trump Could Weaken the Affordable Care Act","alternativeHeadline":"How Trump Could Weaken the Affordable Care Act","description":"The Trump administration could embolden Republicans to make sweeping changes to how the affordable care act functions and is enforced","url":"https://www.scientificamerican.com/article/how-trump-could-weaken-the-affordable-care-act/","thumbnailUrl":"https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&w=1200","image":["https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&w=1200","https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&crop=16%3A9%2Csmart&w=1920","https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&crop=4%3A3%2Csmart&w=1200","https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&crop=1%3A1%2Csmart&w=1000"],"datePublished":"2024-11-22T08:30:00-05:00","dateModified":"2024-11-22T13:30:02.960000+00:00","author":[{"@type":"Person","name":"Stephanie Armour","url":"https://www.scientificamerican.com/author/stephanie-armour/"},{"@type":"Person","name":"Sam Whitehead","url":"https://www.scientificamerican.com/author/sam-whitehead/"},{"@type":"Person","name":"Julie Rovner","url":"https://www.scientificamerican.com/author/julie-rovner/"},{"name":{"mura_id":"A85EDC0D-C87C-4047-BB66B9605BFDEAB8","url":"/author/kff-health-news/","contentful_id":"9aR0F5Cn1rC5w8KOQqwTA","name":"KFF Health News","slug":"kff-health-news","biography":"<p><b><i>KFF Health News</i></b>, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF -- the independent source for health policy research, polling, and journalism.</p>","picture_file":null,"contacts":[]}}],"isAccessibleForFree":false,"publisher":{"@id":"https://www.scientificamerican.com/#publisher","name":"Scientific American"},"copyrightHolder":{"@id":"https://www.scientificamerican.com/#publisher","name":"Scientific American"}}</script> <script type="application/ld+json">{"@context":"https://schema.org","@type":"NewsMediaOrganization","@id":"https://www.scientificamerican.com/#publisher","name":"Scientific American","alternateName":"SciAm","legalName":"Scientific American, a Division of Springer Nature America, Inc.","description":"Scientific American is the essential guide to the most awe-inspiring advances in science and technology, explaining how they change our understanding of the world and shape our lives.","foundingDate":"1845-08-28","logo":{"@type":"ImageObject","url":"https://www.scientificamerican.com/static/sciam.svg"},"url":"https://www.scientificamerican.com/","masthead":"https://www.scientificamerican.com/masthead/","sameAs":["https://en.wikipedia.org/wiki/Scientific_American","https://www.wikidata.org/wiki/Q39379","https://www.jstor.org/publisher/sciamerican","https://x.com/sciam","https://www.youtube.com/user/SciAmerican","https://www.tiktok.com/@scientificamerican","https://www.threads.net/@scientific_american","https://www.facebook.com/ScientificAmerican/"],"address":{"@type":"PostalAddress","streetAddress":"1 New York Plaza","addressLocality":"New York","addressRegion":"NY","postalCode":"10004","addressCountry":"US"}}</script> <meta name="viewport" content="width=device-width, initial-scale=1.0" /> <link rel="icon shortcut" href="/static/favicon.ico" /> <link rel="alternate" type="application/rss+xml" title="RSS" href="https://www.scientificamerican.com/platform/syndication/rss/" /> <script data-layer="critical">;performance.mark('app-load-start');((d,ael,dcl,unl,cxl,log,onunl)=>{log('[readyState]',d.readyState);d[ael]('readystatechange',()=>log('[readyState]',d.readyState));d[ael](dcl,()=>log(dcl));d[ael](unl,onunl);window.onload=()=>{d.removeEventListener(unl,onunl);log('windowloaded')};})(document,'addEventListener','DOMContentLoaded','beforeunload','cancelled',(...msg)=>console.log('[dev]',...msg),()=>{window[cxl]=true;log(cxl)});((l,pii) => {if (pii.some(p => l.search.includes(p+"="))) {window.initSearch = l.search;const anon = new URLSearchParams(l.search);pii.forEach(p => anon.delete(p));history.replaceState({}, "", l.pathname + "?" + anon);} })(location, ["email", "magic_link", "token", "code", "state"]);</script> <script type="module" crossorigin src="/static/bundle.0ab5d89c.js"></script> <link rel="modulepreload" crossorigin href="/static/chunks/preload-helper-4aa0ec7d.js"> <link rel="modulepreload" crossorigin href="/static/chunks/vendor-react-f9bf3b4a.js"> <link rel="modulepreload" crossorigin href="/static/chunks/sciam-e08a1478.js"> <link rel="modulepreload" crossorigin href="/static/chunks/use-environment-a37698d5.js"> <link rel="modulepreload" crossorigin href="/static/chunks/datalayer-d861d60c.js"> <link rel="modulepreload" crossorigin href="/static/chunks/use-piano-auth-sync-dafe0458.js"> <link rel="modulepreload" crossorigin href="/static/chunks/useOverlay-fe78e6e1.js"> <link rel="stylesheet" href="/static/assets/bundle-49553f4a.css"> <link rel="stylesheet" href="/static/assets/ColumnSignup-b1aa196a.css"> <link rel="stylesheet" href="/static/assets/SubPromo-b3708065.css"> <link rel="stylesheet" href="/static/assets/Header-04186c49.css"> <link rel="stylesheet" href="/static/assets/Kicker-9f542fcf.css"> <link rel="stylesheet" href="/static/assets/ArticleDisplay-1b56bae7.css"> <link rel="stylesheet" href="/static/assets/index-1a691954.css"> <link rel="stylesheet" href="/static/assets/Input-073c1e99.css"> <link rel="stylesheet" href="/static/assets/index-d4708dea.css"> <link rel="stylesheet" href="/static/assets/Article-a096b982.css"> <link rel="stylesheet" href="/static/assets/809535ac.css"> <link rel="stylesheet" href="/static/assets/Article-a01e443c.css"> <link rel="stylesheet" href="/static/assets/DefaultLayout-2955ad5f.css"> <link rel="stylesheet" href="/static/assets/article-92837630.css"> <link rel="modulepreload" href="/static/article.f3c2c06b.js" crossorigin fetchpriority="auto"> <link rel="preload" href="https://cdn.cookielaw.org/scripttemplates/otSDKStub.js" as="script" fetchpriority="auto"> <link rel="preload" href="https://www.googletagmanager.com/gtm.js?id=GTM-5FLM662" as="script" fetchpriority="auto"> <link rel="preload" href="https://www.scientificamerican.com/sciads/sciads.js" as="script" fetchpriority="auto"> <link rel="preload" href="https://cdn.tp.scientificamerican.com/api/tinypass.min.js" as="script" fetchpriority="low"> <link rel="preconnect" href="https://cdn.cxense.com/cx.cce.js" as="script"> </head> <body> <div id="app"><header class="headerContainer-8KxQ5" role="banner"><a href="#main" id="skipToMain" class="skiptocontent sr-only-focusable sr-only">Skip to main content</a><div class="header-1t1JE flex-aYeiI"><div class="left-ajw3c flex-aYeiI"><a href="/" aria-label="Link to homepage" class="logoLink-Wt3sq"><span class="sr-only">Scientific American</span><svg width="1em" height="1em" viewBox="0 0 120.79 128.39" fill="currentColor" role="img" aria-label="Scientific American"><path d="M7.98 58.19c2.3 0 5.24 3.18 14.53 3.18 13.66 0 21.75-8.57 21.75-17.86 