THE SECOND TERM OF DONALD TRUMP will bring changes in the delivery of health care, particularly under government-sponsored programs.

Affordable Care Act (ACA)

In his first term in office, President Trump was not able to persuade JEFF ATKINSON of Congress to repeal the ACA (also known as “Obamacare”). During the 2024 campaign, Trump said he “was not running to terminate the ACA,” but he would make it “much better, stronger and far less expensive.” Details of his plan were not provided.

One of the ways the ACA expanded health insurance coverage was to provide subsidies and tax credits to help pay for insurance. The American Rescue Plan, passed in 2021 during the pandemic, increased subsidies for purchasing insurance on ACA exchanges. The increased subsidies are scheduled to expire at the end of 2025.

Trump opposes extension of the increased subsidies. If Trump and Congress do not extend the subsidies, costs will be saved, but millions of people are likely to lose insurance.

Medicare and Medicaid

Trump has promised to “fight for and protect Social Security and Medicare with no cuts, including no changes to the retirement age.” He plans to increase home care benefits under Medicare and use tax credits to help unpaid family caregivers. As of 2024, 67.7 million people are enrolled in Medicare. Medicaid currently has an even larger enrollment: 72.4 million. Laws governing Medicaidare included in the ACA.

Comments by President Trump and people working in his campaign suggest Medicaid is likely to be a subject of cost-cutting. Medicaid funding to the states may be converted to block grants with a high level of flexibility given to the states regarding how the funds are spent. That step likely would substantially reduce federal funding for Medicaid.

The reduced funding could cut the number of people eligible to enroll in Medicaid and reduce the services covered.

Part of the flexibility for administering Medicaid is allowing states to impose work requirements on Medicaid recipients. An alternative to work requirements may include the recipient performing community service or attending school.

In Trump’s first term, some states were allowed to impose work requirements on a trial basis. In Trump’s second term, work requirements may be expanded. According to KFF, a health policy research organization, 61 percent of non-elderly receiving Medicaid benefits were already working full- or part-time.

Health care costs

In his first term, Trump created a demonstration program for some Medicare beneficiaries to cap monthly copayments for insulin at $35. President Joe Biden continued and expanded that program to cover all Medicare beneficiaries.

Trump favors limiting some drug prices to the amount paid by other countries — a program called the Most Favored Nation Rule. Courts put the program on hold, but Trump may try again in his second term. Meanwhile, the government is negotiating with manufacturers regarding the prices of widely used drugs paid by Medicare.

Trump said that part of the funding for health care will come from savings from not spending on what he calls “misguided military adventures overseas.” Another cost-saving measure: In his first term, President Trump signed the No Surprises Act regarding billing to patients who receive care out of network.

Short-term insurance policies

The Trump administration has favored expanded use of short-term health insurance policies as a way to reduce health care costs. The short-term policies could be issued for an initial period of 12 months and an extension of up to 36 months.

Traditionally, short-term policies were, as the name implies, intended for short-term use, such as by people between jobs or early retirees who are waiting for Medicare coverage. Short-term policies often do not cover certain types of treatment, including prescription drugs, mental health, substance abuse, maternity care or preventive care. Such policies also may not cover pre-existing conditions.

President Biden referred to these policies as “junk insurance” and limited their use to three months with a renewal of a maximum of four additional months. The Trump administration is likely to eliminate or modify those rules.

Reproductive rights

Trump’s views on reproductive rights have changed over time. In a video statement in April 2024, as well as on subsequent occasions, he said that decisions on reproductive rights should be left to the states, adding that he was in favor of exceptions for rape, incest and cases in which the mother’s life is in danger.

In the months before that, Trump expressed likely support for a nationwide ban on abortion after 15 or 16 weeks of gestation. In the video, he said he was “proudly the person responsible” for the Supreme Court’s decision to overturn Roe v. Wade.

Trump has said he would not sign a nationwide abortion ban, but many commentators expect he would if the ban was subject to exceptions.

Trump supports access to in vitro fertilization.

Care for transgender individuals

Trump has said that on “Day One” of his administration, any hospital or health care provider who “participates in the chemical or physical mutilation of minor youth” will be terminated from eligibility from receiving federal funds, including from Medicaid and Medicare. In addition to stopping most gender-affirming care, Trump said he would back a federal law recognizing only two genders.

Drug addiction and mental health services

Trump has pledged to “forge new public/private partnerships for companies willing to provide job opportunities and skills training for former addicts and will expand federal support for faith-based counseling, treatment and recovery programs.”

President Trump has promised to “make America healthy again.” For some, there may be improvements or continuation of the status quo (such as people covered by Medicare). For others, their health care may be in jeopardy (such as persons who will lose insurance). •