THE FUTURE OF THE AFFORDABLE CARE ACT UNDER TRUMP'S SECOND TERM AS PRESIDENT

April 1, 2025

As 2025 enters its 4th month, the future of the Affordable Care Act (ACA) remains uncertain. While President Trump made mixed statements during his 2024 campaign, his past record suggests significant changes may be coming, particularly if Republicans control the House.

1. Key ACA Changes on the Horizon

   Biden-era ACA subsidies, which made healthcare more affordable, are set to expire in late 2025. Without congressional action, premiums could rise sharply, reducing ACA enrollment from 22.8 million in 2025 to 15.4 million by 2030

2. Congressional Control and ACA Revisions

   If Republicans maintain control of the House, expect efforts to cut ACA subsidies, reduce Medicaid funding, and possibly use budget reconsilation to alter the ACA

3. Limited Coverage & Weak Mandates

   Trump may promote short-term health plans with lower costs but limited coverage and further weaken the individual mandate, decreasing ACA enrollment

4. Increase State Control Over Healthcare

   States could gain greater control over healthcare programs, with fewer federal regulations and more localized solutions

5. Expansion of Health Savings Accounts (HSAs)

   Trump may push for higher HSA contribution limits and increase employer involvement in HSA-compatible plans

6. Medicaid Restrictions

   Possible stricter work requirements and block grants for Medicaid could limit eligibility and federal spending

7. ACA Regulation Changes

   Trump may push to relax essential health benefits, reducing mandatory coverage requirements and encouraging state-based insurance markets

   
   

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