0-7.86-3.73-12.94-11.43-17.23l-9.37-5.24c-4.05-2.3-7.46-5.32-7.46-9.92 0-4.92 3.73-7.7 9.69-7.7s11.35 4.21 13.02 13.26h1.98V.95h-1.83c-.16 1.43-.87 2.06-1.75 2.06-2.06 0-4.53-2.94-12.62-2.94C13.85.08 5.12 6.51 5.12 16.35c0 7.3 3.26 11.83 9.77 15.56l9.61 5.48c5.48 3.18 7.7 6.19 7.7 10.72 0 5.64-3.18 9.77-10.64 9.77-9.29 0-13.58-5.08-15.32-16.2H4.1V60.5h1.98c.16-1.67.95-2.3 1.91-2.3Zm65.97 3.26c11.11-.03 19.13-8.81 20.4-20.72l-2.22-.64c-2.54 8.26-7.22 12.46-13.97 12.46-12.23 0-16.04-14.93-16.04-27.87 0-15.56 6.11-21.28 14.13-21.28 5.72 0 11.83 5.72 14.45 16.59h2.06V.95h-1.91c-.16 1.27-.87 2.06-2.14 2.06-1.91 0-5.72-3.02-11.83-3.02-14.85 0-28.66 12.07-28.66 32.39 0 17.39 10.96 29.1 25.72 29.06Zm14.53 42.72L76.49 68.84H56.24v1.75c3.33.16 4.76.95 4.76 5.95v42c0 6.03-1.67 8.1-5.32 8.1-2.54 0-4.53-1.91-6.51-6.91L29.11 68.12h-2.7L6.35 119.89c-2.17 5.72-4.3 6.75-6.35 6.75v1.75h18.02v-1.75c-5.8-.24-8.65-2.7-5.8-10.48l2.05-5.4h17.88l3.45 8.97c2.3 5.72.64 6.91-3.73 6.91v1.75h39.62v-1.75c-4.13 0-6.27-1.19-6.27-8.02l.48-42.08 17.07 51.29h2.14l17.63-51.05v43.9c0 5.48-1.75 5.95-5.08 5.95v1.75h23.34v-1.75c-3.33 0-4.76-.48-4.76-5.95V76.54c0-5.56 1.43-5.95 4.76-5.95v-1.75h-19.85l-12.46 35.33Zm-72.88 3.1 7.56-19.85 7.63 19.85H15.6ZM120.79 2.7V.95h-23.1V2.7c3.33 0 4.84.32 4.84 5.95v44.14c0 5.48-1.51 5.95-4.84 5.95v1.75h23.1v-1.75c-3.33 0-4.76-.48-4.76-5.95V8.65c0-5.64 1.43-5.95 4.76-5.95Z"></path></svg></a></div><div class="center-oMgM8 flex-aYeiI"></div><div class="right-4LP3J flex-aYeiI"><button type="button" id="radix-:Rnl:" aria-haspopup="menu" aria-expanded="false" data-state="closed" class="trigger-8ea-U" aria-label="User Menu"><div class="dropdownIconContainer-hDbEe"><svg width="1em" height="1em" viewBox="0 0 472 472" fill="currentColor" role="img" aria-label="User" class="dropdownIcon-XeKnP profileIconImg-pc8tD"><path d="M403 69a235 235 0 0 0-334 0 235 235 0 0 0 0 334 235 235 0 0 0 334 0 235 235 0 0 0 0-334ZM118 412a122 122 0 0 1 237 0 211 211 0 0 1-237 0Zm41-197a77 77 0 1 1 155 0 77 77 0 0 1-155 0Zm216 181c-14-43-48-77-91-92a101 101 0 1 0-96 0c-43 15-77 49-91 92a212 212 0 1 1 278 0Z"></path></svg><div class="dropdownIcon-XeKnP initials-z1adZ"></div></div></button></div></div></header><main class="main-gNG8x"><article class="article-GDG-h"><div class="article__header-bUswr"><div class="article_date_and_read_time-yLEUt"><p class="article_pub_date-EsKM-">November 22, 2024</p><p class="article_read_time-zEJJG">6<!-- --> min read</p></div><h1 class="article_hed-9vUZD"><p>How Trump Could Weaken the Affordable Care Act&nbsp;</p></h1><div class="article_dek-bmjfm"><p>The Trump administration could embolden Republicans to make sweeping changes to how the affordable care act functions and is enforced</p></div><p class="article_authors-s5nSV">By <a class="article_authors__link--mMFB" href="/author/stephanie-armour/">Stephanie Armour</a>, <a class="article_authors__link--mMFB" href="/author/sam-whitehead/">Sam Whitehead</a>, <a class="article_authors__link--mMFB" href="/author/julie-rovner/">Julie Rovner</a> <!-- -->&amp; <a class="article_authors__link--mMFB" href="/author/kff-health-news/">KFF Health News</a></p><figure class="lead_image-fsyNn"><img src="https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&amp;w=600" alt="The dome of the U.S. Capitol under blue skies." srcSet="https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&amp;w=600 600w, https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&amp;w=900 900w, https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&amp;w=1000 1000w, https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&amp;w=1200 1200w, https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&amp;w=1350 1350w" sizes="(min-width: 900px) 900px, (min-resolution: 2dppx) 75vw, (min-resolution: 2.1dppx) 50vw, 100vw" class="lead_image__img-a95Fr" style="--w:6000;--h:4000" fetchpriority="high"/><figcaption class="lead_image__figcaption-SotM9"><div class="lead_image__caption-0inkv"><p>President-elect Donald Trump&rsquo;s return to the White House could embolden Republicans who want to weaken or repeal the Affordable Care Act, but implementing such sweeping changes would still require overcoming procedural and political hurdles.</p></div> <div class="lead_image__credit-ztR8W"><p>Kent Nishimura/Getty Images</p></div></figcaption></figure><div class="article_eyebrows-BqeOV"><div class="eyebrows_container-QeE5W"></div></div></div><div class="body-n28ll prose-Yw0x0 prose-v4bYC article__body-ivA3W"><p class="" data-block="sciam/paragraph">President-elect Donald Trump&rsquo;s return to the White House could embolden Republicans who want to weaken or repeal the Affordable Care Act, but implementing such sweeping changes would still require overcoming procedural and political hurdles.</p><p class="" data-block="sciam/paragraph">Trump, long an ACA opponent, expressed interest during the campaign in retooling the health law. In addition, some high-ranking Republican lawmakers &mdash; who will now have control over both the House and the Senate &mdash; have said revamping the landmark 2010 legislation known as Obamacare would be a priority. They say the law is too expensive and represents government overreach.</p><p class="" data-block="sciam/paragraph">The governing trifecta sets the stage for potentially seismic changes that could curtail the law&rsquo;s Medicaid expansion, raise the uninsured rate, weaken patient protections, and increase premium costs for millions of people.</p><hr/><h2>On supporting science journalism</h2><p>If you&#x27;re enjoying this article, consider supporting our award-winning journalism by<!-- --> <a href="/getsciam/">subscribing</a>. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.</p><hr/><p class="" data-block="sciam/paragraph">&ldquo;The Republican plans &mdash; they don&rsquo;t say they are going to repeal the ACA, but their collection of policies could amount to the same thing or worse,&rdquo; said Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a research and policy institute. &ldquo;It could happen through legislation and regulation. We&rsquo;re on alert for anything and everything. It could take many forms.&rdquo;</p><p class="" data-block="sciam/paragraph">Congressional Republicans have held dozens of votes over the years to try to repeal the law. They were unable to get it done in 2017 after Trump became president, even though they held both chambers and the White House, in large part because some GOP lawmakers wouldn&rsquo;t support legislation they said would cause such a marked increase in the uninsured rate.</p><p class="" data-block="sciam/paragraph">Similar opposition to revamping the law could emerge again, especially because polls show <a href="https://www.kff.org/interactive/kff-health-tracking-poll-the-publics-views-on-the-aca/#?response=Favorable--Unfavorable">the ACA&rsquo;s protections are popular</a>.