Millions of people are at risk of losing their health insurance after Trump’s victory

Millions of Americans are at risk of losing subsidies next year that will help them pay for health insurance after the election victory of President Donald Trump and the victory of Republicans in the Senate.

The subsidies — which expire at the end of 2025 — came out of the 2021 American Savings Plan, and increased the amount of help available to people who want to buy health insurance through the Affordable Care Act. The American Savings Plan also expanded the number of people eligible for aid, and extended it to many of the middle class.

The looming expiration date means the next Congress and the next president will need to decide whether to extend it — something Trump and Republicans have already signaled they don’t support, said Chris Meekins. , a life strategy research analyst at the investment firm Raymond James.

“If the Republicans end up winning the House, in addition to the Senate and the White House, to sweep the GOP, I think there’s less than a 5% chance they’ll be added,” said Meekins, who was the top HHS official at the time. Trump’s first. . Even a Democratic control of the House probably won’t keep the subsidies, he added.

Several important House races are still to be decided. As of Thursday afternoon, House Republicans had won 209 seats, just nine short of a majority, according to the NBC News tracker.

By 2024, more than 20 million people will have health insurance through the ACA, according to the Centers for Medicare and Medicaid Services.

Since the 2021 subsidies went into effect, enrollment in ACA plans with reduced premiums has doubled, especially in red states in the South, said Cynthia Cox, ACA program manager at KFF, a group of non-participatory health care policy research.

The Affordable Care Act, passed in 2022, extended subsidies through 2025. In the 32 states where data is available, 15.5 million people receive subsidies, according to KFF.

If subsidies are not extended, the Congressional Budget Office — a nonpartisan organization that provides financial and economic information to Congress — estimates that nearly 4 million people will lose their coverage by 2026 because they can’t afford it. Enrollment will continue to decline each year, with activity reaching a low of 15.4 million people by 2030.

A spokesman for Trump did not respond to a request for comment.

It is possible, Cox said, that the current Congress could increase aid during the so-called duck session, although he added that it is unlikely.

“The election results make it very easy,” Cox said. “And what we are looking at is a huge increase in what people are paying for their fees. It will be an average increase of more than 75%. For some people, it will be twice as much. ”

Grants are a difficult issue for Republicans, Meekins said, because they are expensive. The CBO estimates that it would cost $335 billion over 10 years to extend them permanently.

Additionally, Trump and Republicans in Congress have said they will make “major” changes to the health care law.

Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, said if Republicans take full control of Congress, those changes could be significant.

“President Trump could cut funding to meet the ACA’s goals,” Gostin said. “This means that fewer people will know their rights under the law and many will not enroll in ACA health care plans. Trump will likely cut Medicaid funding and support states that refuse to expand Medicaid services.”

Gostin also noted that “challenges to the ACA’s preventive services mandate are continuing in the courts.” The directive requires health insurers to fully cover certain preventive services, including cancer screenings such as colonoscopies and mammograms, at no cost to the patient.

In June, a federal appeals court said the order must remain in place until the case is decided.

Cox said he expects Republicans to keep dismantling the ACA, as they did in Trump’s first term, when they removed the tax penalty associated with the law’s individual mandate, which required people to have health insurance. good or pay taxes. The order is still technically in place, but the penalty has been reduced to zero.

“If the Republicans control the House, the Senate and the presidency, we could see a rematch in 2017,” he said.

Gostin said that completely repealing the ACA will be a challenge, even if Republicans control all three chambers.

“The ACA will survive, but it’s kind of bare bones,” Gostin said.