Trump's victory could bring changes to the medical safety net: Shots

President-elect Donald Trump shakes hands with Robert F. Kennedy Jr. at a campaign rally in October. Kennedy, a vaccine skeptic, is one of Trump's top health advisers.

Alex Brandon/Associated Press

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Alex Brandon/Associated Press

Former President Donald Trump's election victory and upcoming return to the White House could bring about changes that would reduce the nation's public health insurance program, potentially increasing the uninsured rate, while also reducing abortion and other It would impose new barriers to reproductive health care.

Its effects will be felt far beyond Washington, D.C., including the erosion of consumer protections in the Affordable Care Act, the imposition of work requirements in Medicaid and the reduction of funding for safety-net insurance, and the federal government that protects public health. This may include challenges to institutions.

Possible efforts to limit the mailing of abortion pills could lead to stricter abortion regulations nationwide.

And the elevation of vaccine skeptic Robert F. Kennedy Jr. to an adviser to President Trump's inner circle has led to criticism of public health interventions backed by rigorous science, such as fluoridation of public water supplies and child immunization. There is a possibility of exposure.

Trump's victory would give skeptics and critics of federal health programs and policies a much broader platform. Public health officials fear that, in the worst case scenario, the United States could see an increase in preventable diseases. Declining public trust in established science. And debunked concepts, such as the link between vaccines and autism, have been adopted as policy.

President Trump said: NBC News interview On November 3, Trump said he would “make a decision” about banning some vaccines and would consult with Kennedy, whom he called a “very talented person.”

Here's what we know about how the Trump administration will address some major health care issues.

obamacare changes

President Trump has said he will not try to repeal the Affordable Care Act again, but his administration will have to make an immediate decision next year on whether to support an extension of enhanced premium subsidies for Obamacare insurance plans. It will be. Without sufficient subsidies, Significant increase in insurance premiums As a result, enrollment is expected to decline. Current uninsured rate, Approximately 8%may rise.

The details of the policy don't go much beyond the “concept of the plan” that Trump described during his debate with Harris, but Vice President-elect J.D. Vance later said the administration would seek to introduce more competition into the ACA market. He said there was.

Republicans are claiming the White House as well as a majority in the Senate, but control of the House of Representatives was still undecided as of Wednesday afternoon.

According to polls, the ACA gained support among the peoplewhich includes provisions such as protections for pre-existing conditions and allowing young people to stay on their family's health insurance until they turn 26.

Trump supporters and people who have worked in his administration say the former president wants to improve the law in ways that reduce costs. They point to his efforts to pioneer health care price transparency during his presidency and argue that he has already taken a hard line on lowering high medical costs.

“I think he will build on his first term when it comes to affordability,” said Brian Blaze, who served as President Trump's health adviser from 2017 to 2019. He said there would be “much more emphasis” on economic policy compared to a Democratic administration. “Minimize fraud and waste.”

Efforts to weaken the ACA include reducing enrollment funding, allowing consumers to purchase more health plans that do not comply with the ACA's consumer protections, and forcing insurance companies to This could include allowing patients to be charged higher premiums.

Democrats say they expect the worst.

“We know what their agenda is,” said Leslie Dutch, executive director of Protect Our Care, a health policy and advocacy group in Washington, D.C. He helped implement the ACA during the Obama administration. “They're going to raise costs for millions of Americans and strip insurance from millions of Americans while giving tax breaks to the wealthy.”

Theo Merkel, director of the Private Health Reform Initiative at Blais' right-wing Paragon Health Institute, said the enhanced ACA subsidies extended by the Anti-Inflation Act of 2022 will do nothing to improve plans or lower premiums. He also said that he would not stand up. He said the low value of the plan was being compensated for with increased government subsidies.

drug price negotiation

Other Trump supporters say the president-elect may support preserving Medicare's ability to negotiate drug prices, another provision of the IRA. Merkel, who worked in President Trump's first White House, said President Trump has advocated lowering drug prices and in 2020 moved ahead with a pilot model that would link the prices of some Medicare drugs to overseas cost savings. It is said that The pharmaceutical industry successfully sued to block the program.

Health organization leadership

Several names have already been floated around Mr. Trump as possible candidates to lead the Department of Health and Human Services. Among them are former Louisiana governors Bobby Jindal and Seema Verma, who ran the Centers for Medicare and Medicaid Services during the Trump administration.

Kennedy, who stopped running as an independent and endorsed Trump, told supporters that Trump had promised him control of HHS. Trump publicly said before Election Day that he would give Kennedy a bigger role in his administration, but getting Senate confirmation for a Cabinet post may be difficult.

Medicaid reduction or limitation

President Trump has vowed to protect Medicare and said he supports funding home care benefits, but was less specific about Medicaid, which provides insurance to low-income and disabled people. Some health analysts expect the program to be particularly susceptible to spending cuts, potentially funding an extension of tax cuts that expire at the end of next year.

Possible changes include imposing work requirements on beneficiaries in some states. The administration and Congressional Republicans may also seek to overhaul the way Medicaid is funded. Currently, the federal government pays states a variable percentage of the program costs. Conservatives have long sought to cap federal allocations to states, which critics say would lead to severe cuts.

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

reproductive health

The future possibilities for reproductive health rights are less clear.

President Trump said decisions regarding abortion restrictions should be left up to each state. Thirteen states ban abortion with some exceptions, while another 28 states restrict abortion procedures based on gestational age. According to the Guttmacher Institutea research and policy organization focused on advancing reproductive rights. Before the election, President Trump said he would not sign a nationwide abortion ban.

State ballot measure to protect abortion rights adopted in seven statesThat includes Missouri, which Trump won by about 18 points, according to preliminary reporting from The Associated Press. Abortion rights bills were rejected by voters in Florida and South Dakota.

President Trump will either rescind FDA approval to restrict access to the abortion drug, which is used in more than half of abortions, or a 19th-century law that abortion opponents have banned from shipping the drug. It could move to either implement the Comstock Act. President Trump has said he does not intend to use the law generally to ban mail delivery of drugs.

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of KFF's core operating programs.