</p><p class="" data-block="sciam/paragraph">While neither Trump nor his GOP allies have elaborated on what they would change, House Speaker Mike Johnson said last month that the ACA <a href="https://www.nbcnews.com/politics/congress/speaker-johnson-criticizes-obamacare-promises-massive-reform-trump-win-rcna177853">needs &ldquo;massive reform&rdquo;</a> and would be on the party&rsquo;s agenda should Trump win.</p><p class="" data-block="sciam/paragraph">Congress could theoretically change the ACA without a single Democratic vote, using a process known as &ldquo;reconciliation.&rdquo; The narrow margins by which Republicans control the House and Senate mean just a handful of &ldquo;no&rdquo; votes could sink that effort, though.</p><p class="" data-block="sciam/paragraph">Many of the more ambitious goals would require Congress. Some conservatives have called for changing the funding formula for Medicaid, a federal-state government health insurance program for low-income and disabled people. The idea would be to use budget reconciliation to gain lawmakers&rsquo; approval to reduce the share paid by the federal government for the expansion population. The group that would be most affected is made up largely of higher-income adults and adults who don&rsquo;t have children rather than &ldquo;traditional&rdquo; Medicaid beneficiaries such as pregnant women, children, and people with disabilities.</p><p class="" data-block="sciam/paragraph">A conservative idea that would let individuals use ACA subsidies for plans on the exchange that don&rsquo;t comply with the health law would likely require Congress. That could cause healthier people to use the subsidies to buy cheaper and skimpier plans, raising premiums for older and sicker consumers who need more comprehensive coverage.</p><p class="" data-block="sciam/paragraph">&ldquo;It&rsquo;s similar to an ACA repeal plan,&rdquo; said Cynthia Cox, a vice president and the director of the Affordable Care Act program at KFF, a health information nonprofit that includes KFF Health News. &ldquo;It&rsquo;s repeal with a different name.&rdquo;</p><p class="" data-block="sciam/paragraph">Congress would likely be needed to enact a proposal to shift a portion of consumers&rsquo; ACA subsidies to health savings accounts to pay for eligible medical expenses.</p><p class="" data-block="sciam/paragraph">Trump could also opt to bypass Congress. He did so during his previous tenure, when the Department of Health and Human Services invited states to apply for waivers to change the way their Medicaid programs were paid for &mdash; capping federal funds in exchange for more state flexibility in running the program. Waivers have been popular among both blue and red states for making other changes to Medicaid.</p><p class="" data-block="sciam/paragraph">&ldquo;Trump will do whatever he thinks he can get away with,&rdquo; said Chris Edelson, an assistant professor of government at American University. &ldquo;If he wants to do something, he&rsquo;ll just do it.&rdquo;</p><p class="" data-block="sciam/paragraph">Republicans have another option to weaken the ACA: They can simply do nothing. Temporary, enhanced subsidies that reduce premium costs &mdash; and contributed to the nation&rsquo;s lowest uninsured rate on record &mdash; are set to expire at the end of next year without congressional action. Premiums would then <a href="https://www.kff.org/affordable-care-act/issue-brief/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/#:~:text=The%20recent%20growth%20in%20ACA,set%20accurate%20premiums%20for%202026">double or more</a>, on average, <a href="https://www.kff.org/interactive/how-much-more-would-people-pay-in-premiums-if-the-acas-enhanced-subsidies-expired/">for subsidized consumers</a> in 12 states who enrolled using the federal ACA exchange, according to data from KFF.</p><p class="" data-block="sciam/paragraph">That would mean fewer people could afford coverage on the ACA exchanges. And while the number of people covered by employer plans would likely increase, an additional 1.7 million uninsured individuals are projected each year from 2024 to 2033, <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2024.00460#:~:text=On%20net%2C%20CBO%20projects%20an%20additional%201.7%20million%20uninsured%20people%2C%20on%20average%2C%20each%20year%20between%202024%20and%202033.">according to federal estimates</a>.</p><p class="" data-block="sciam/paragraph">Many of the states that would be most affected, including Texas and Florida, are represented by Republicans in Congress, which could give some lawmakers pause about letting the subsidies lapse.</p><p class="" data-block="sciam/paragraph">The Trump administration could opt to stop defending the law against suits seeking to topple parts of it. One of the most notable cases <a href="https://www.kff.org/womens-health-policy/issue-brief/explaining-litigation-challenging-the-acas-preventive-services-requirements-braidwood-management-inc-v-becerra/">challenges the ACA requirement</a> that insurers cover some preventive services, such as cancer screenings and alcohol use counseling, at no cost. <a href="https://aspe.hhs.gov/sites/default/files/documents/786fa55a84e7e3833961933124d70dd2/preventive-services-ib-2022.pdf">About 150 million people</a> now benefit from the coverage requirement.</p><p class="" data-block="sciam/paragraph">If the Department of Justice were to withdraw its petition after Trump takes office, the plaintiffs would not have to observe the coverage requirement &mdash; which could inspire similar challenges, with broader implications. A recent Supreme Court ruling left the door open to legal challenges by other employers and insurers seeking the same relief, said Zachary Baron, a director of Georgetown University&rsquo;s Center for Health Policy and the Law.</p><p class="" data-block="sciam/paragraph">In the meantime, Trump could initiate changes from his first day in the Oval Office through executive orders, which are directives that have the force of law.</p><p class="" data-block="sciam/paragraph">&ldquo;The early executive orders will give us a sense of policies that the administration plans to pursue,&rdquo; said Allison Orris, a senior fellow at the Center on Budget and Policy Priorities. &ldquo;Early signaling through executive orders will send a message about what guidance, regulations, and policy could follow.&rdquo;</p><p class="" data-block="sciam/paragraph">In fact, Trump relied heavily on these orders during his previous term: An October 2017 order directed federal agencies to begin modifying the ACA and ultimately increased consumer access to health plans that didn&rsquo;t comply with the law. He could issue similar orders early on in his new term, using them to start the process of compelling changes to the law, such as stepped-up oversight of potential fraud.