The election is over and whatever opinion anyone has about the outcome, we can all be certain that millions will feel the impact of changes to healthcare when Republican leaders take over next year.
President-elect Trump has not yet given up on his 2017 goal to repeal and replace the Affordable Care Act (ACA) which now insures over 45 million people between the insurance marketplaces and Medicaid. Just following the election, the President-elect affirmed his openness to repealing the ACA on NBC despite the fact that the ACA has reached record public support among both Republicans and Democrats based on the latest Gallup polling.
Although there’s not much support for the President-elect’s renewed interest in repeal, the ACA still faces dangers under Republican rule. That’s because the enhanced tax credits that enable millions more people to afford coverage on the marketplaces are set to expire in one year (December, 2025) and many Republicans are already refusing to extend these affordability measures that lower costs. The enhanced credits have reduced premium payments by an estimated $705 a year for enrollees and enabled millions more people to get coverage.
If Congressional Republicans now in the majority refuse to extend the tax credits, ACA premiums are likely to increase an average of over 75%. In some states, patients will see their payments more than double. The Congressional Budget Office (CBO) estimates that around 4 million people will lose coverage while millions more face much higher costs even as the price of everything else–housing, food, consumer goods–continues to rise as well.
At the same time as the ACA faces danger, Medicaid is also in peril. Medicaid is the nation’s largest health program, covering nearly 77 million people of all ages. In many states, Medicaid is known by a specific name like BadgerCare in WI, MassHealth in MA, or Husky Health in CT. Federally and in states, its coverage is far reaching and creates tremendous value for local economies and families.
Medicaid is the leading payer of long-term care services, both in facilities and in home, for people with disabilities and for seniors. Medicaid is also the largest provider of healthcare for children–nearly half of all kids are covered by Medicaid. Medicaid is also the largest payer of births, covering nearly half of births and more than half in some states, and the largest payer of birth control. Medicaid also pays for mental and behavioral health services, for substance abuse treatment, and for emergency disaster relief services when states are hit by hurricanes, fires, or other disasters whether natural or man-made.
Medicaid is jointly funded by states and the federal government through a formula called FMAP (Federal Medicaid Assistance Percentage). It’s the largest source of federal funding to most states and supports countless benefits in addition to those listed above, including services like school nurses, medical transport for seniors and people with disabilities, and even covers abortion services in some states. In rural areas, Medicaid is the leading funder of hospitals and clinics. In every state, Medicaid is the largest item in the state budget.
Republicans have long targeted Medicaid with repeated efforts to restructure or cut the program in order to finance their other priorities including tax breaks that primarily benefit the wealthy and corporations. In 2025, for instance, Republicans are seeking to make permanent Trump’s signature tax law, the Tax Cuts and Jobs Act, which has lavished big tax breaks on the wealthiest households while driving up the national debt and providing limited benefits to the bottom 60% of Americans. Extending the Trump tax breaks for the wealthy will cost the rest of us.
Some Republicans are proposing to double down on giveaways to the wealthiest 20% of Americans through an extension of the Trump tax breaks by making massive cuts to Medicaid and other critical programs. Although Trump campaigned on lowering costs and “fixing” the economy, cutting Medicaid and ACA tax credits would actually do the opposite: raise costs for average people and put healthcare out of reach for millions of Americans particularly millions of seniors, kids, people with disabilities and others who are struggling to make ends meet on a fixed income.
Medicaid is especially critical as a program for seniors, a growing part of the American population. Although seniors and people with disabilities make up just a quarter of Medicaid enrollees, they comprise about half of all Medicaid spending. Make no mistake, cuts to Medicaid will disproportionately impact aging Americans and heap greater burdens on their families who are already struggling with care responsibilities.
It will be critical in the coming year for average Americans who have a stake in Medicaid and the services it provides to our families to pay close attention and stay in touch with Congressional lawmakers. Educating lawmakers about the impact of cuts to Medicaid and the ACA to real people in the district is a powerful tactic to influence the coming debate and to protect the programs and services we all depend on every day.