Health Care Alert: On January 20, 2025, President Trump rescinded President Biden’s Executive Orders related to ACA enrollment deadlines, eligibility requirements, and federal subsidies for Medicaid expansion—resulting in a potential decrease in access to affordable health care for millions of Americans.
Since it was signed into law in 2010, the Affordable Care Act (ACA) has enabled significantly more people to afford health insurance and access care. When the law was first introduced, one out of every six Americans lacked health coverage. According to the latest report from the U.S. Census Bureau, 92 percent of Americans had some type of health insurance in 2023.
Individuals who don’t want or can’t afford private insurance, including an employer-sponsored plan, can purchase coverage through the ACA Marketplace. All Marketplace plans provide essential benefits, such as protections for pre-existing conditions, an emphasis on low-cost preventive care, no age-based discrimination, and no annual caps on coverage. Employer-sponsored plans offered by private insurers are still required to include these essential benefits.
At the Health Foundation, we applaud how the Affordable Care Act has made quality health coverage available to more people. With its patient protections and provisions, the ACA affirms health care as a human right for each one of us—not a privilege reserved for those who can afford it.
Remembering the attempts to “repeal and replace”
In 2017, the Republican-led Congress, under the leadership of President Trump during his first term, attempted to repeal and replace the ACA. The various replacement proposals included a greater emphasis on health savings accounts and high-deductible plans.
Eight years later, at the start of Trump’s second presidential term, the fate of the ACA—and the ability for millions to access health care—is again at risk.
Weakening the ACA in 2025
Critical of the Affordable Care Act, the Trump Administration favors a health insurance approach centered on high-deductible plans, catastrophic coverage, and health savings accounts.
As President Trump begins his second four-year term, here are just some of the ways his Administration is poised to weaken the ACA:
- Allowing health plans to deny coverage for pre-existing conditions – One of the ACA’s most effective innovations was creating a system that does not discriminate against people with pre-existing health conditions. Pre-existing conditions include allergies, asthma, cancer, depression, diabetes, and even pregnancy. Without automatic coverage for pre-existing conditions, people can be subjected to extended waiting periods for insurance eligibility, or denied coverage altogether.
- Deemphasizing preventive care – Another hallmark of the ACA is a focus on comprehensive preventive care for no or minimal cost. This includes vaccines and screenings for cancer, diabetes, hypertension, autism, and other conditions.
- Letting health insurers create different risk pools – The ACA requires health insurers, including all ACA-compliant health plans managed by the states, to use a single risk pool to set their premiums. A risk pool, which is at the heart of how insurance works, consists of individuals whose medical costs are combined to establish premiums. The higher medical costs of less healthy people are offset by the lower costs of people in good health. In other words, the cost of insuring everyone is shared across the same pool. The larger the risk pool, the more predictable and stable the premiums.Any legislation that allows insurers to create multiple risk pools—and charge different premiums depending on a subscriber’s health—undermines the ability to deliver affordable, quality health care for all of us.
- Allowing the expanded premium tax credits to expire – A provision to extend the expanded tax credits, as part of the 2022 Inflation Reduction Act, made health care more affordable for millions of people. These expanded premium tax credits are set to expire after this year—unless the GOP-led Congress acts. Mr. Trump has not voiced his support for such an action.
Another core ACA provision that could come under threat is dependent coverage up until age 26.
A few sabotage efforts have already been put into motion. Through an executive order rescission on January 20, the Trump Administration shortened ACA open enrollment periods and reduced federal funding for the Medicaid expansion. An estimated 3 million adults across nine states will lose their health coverage because of state trigger laws tied to federal funding,
We should strengthen, not dismantle, the ACA
The Affordable Care Act is popular and effective. The most recent open-enrollment numbers hit a record high, and more than 90 percent of Americans have health coverage. To weaken the ACA would only cause us to go backwards in our fight for health equity.
Let’s stay committed to the goal of equitable access to health care and keep building on the Affordable Care Act—not taking it apart.