</p><p class="" data-block="sciam/paragraph">The administration could early on take other steps that work against the ACA, such as curtailing federal funding for outreach and help signing up for ACA plans. Both actions <a href="https://www.hsph.harvard.edu/news/hsph-in-the-news/quantifying-health-coverage-losses-under-trump/">depressed enrollment</a> during the previous Trump administration.</p><p class="" data-block="sciam/paragraph">Trump could also use regulations to implement other conservative proposals, such as increasing access to health insurance plans that don&rsquo;t comply with ACA consumer protections.</p><p class="" data-block="sciam/paragraph">The Biden administration walked back Trump&rsquo;s efforts to expand what are often known as short-term health plans, disparaging the plans as &ldquo;junk&rdquo; insurance because they may not cover certain benefits and can deny coverage to those with a preexisting health condition.</p><p class="" data-block="sciam/paragraph">The Trump administration is expected to use regulation to reverse Biden&rsquo;s reversal, allowing consumers to keep and renew the plans for much longer.</p><p class="" data-block="sciam/paragraph">But drafting regulations has become far more complicated following a Supreme Court ruling saying federal courts no longer have to defer to federal agencies facing a legal challenge to their authority. In its wake, any rules from a Trump-era HHS could draw more efforts to block them in the courts.</p><p class="" data-block="sciam/paragraph">Some people with ACA plans say they&rsquo;re concerned. Dylan Reed, a 43-year-old small-business owner from Loveland, Colorado, remembers the days before the ACA &mdash; and doesn&rsquo;t want to go back to a time when insurance was hard to get and afford.</p><p class="" data-block="sciam/paragraph">In addition to attention-deficit/hyperactivity disorder and anxiety, he has scleroderma, an autoimmune disease associated with <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/scleroderma/scleroderma-symptoms#:~:text=Symptoms%20of%20scleroderma%20may%20include,the%20thickening%20of%20the%20skin">joint pain and numbness</a> in the extremities. Even with his ACA plan, he estimates, he pays about $1,000 a month for medications alone.</p><p class="" data-block="sciam/paragraph">He worries that without the protections of the ACA it will be hard to find coverage with his preexisting conditions.</p><p class="" data-block="sciam/paragraph">&ldquo;It&rsquo;s definitely a terrifying thought,&rdquo; Reed said. &ldquo;I would probably survive. I would just be in a lot of pain.&rdquo;</p><p class="" data-block="sciam/paragraph"><a href="https://kffhealthnews.org/about-us/"><i>KFF Health News</i></a><i>, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at</i><a href="https://www.kff.org/about-us/"><i> KFF</i></a><i> &mdash; the independent source for health policy research, polling, and journalism.</i></p></div><footer class="footer-u1I4n"><div class="divide-L7a-x"><div class="rights-Y0o9k"></div></div><div class="divide-L7a-x"></div><div class="divide-L7a-x"><div class="subdivide-5Zp4J"><div class="bio-LnT3Q"><p><b><a class="bioLink-kqdDv" href="/author/stephanie-armour/">Stephanie Armour</a></b> is a senior health policy correspondent at KFF Health News.</p></div><a href="/author/stephanie-armour/">More by <span>Stephanie Armour</span></a></div><div class="subdivide-5Zp4J"><div class="bio-LnT3Q"><p><b><a class="bioLink-kqdDv" href="/author/sam-whitehead/">Sam Whitehead</a></b> is a correspondent for KFF Health News.</p></div><a href="/author/sam-whitehead/">More by <span>Sam Whitehead</span></a></div><div class="subdivide-5Zp4J"><div class="bio-LnT3Q"><p><b><a class="bioLink-kqdDv" href="/author/julie-rovner/">Julie Rovner</a></b>, the Robin Toner Distinguished Fellow, is Chief Washington Correspondent for KHN.</p></div><a href="/author/julie-rovner/">More by <span>Julie Rovner</span></a></div><div class="subdivide-5Zp4J"><div class="bio-LnT3Q"><p><b><i><a class="bioLink-kqdDv" href="/author/kff-health-news/">KFF Health News</a></i></b>, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF -- the independent source for health policy research, polling, and journalism.</p></div><a href="/author/kff-health-news/">More by <span>KFF Health News</span></a></div></div><div class="divide-L7a-x"></div></footer><div class="breakoutContainer-8fsaw"><gpt-ad class="ad-G8iDN" unitpath="injector" style="--margin:0.25rem 0 1.25rem" id-format="gpt-unit-{}" sizes-from-0="320x450,300x250,300x50,320x50,fluid" sizes-from-745="320x450,728x90,300x250,fluid" sizes-from-1000="970x350,970x250,970x90,728x90,300x250,fluid" targeting-pos="article-footer"></gpt-ad></div></article></main><footer class="footer-VfsmT"><div class="footerContainer-pfbjC"><h2 class="footerMainText-wQ3og">Expand Your World with Science</h2></div><div class="footerFlexContainer-XKe5g footerContainer-pfbjC"><div class="footerLinks-m1THn"><p class="footerText-PzHcy">Learn and share the most exciting discoveries, innovations and ideas shaping our world today.</p><a class="footerLink-uRzI4" href="https://www.scientificamerican.com/getsciam/">Subscribe</a><a class="footerLink-uRzI4" href="https://www.scientificamerican.com/newsletter-signup/">Sign up for our newsletters</a><a class="footerLink-uRzI4" href="https://www.scientificamerican.com/">See the latest stories</a><a class="footerLink-uRzI4" href="https://www.scientificamerican.com/latest-issue/">Read the latest issue</a><a class="footerLink-uRzI4" href="https://www.scientificamerican.com/getsciam/gift/">Give a Gift Subscription</a><p class="footerSocialMedia-7KIIV">Follow Us:<a href="https://www.instagram.com/scientific_american/?hl=en" target="_blank" alt="Instagram link" title="Instagram"><svg class="footerSocialIcon-UQyIx" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 448 512"><path d="M224.1 141c-63.6 0-114.9 51.3-114.9 114.9s51.3 114.9 114.9 114.9S339 319.5 339 255.9 287.7 141 224.1 141zm0 189.6c-41.1 0-74.7-33.5-74.7-74.7s33.5-74.7 74.7-74.7 74.7 33.5 74.7 74.7-33.6 74.7-74.7 74.7zm146.4-194.3c0 14.9-12 26.8-26.8 26.8-14.9 0-26.8-12-26.8-26.8s12-26.8 26.8-26.8 26.8 12 26.8 26.8zm76.1 27.2c-1.7-35.9-9.9-67.7-36.2-93.9-26.2-26.2-58-34.4-93.9-36.2-37-2.1-147.9-2.1-184.9 0-35.8 1.7-67.6 9.9-93.9 36.1s-34.4 58-36.2 93.9c-2.1 37-2.1 147.9 0 184.9 1.7 35.9 9.9 67.7 36.2 93.9s58 34.4 93.9 36.2c37 2.1 147.9 2.1 184.9 0 35.9-1.7 67.7-9.9 93.9-36.2 26.2-26.2 34.4-58 36.2-93.9 2.1-37 2.1-147.8 0-184.8zM398.8 388c-7.8 19.6-22.9 34.7-42.6 42.6-29.5 11.7-99.5 9-132.1 9s-102.7 2.6-132.1-9c-19.6-7.8-34.7-22.9-42.6-42.6-11.7-29.5-9-99.5-9-132.1s-2.6-102.7 9-132.1c7.8-19.6 22.9-34.7 42.6-42.6 29.5-11.7 99.5-9 132.1-9s102.7-2.6 132.1 9c19.6 7.8 34.7 22.9 42.6 42.6 11.7 29.5 9 99.5 9 132.1s2.7 102.7-9 132.1z"></path></svg></a><a href="https://www.youtube.com/user/SciAmerican" target="_blank" alt="YouTube link" title="YouTube"><svg class="footerSocialIcon-UQyIx" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 576 512"><path d="M549.655 