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HEALTHCARE - Having secured control of both chambers of the U.S. Congress and the White House starting in January, Republicans are making no secret of their intention to pursue sweeping healthcare cuts that would raise costs and imperil insurance coverage for millions of people across the country.
Rep. Jodey Arrington (R-Texas), chairman of the House Budget Committee, toldreporters earlier this week that the GOP is looking to use the filibuster-evading reconciliation process to pursue cuts to "mandatory programs"—a category that includes Medicare, Medicaid, and Social Security.
Bobby Kogan, senior director of federal budget policy at the Center for American Progress, noted in response to Arrington's comments that Republicans attempted to cut both Medicaid and Affordable Care Act (ACA) tax credits that help enrollees afford health insurance.
The Republican Study Committee, of which Arrington is a member, proposed eliminating the ACA tax credits in its 2025 budget proposal—a move that could result in around 4 million people losing insurance.
The tax credits are set to expire next year, meaning Republicans could just do nothing and allow them to lapse.
Last time Republicans had a federal trifecta, they tried and failed to fully repeal the ACA—an effort that sparked a wave of civil disobedience on Capitol Hill.
Both President-elect Donald Trump and House Speaker Mike Johnson (R-La.) said on the campaign trail that they're looking to try again.
"We're going to replace it," Trump said during his lone debate with Vice President Kamala Harris in September—while admitting that he did not have a fully formed alternative plan.
Johnson, for his part, said during a campaign stop in Pennsylvania last month that "healthcare reform's going to be a big part of the agenda." When a voter posed the question, "No Obamacare?" Johnson replied in the affirmative, "No Obamacare."
"The ACA is so deeply ingrained, we need massive reform to make this work," he added, "and we've got a lot of ideas on how to do that."
Sarah Lueck and Allison Orris of the Center on Budget and Policy Priorities wroteWednesday that Trump's return to the White House and the GOP's capture of both chambers of Congress poses "big risks to people's ability to access and afford health coverage in Medicaid and the marketplaces."
"While Republicans have moved away from talking about their plans for changing health coverage in the U.S. as 'repeal,'" Lueck and Orris added, "Trump's first term and Republicans' recently released policy agendas suggest they may pursue policies that would have much the same result: higher costs for people, reduced access to care for vulnerable groups, and more people who are uninsured."
"Just as a grassroots movement of Americans around the country succeeded in saving the Affordable Care Act during Trump's first term, we can save Social Security and Medicare."
Even if Republicans don't succeed at enacting major legislative changes to the nation's healthcare system, Trump will still have the power to do significant damage unilaterally. Lueck and Orris noted that the first Trump administration "took numerous administrative steps that made it harder for eligible people to get coverage" and weakened consumer protections, from adding new paperwork requirements to the Medicaid enrollment process to expanding so-called "junk" insurance plans.
Vice President-elect JD Vance also suggested during the 2024 campaign that a second Trump administration could seek to roll back protections for people with preexisting conditions.
"If there are a lot of details still to be filled in, the theme of the GOP's healthcare agenda is clear: cuts," Vox's Dylan Scott wrote days before the November 5 election. "Cutting regulations. Cutting spending."
Stephanie Armour of KFF Health Newswrote following Trump's victory that his second term "will likely bring changes that scale back the nation's public health insurance programs—increasing the uninsured rate, while imposing new barriers to abortion and other reproductive care."
Medicaid is particularly vulnerable, Armour noted, with Trump and the Republican Party potentially set to pursue "the imposition of work requirements on beneficiaries in some states" and changes to how the program is funded.
"Now, the federal government pays states a variable percentage of program costs," Armour explained. "Conservatives have long sought to cap the federal allotments to states, which critics say would lead to draconian cuts."
As for Medicare, the Project 2025 agenda authored by many former members of Trump's first administration calls for making privatized Medicare Advantageplans the default enrollment option for the nation's seniors—a change that advocates say would pose an existential threat to traditional Medicare.
"Trump and Republicans will try to cut our earned benefits," Alex Lawson, executive director of the progressive advocacy group Social Security Works, warned in an op-ed for Common Dreams on Wednesday. "But just as a grassroots movement of Americans around the country succeeded in saving the Affordable Care Act during Trump's first term, we can save Social Security and Medicare."
(Jake Johnson is a senior editor and staff writer for Common Dreams where this was first published.)