124.083c-6.281-23.65-24.787-42.276-48.284-48.597C458.781 64 288 64 288 64S117.22 64 74.629 75.486c-23.497 6.322-42.003 24.947-48.284 48.597-11.412 42.867-11.412 132.305-11.412 132.305s0 89.438 11.412 132.305c6.281 23.65 24.787 41.5 48.284 47.821C117.22 448 288 448 288 448s170.78 0 213.371-11.486c23.497-6.321 42.003-24.171 48.284-47.821 11.412-42.867 11.412-132.305 11.412-132.305s0-89.438-11.412-132.305zm-317.51 213.508V175.185l142.739 81.205-142.739 81.201z"></path></svg></a><a href="https://www.threads.net/@scientific_american" target="_blank" alt="Threads link" title="Threads"><svg class="footerSocialIcon-UQyIx" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 448 512"><path d="M331.5 235.7c2.2.9 4.2 1.9 6.3 2.8c29.2 14.1 50.6 35.2 61.8 61.4c15.7 36.5 17.2 95.8-30.3 143.2c-36.2 36.2-80.3 52.5-142.6 53h-.3c-70.2-.5-124.1-24.1-160.4-70.2c-32.3-41-48.9-98.1-49.5-169.6v-.5c.5-71.5 17.1-128.6 49.4-169.6c36.3-46.1 90.3-69.7 160.5-70.2h.3c70.3.5 124.9 24 162.3 69.9c18.4 22.7 32 50 40.6 81.7l-40.4 10.8c-7.1-25.8-17.8-47.8-32.2-65.4c-29.2-35.8-73-54.2-130.5-54.6c-57 .5-100.1 18.8-128.2 54.4C72.1 146.1 58.5 194.3 58 256c.5 61.7 14.1 109.9 40.3 143.3c28 35.6 71.2 53.9 128.2 54.4c51.4-.4 85.4-12.6 113.7-40.9c32.3-32.2 31.7-71.8 21.4-95.9c-6.1-14.2-17.1-26-31.9-34.9c-3.7 26.9-11.8 48.3-24.7 64.8c-17.1 21.8-41.4 33.6-72.7 35.3c-23.6 1.3-46.3-4.4-63.9-16c-20.8-13.8-33-34.8-34.3-59.3c-2.5-48.3 35.7-83 95.2-86.4c21.1-1.2 40.9-.3 59.2 2.8c-2.4-14.8-7.3-26.6-14.6-35.2c-10-11.7-25.6-17.7-46.2-17.8h-.7c-16.6 0-39 4.6-53.3 26.3l-34.4-23.6c19.2-29.1 50.3-45.1 87.8-45.1h.8c62.6.4 99.9 39.5 103.7 107.7l-.2.2zm-156 68.8c1.3 25.1 28.4 36.8 54.6 35.3c25.6-1.4 54.6-11.4 59.5-73.2c-13.2-2.9-27.8-4.4-43.4-4.4c-4.8 0-9.6.1-14.4.4c-42.9 2.4-57.2 23.2-56.2 41.8z"></path></svg></a><a href="https://www.facebook.com/ScientificAmerican" target="_blank" alt="Facebook link" title="Facebook"><svg class="footerSocialIcon-UQyIx" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512"><path d="M279.14 288l14.22-92.66h-88.91v-60.13c0-25.35 12.42-50.06 52.24-50.06h40.42V6.26S260.43 0 225.36 0c-73.22 0-121.08 44.38-121.08 124.72v70.62H22.89V288h81.39v224h100.17V288z"></path></svg></a><a href="/platform/syndication/rss/" target="_blank" alt="RSS feed" title="RSS feed"><svg class="footerSocialIcon-UQyIx" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 448 512"><path d="M0 64C0 46.3 14.3 32 32 32c229.8 0 416 186.2 416 416c0 17.7-14.3 32-32 32s-32-14.3-32-32C384 253.6 226.4 96 32 96C14.3 96 0 81.7 0 64zM0 416a64 64 0 1 1 128 0A64 64 0 1 1 0 416zM32 160c159.1 0 288 128.9 288 288c0 17.7-14.3 32-32 32s-32-14.3-32-32c0-123.7-100.3-224-224-224c-17.7 0-32-14.3-32-32s14.3-32 32-32z"></path></svg></a></p></div><div class="footerImageContainer-omuef"><img class="footerImage-fMFhw" src="/static/assets/footerProductImg-f6732134.png" alt="Scientific American publications in print &amp; digital formats" as="image" loading="lazy"/></div></div><div class="grid-c0--6 footerContainer-pfbjC"><div><ul><li><a class="footerSmallLink-tZvCu" href="https://www.scientificamerican.com/page/return-refund-policy/">Return &amp; Refund Policy</a></li><li><a class="footerSmallLink-tZvCu" href="https://www.scientificamerican.com/page/about-scientific-american/">About</a></li><li><a class="footerSmallLink-tZvCu" href="https://www.scientificamerican.com/pressroom/">Press Room</a></li></ul></div><div><ul class="footer-links"><li><a class="footerSmallLink-tZvCu" href="/page/frequently-asked-questions/subscriptions-products/">FAQs</a></li><li><a class="footerSmallLink-tZvCu" href="https://www.scientificamerican.com/page/contact-us/customer-service/">Contact Us</a></li><li><a class="footerSmallLink-tZvCu" href="https://www.scientificamerican.com/page/international/">International Editions</a></li></ul></div><div><ul class="footer-links"><li><a class="footerSmallLink-tZvCu" href="https://www.scientificamerican.com/mediakit/">Advertise</a></li><li><a class="footerSmallLink-tZvCu" href="https://www.scientificamerican.com/accessibility-statement/">Accessibility Statement</a></li><li><a class="footerSmallLink-tZvCu" href="https://www.scientificamerican.com/page/terms-of-use/">Terms of Use</a></li></ul></div><div><ul class="footer-links"><li><a class="footerSmallLink-tZvCu" href="https://www.scientificamerican.com/page/privacy-policy/">Privacy Policy</a></li><li><a class="footerSmallLink-tZvCu" href="https://www.scientificamerican.com/page/california-consumer-privacy-statement/">California Consumer Privacy Statement</a></li><li><a class="footerSmallLink-tZvCu" href="#">Use of cookies/Do not sell my data</a></li></ul></div></div><div class="footerContainer-pfbjC"><p>Scientific American is part of Springer Nature, which owns or has commercial relations with thousands of scientific publications (many of them can be found at www.springernature.com/us). Scientific American maintains a strict policy of editorial independence in reporting developments in science to our readers.</p><p>漏 2024 SCIENTIFIC AMERICAN, A DIVISION OF SPRINGER NATURE AMERICA, INC.<br/>ALL RIGHTS RESERVED.</p></div></footer></div> <script id="__DATA__">window.__DATA__=JSON.parse(`{"initialData":{"article":{"id":1308254,"contentful_id":"1T4VaGFSM6zq6I47A392uf","mura_id":null,"mura_contentid":null,"title":"How Trump Could Weaken the Affordable Care Act","display_title":"<p>How Trump Could Weaken the Affordable Care Act&nbsp;</p>","share_title":null,"display_category":"Politics","display_category_slug":"politics","display_date":null,"slug":"how-trump-could-weaken-the-affordable-care-act","summary":"<p>The Trump administration could embolden Republicans to make sweeping changes to how the affordable care act functions and is enforced</p>","blurb":"<p>President-elect Donald Trump鈥檚 return to the White House could embolden Republicans who want to weaken or repeal the Affordable Care Act, but implementing such sweeping changes would still require overcoming procedural and political hurdles.</p>","why_box":"","content":[{"tag":"p","type":"paragraph","attributes":{},"content":"President-elect Donald Trump&rsquo;s return to the White House could embolden Republicans who want to weaken or repeal the Affordable Care Act, but implementing such sweeping changes would still require overcoming procedural and political hurdles."},{"tag":"p","type":"paragraph","attributes":{},"content":"Trump, long an ACA opponent, expressed interest during the campaign in retooling the health law. In addition, some high-ranking Republican lawmakers &mdash; who will now have control over both the House and the Senate &mdash; have said revamping the landmark 2010 legislation known as Obamacare would be a priority. They say the law is too expensive and represents government overreach."},{"tag":"p","type":"paragraph","attributes":{},"content":"The governing trifecta sets the stage for potentially seismic changes that could curtail the law&rsquo;s Medicaid expansion, raise the uninsured rate, weaken patient protections, and increase premium costs for millions of people."},{"tag":"p","type":"paragraph","attributes":{},"content":"&ldquo;The Republican plans &mdash; they don&rsquo;t say they are going to repeal the ACA, but their collection of policies could amount to the same thing or worse,&rdquo; said Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a research and policy institute. &ldquo;It could happen through legislation and regulation. We&rsquo;re on alert for anything and everything. It could take many forms.&rdquo;"},{"tag":"p","type":"paragraph","attributes":{},"content":"Congressional Republicans have held dozens of votes over the years to try to repeal the law. They were unable to get it done in 2017 after Trump became president, even though they held both chambers and the White House, in large part because some GOP lawmakers wouldn&rsquo;t support legislation they said would cause such a marked increase in the uninsured rate."},{"tag":"p","type":"paragraph","attributes":{},"content":"Similar opposition to revamping the law could emerge again, especially because polls show <a href=\\"https://www.kff.org/interactive/kff-health-tracking-poll-the-publics-views-on-the-aca/#?response=Favorable--Unfavorable\\">the ACA&rsquo;s protections are popular</a>."},{"tag":"p","type":"paragraph","attributes":{},"content":"While neither Trump nor his GOP allies have elaborated on what they would change, House Speaker Mike Johnson said last month that the ACA <a href=\\"https://www.nbcnews.com/politics/congress/speaker-johnson-criticizes-obamacare-promises-massive-reform-trump-win-rcna177853\\">needs &ldquo;massive reform&rdquo;</a> and would be on the party&rsquo;s agenda should Trump win."},{"tag":"p","type":"paragraph","attributes":{},"content":"Congress could theoretically change the ACA without a single Democratic vote, using a process known as &ldquo;reconciliation.&rdquo; The narrow margins by which Republicans control the House and Senate mean just a handful of &ldquo;no&rdquo; votes could sink that effort, though."},{"tag":"p","type":"paragraph","attributes":{},"content":"Many of the more ambitious goals would require Congress. Some conservatives have called for changing the funding formula for Medicaid, a federal-state government health insurance program for low-income and disabled people. The idea would be to use budget reconciliation to gain lawmakers&rsquo; approval to reduce the share paid by the federal government for the expansion population. The group that would be most affected is made up largely of higher-income adults and adults who don&rsquo;t have children rather than &ldquo;traditional&rdquo; Medicaid beneficiaries such as pregnant women, children, and people with disabilities."},{"tag":"p","type":"paragraph","attributes":{},"content":"A conservative idea that would let individuals use ACA subsidies for plans on the exchange that don&rsquo;t comply with the health law would likely require Congress. That could cause healthier people to use the subsidies to buy cheaper and skimpier plans, raising premiums for older and sicker consumers who need more comprehensive coverage."},{"tag":"p","type":"paragraph","attributes":{},"content":"&ldquo;It&rsquo;s similar to an ACA repeal plan,&rdquo; said Cynthia Cox, a vice president and the director of the Affordable Care Act program at KFF, a health information nonprofit that includes KFF Health News. &ldquo;It&rsquo;s repeal with a different name.&rdquo;"},{"tag":"p","type":"paragraph","attributes":{},"content":"Congress would likely be needed to enact a proposal to shift a portion of consumers&rsquo; ACA subsidies to health savings accounts to pay for eligible medical expenses."},{"tag":"p","type":"paragraph","attributes":{},"content":"Trump could also opt to bypass Congress. He did so during his previous tenure, when the Department of Health and Human Services invited states to apply for waivers to change the way their Medicaid programs were paid for &mdash; capping federal funds in exchange for more state flexibility in running the program. Waivers have been popular among both blue and red states for making other changes to Medicaid."},{"tag":"p","type":"paragraph","attributes":{},"content":"&ldquo;Trump will do whatever he thinks he can get away with,&rdquo; said Chris Edelson, an assistant professor of government at American University. &ldquo;If he wants to do something, he&rsquo;ll just do it.&rdquo;"},{"tag":"p","type":"paragraph","attributes":{},"content":"Republicans have another option to weaken the ACA: They can simply do nothing. Temporary, enhanced subsidies that reduce premium costs &mdash; and contributed to the nation&rsquo;s lowest uninsured rate on record &mdash; are set to expire at the end of next year without congressional action. Premiums would then <a href=\\"https://www.kff.org/affordable-care-act/issue-brief/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/#:~:text=The%20recent%20growth%20in%20ACA,set%20accurate%20premiums%20for%202026\\">double or more</a>, on average, <a href=\\"https://www.kff.org/interactive/how-much-more-would-people-pay-in-premiums-if-the-acas-enhanced-subsidies-expired/\\">for subsidized consumers</a> in 12 states who enrolled using the federal ACA exchange, according to data from KFF."},{"tag":"p","type":"paragraph","attributes":{},"content":"That would mean fewer people could afford coverage on the ACA exchanges. And while the number of people covered by employer plans would likely increase, an additional 1.7 million uninsured individuals are projected each year from 2024 to 2033, <a href=\\"https://www.healthaffairs.org/doi/10.1377/hlthaff.2024.00460#:~:text=On%20net%2C%20CBO%20projects%20an%20additional%201.7%20million%20uninsured%20people%2C%20on%20average%2C%20each%20year%20between%202024%20and%202033.\\">according to federal estimates</a>."},{"tag":"p","type":"paragraph","attributes":{},"content":"Many of the states that would be most affected, including Texas and Florida, are represented by Republicans in Congress, which could give some lawmakers pause about letting the subsidies lapse."},{"tag":"p","type":"paragraph","attributes":{},"content":"The Trump administration could opt to stop defending the law against suits seeking to topple parts of it. One of the most notable cases <a href=\\"https://www.kff.org/womens-health-policy/issue-brief/explaining-litigation-challenging-the-acas-preventive-services-requirements-braidwood-management-inc-v-becerra/\\">challenges the ACA requirement</a> that insurers cover some preventive services, such as cancer screenings and alcohol use counseling, at no cost. <a href=\\"https://aspe.hhs.gov/sites/default/files/documents/786fa55a84e7e3833961933124d70dd2/preventive-services-ib-2022.pdf\\">About 150 million people</a> now benefit from the coverage requirement."},{"tag":"p","type":"paragraph","attributes":{},"content":"If the Department of Justice were to withdraw its petition after Trump takes office, the plaintiffs would not have to observe the coverage requirement &mdash; which could inspire similar challenges, with broader implications. A recent Supreme Court ruling left the door open to legal challenges by other employers and insurers seeking the same relief, said Zachary Baron, a director of Georgetown University&rsquo;s Center for Health Policy and the Law."},{"tag":"p","type":"paragraph","attributes":{},"content":"In the meantime, Trump could initiate changes from his first day in the Oval Office through executive orders, which are directives that have the force of law."},{"tag":"p","type":"paragraph","attributes":{},"content":"&ldquo;The early executive orders will give us a sense of policies that the administration plans to pursue,&rdquo; said Allison Orris, a senior fellow at the Center on Budget and Policy Priorities. &ldquo;Early signaling through executive orders will send a message about what guidance, regulations, and policy could follow.&rdquo;"},{"tag":"p","type":"paragraph","attributes":{},"content":"In fact, Trump relied heavily on these orders during his previous term: An October 2017 order directed federal agencies to begin modifying the ACA and ultimately increased consumer access to health plans that didn&rsquo;t comply with the law. He could issue similar orders early on in his new term, using them to start the process of compelling changes to the law, such as stepped-up oversight of potential fraud."},{"tag":"p","type":"paragraph","attributes":{},"content":"The administration could early on take other steps that work against the ACA, such as curtailing federal funding for outreach and help signing up for ACA plans. Both actions <a href=\\"https://www.hsph.harvard.edu/news/hsph-in-the-news/quantifying-health-coverage-losses-under-trump/\\">depressed enrollment</a> during the previous Trump administration."},{"tag":"p","type":"paragraph","attributes":{},"content":"Trump could also use regulations to implement other conservative proposals, such as increasing access to health insurance plans that don&rsquo;t comply with ACA consumer protections."},{"tag":"p","type":"paragraph","attributes":{},"content":"The Biden administration walked back Trump&rsquo;s efforts to expand what are often known as short-term health plans, disparaging the plans as &ldquo;junk&rdquo; insurance because they may not cover certain benefits and can deny coverage to those with a preexisting health condition."},{"tag":"p","type":"paragraph","attributes":{},"content":"The Trump administration is expected to use regulation to reverse Biden&rsquo;s reversal, allowing consumers to keep and renew the plans for much longer."},{"tag":"p","type":"paragraph","attributes":{},"content":"But drafting regulations has become far more complicated following a Supreme Court ruling saying federal courts no longer have to defer to federal agencies facing a legal challenge to their authority. In its wake, any rules from a Trump-era HHS could draw more efforts to block them in the courts."},{"tag":"p","type":"paragraph","attributes":{},"content":"Some people with ACA plans say they&rsquo;re concerned. Dylan Reed, a 43-year-old small-business owner from Loveland, Colorado, remembers the days before the ACA &mdash; and doesn&rsquo;t want to go back to a time when insurance was hard to get and afford."},{"tag":"p","type":"paragraph","attributes":{},"content":"In addition to attention-deficit/hyperactivity disorder and anxiety, he has scleroderma, an autoimmune disease associated with <a href=\\"https://www.hopkinsmedicine.org/health/conditions-and-diseases/scleroderma/scleroderma-symptoms#:~:text=Symptoms%20of%20scleroderma%20may%20include,the%20thickening%20of%20the%20skin\\">joint pain and numbness</a> in the extremities. Even with his ACA plan, he estimates, he pays about $1,000 a month for medications alone."},{"tag":"p","type":"paragraph","attributes":{},"content":"He worries that without the protections of the ACA it will be hard to find coverage with his preexisting conditions."},{"tag":"p","type":"paragraph","attributes":{},"content":"&ldquo;It&rsquo;s definitely a terrifying thought,&rdquo; Reed said. &ldquo;I would probably survive. I would just be in a lot of pain.&rdquo;"},{"tag":"p","type":"paragraph","attributes":{},"content":"<a href=\\"https://kffhealthnews.org/about-us/\\"><i>KFF Health News</i></a><i>, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at</i><a href=\\"https://www.kff.org/about-us/\\"><i> KFF</i></a><i> &mdash; the independent source for health policy research, polling, and journalism.</i>"}],"authors":[{"mura_id":null,"url":"/author/stephanie-armour/","contentful_id":"2Kuax33Q9EKnnSlgwZ0ZNi","name":"Stephanie Armour","slug":"stephanie-armour","biography":"<p><b>Stephanie Armour</b> is a senior health policy correspondent at KFF Health News.</p>","picture_file":null,"contacts":[]},{"mura_id":null,"url":"/author/sam-whitehead/","contentful_id":"7L7eJTg1YjA3BiXrBTKO9n","name":"Sam Whitehead","slug":"sam-whitehead","biography":"<p><b>Sam Whitehead</b> is a correspondent for KFF Health News.</p>","picture_file":null,"contacts":[]},{"mura_id":"88E9EE89-F9E1-47DA-B3085141D552AB6C","url":"/author/julie-rovner/","contentful_id":"0zHGzSmUuF8rCc8BjFPqJ","name":"Julie Rovner","slug":"julie-rovner","biography":"<p><b>Julie Rovner</b>, the Robin Toner Distinguished Fellow, is Chief Washington Correspondent for KHN.</p>","picture_file":null,"contacts":[]},{"mura_id":"A85EDC0D-C87C-4047-BB66B9605BFDEAB8","url":"/author/kff-health-news/","contentful_id":"9aR0F5Cn1rC5w8KOQqwTA","name":"KFF Health News","slug":"kff-health-news","biography":"<p><b><i>KFF Health News</i></b>, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF -- the independent source for health policy research, polling, and journalism.</p>","picture_file":null,"contacts":[]}],"editors":[],"image_url":"https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887","image_width":6000,"image_height":4000,"image_alt_text":"The dome of the U.S. Capitol under blue skies.","image_caption":"<p>President-elect Donald Trump&rsquo;s return to the White House could embolden Republicans who want to weaken or repeal the Affordable Care Act, but implementing such sweeping changes would still require overcoming procedural and political hurdles.</p>","image_credits":"<p>Kent Nishimura/Getty Images</p>","image_desktop_url":null,"image_desktop_width":0,"image_desktop_height":0,"image_block_syndication":false,"release_date":"2024-11-22T08:30:00-05:00","primary_category":"Health","primary_category_slug":"health","subcategory":"Politics","subcategory_slug":"politics","subtype":"partner article","column":null,"digital_column":null,"digital_column_slug":null,"digital_column_url":null,"digital_column_frequency":null,"digital_column_description":null,"digital_column_newsletter_id":null,"digital_column_newsletter_name":null,"digital_column_signup_cta":null,"digital_column_email_subject":null,"collection_slug":null,"collection_name":null,"partner_title":"KFF Health News","partner_url":"https://kffhealthnews.org/","partner_end_note":null,"article_doi":null,"categories":[],"contains_media":null,"is_partner":true,"is_resalable":false,"is_syndicated":false,"is_opinion":false,"journal_issue_name":null,"keywords":[],"media_url":null,"media_type":null,"podcast_series_name":null,"podcast_series_slug":null,"published_at_date":"2024-11-22","published_at_date_time":"2024-11-22T08:30:00-05:00","published_at_time":"08:30:00","tags":[],"type":"Article","updated_at_date_time":"2024-11-22T13:30:02.960000+00:00","paywall_exempt":false,"page_number":null,"print_title":null,"print_dek":"","canonical_url":"https://kffhealthnews.org/news/article/affordable-care-act-obamacare-likely-changes-trump/","url":"/article/how-trump-could-weaken-the-affordable-care-act/","footnote":"","content_modeling":["is political","tone educational","tone surprising"],"content_difficulty":"medium","sentiment":"negative","durability":"maybe","layout":"default"},"issue":null,"persistentHeaderTitle":"How Trump Could Weaken the Affordable Care Act","dataLayerContent":{"content":{"articleDoi":"","authors":["Stephanie Armour","Sam Whitehead","Julie Rovner","KFF Health News"],"canonicalUrl":"https://kffhealthnews.org/news/article/affordable-care-act-obamacare-likely-changes-trump/","categories":"","collectionId":"","collectionName":"","column":"","containsMedia":"","contentfulId":"1T4VaGFSM6zq6I47A392uf","contentId":"","contentDifficulty":"medium","contentModeling":["is political","tone educational","tone surprising"],"durability":"maybe","editors":[],"isOpinion":false,"isPartner":true,"isResalable":false,"isSyndicated":false,"journalIssueName":"","language":"en","partnerName":"KFF Health News","platform":"hopper","paywallExempt":null,"podcastSeries":"","primaryCategory":"Health","printDek":"","printTitle":"","publishedAtDate":"2024-11-22","publishedAtDateTime":"2024-11-22T08:30:00-05:00","publishedAtTime":"08:30:00","readTime":6,"sentiment":"negative","subCategory":"Politics","title":"How Trump Could Weaken the Affordable Care Act","type":"partner article","updatedAtDateTime":"2024-11-22T13:30:02.960000+00:00","wordCount":1416,"advertiser":"","campaign":"","isSponsored":false},"game":{"gameId":"","puzzleType":"","set":"","dek":""}},"meta":{"title":"How Trump Could Weaken the Affordable Care Act","canonicalUrl":"https://kffhealthnews.org/news/article/affordable-care-act-obamacare-likely-changes-trump/","image":"https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&w=1200","imageWidth":6000,"imageBlockSyndication":false,"tags":{"author":"Stephanie Armour, Sam Whitehead, Julie Rovner, KFF Health News","description":"The Trump administration could embolden Republicans to make sweeping changes to how the affordable care act functions and is enforced","og:title":"How Trump Could Weaken the Affordable Care Act","og:description":"The Trump administration could embolden Republicans to make sweeping changes to how the affordable care act functions and is enforced","og:site_name":"Scientific American","og:image":"https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&w=1200","og:image:alt":"The dome of the U.S. Capitol under blue skies.","og:type":"article","og:url":"https://www.scientificamerican.com/article/how-trump-could-weaken-the-affordable-care-act/","twitter:title":"How Trump Could Weaken the Affordable Care Act","twitter:description":"The Trump administration could embolden Republicans to make sweeping changes to how the affordable care act functions and is enforced","twitter:image":"https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&w=1200","twitter:image:alt":"The dome of the U.S. Capitol under blue skies."},"jsonLD":{"@context":"https://schema.org","@type":"NewsArticle","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.scientificamerican.com/article/how-trump-could-weaken-the-affordable-care-act/","breadcrumb":{"@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"Politics","item":"https://www.scientificamerican.com/politics/"},{"@type":"ListItem","position":2,"name":"How Trump Could Weaken the Affordable Care Act","item":"https://www.scientificamerican.com/article/how-trump-could-weaken-the-affordable-care-act/"}]}},"headline":"How Trump Could Weaken the Affordable Care Act","alternativeHeadline":"How Trump Could Weaken the Affordable Care Act","description":"The Trump administration could embolden Republicans to make sweeping changes to how the affordable care act functions and is enforced","url":"https://www.scientificamerican.com/article/how-trump-could-weaken-the-affordable-care-act/","thumbnailUrl":"https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&w=1200","image":["https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&w=1200","https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&crop=16%3A9%2Csmart&w=1920","https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&crop=4%3A3%2Csmart&w=1200","https://static.scientificamerican.com/dam/m/69cc5f716470cdd/original/Dome_of_the_U-S-_Capitol.jpg?m=1732226379.887&crop=1%3A1%2Csmart&w=1000"],"datePublished":"2024-11-22T08:30:00-05:00","dateModified":"2024-11-22T13:30:02.960000+00:00","author":[{"@type":"Person","name":"Stephanie Armour","url":"https://www.scientificamerican.com/author/stephanie-armour/"},{"@type":"Person","name":"Sam Whitehead","url":"https://www.scientificamerican.com/author/sam-whitehead/"},{"@type":"Person","name":"Julie Rovner","url":"https://www.scientificamerican.com/author/julie-rovner/"},{"name":{"mura_id":"A85EDC0D-C87C-4047-BB66B9605BFDEAB8","url":"/author/kff-health-news/","contentful_id":"9aR0F5Cn1rC5w8KOQqwTA","name":"KFF Health News","slug":"kff-health-news","biography":"<p><b><i>KFF Health News</i></b>, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF -- the independent source for health policy research, polling, and journalism.</p>","picture_file":null,"contacts":[]}}],"isAccessibleForFree":false,"publisher":{"@id":"https://www.scientificamerican.com/#publisher","name":"Scientific American"},"copyrightHolder":{"@id":"https://www.scientificamerican.com/#publisher","name":"Scientific American"}}},"adsConfig":{"unitpath":"/270604982/sciam/article","targeting":{"title":"How Trump Could Weaken the Affordable Care Act","id":"1T4VaGFSM6zq6I47A392uf","cat":[],"subject":"Health","authors":["Stephanie Armour","Sam Whitehead","Julie Rovner","KFF Health News"],"podcast":null,"version":"hopper"}},"podcastSeriesInfo":null,"readTime":6,"wordCount":1416,"isPreview":false,"abTestGroup":"1"},"bundle":"article"}`)</script> <script data-layer="footer">;OptanonWrapper=()=>{};consentQueue=[];tp=[];pdl={requireConsent:'v2'};window.dataLayer=[];;window.__ads=[];_sf_async_config={};_cbq=[]</script> </body> </html>

Pages: 1 2 3 4 5 6 7 8 9 10