The Precarious Future of Healthcare Under Trump’s Agenda
President Donald Trump, whose inaugural address emphasized the importance of affordability, is planning substantial cuts to federal healthcare programs. This move has sparked alarm among advocates who champion insurance access through the Affordable Care Act (ACA) and Medicaid.
While Trump and House Speaker Mike Johnson (R-Louisiana) have stated that cuts to Medicare and Social Security are off the table, Medicaid and the ACA, also known as Obamacare, are positioned as prime targets for budget reductions.
North Carolina,with over 3 million residents enrolled in Medicaid and 975,000 accessing healthcare through the ACA marketplace,is particularly vulnerable to these potential cuts. Notably, the state’s expansion of Medicaid, which added 600,000 individuals in 2024, could be jeopardized if federal reimbursements are lowered.
Trump has a long-standing history of criticism against the ACA. During his previous term, he made several attempts to repeal the program, which were ultimately thwarted by Congress.In his 2024 campaign, he declared,“Obamacare stinks” and pledged to replace it,even though he offered no specifics.
NCGOP spokesman Matt Mercer maintains that “The number one driver of health care costs for over a decade and a half has been Obamacare,” asserting that President Trump and Republicans will deliver solutions for reduced costs and increased choice for all Americans.”
Democrats, however, interpret these statements as a clear indication that the ACA is in Trump’s crosshairs. “When you look at what Trump’s allies have already said, they are actively looking for government programs to cut, right?” stated Abhi Rahman, a spokesperson for the Democratic National Committee. “Donald Trump has repeatedly denigrated the ACA.”
The ACA’s future appears uncertain. While repealing it outright would face significant opposition given widespread public support, option strategies like allowing subsidy enhancements enacted in 2021 to expire could significantly impact coverage. The Congressional Budget Office estimates this move would save the federal government $335 billion annually but leave 4 million people nationwide without coverage.
A recent Kaiser Family Foundation analysis revealed that ceasing enhanced subsidies would, on average, double out-of-pocket costs for ACA enrollees in North Carolina. Critics argue the program has become overextended, serving too many middle-income individuals who could afford higher premiums.
Fiscal conservatives point to potential waste and overpayment within Medicaid, advocating for more substantial cuts and reforms. Though, a recent Kaiser poll suggests that Americans are more likely to believe the federal government underfunds Medicare and Medicaid than overfunds them.
Trump’s executive order rescinding a 2022 directive from former President Joe biden to explore strategies for lowering prescription drug costs in Medicaid and Medicare further fuels concerns about his healthcare priorities.Rahman criticizes this move, stating, “Trump has proven time and time again that he is in the pocket of Big Pharma. There’s no telling what he’ll do for his billionaire backers.”
Mercer, on the other hand, interprets the order as part of a broader effort “to dismantle government inefficiency and implementation of the Inflation Reduction Act, which spectacularly failed at its title.”
The future of healthcare under Trump’s governance remains uncertain, with significant challenges and potential disruptions looming for millions of americans.
How might reduced Medicaid and ACA funding impact access to healthcare, especially for vulnerable populations and non-expansion states like North Carolina?
Archyde News: An Interview with Dr.Affina Care,healthcare policy expert
Archyde News,January 22,2025
Interviewer (IV): Today we’re joined by Dr. Affina Care, a leading healthcare policy expert. Dr. Care, thank you for being with us today.
Dr. Affina Care (AC): Thank you for having me.
IV: Let’s dive right in. President Trump has indicated that Medicaid and ACA programs may face significant cuts to fund tax reform. As a policy expert, what are your main concerns?
AC: My primary concern is the potential impact on the most vulnerable Americans who rely on these programs for their healthcare needs. Medicaid expansion under the ACA has provided insurance coverage to millions of low-income individuals, and any rollbacks could reverse these gains. Additionally, cuts to Medicaid funding could force states to limit eligibility, reduce benefits, or decrease payment rates to providers, further straining access to care.
IV: We’ve heard arguments from the administration and allies that these programs need reform to curb waste and fraud. how do you respond to these claims?
AC: While it’s true that no system is immune to inefficiencies, we must be cautious not to punish the majority for the actions of a few. comprehensive audits are needed to identify and address any instances of abuse. arbitrarily cutting funding risks disrupting essential services and harming individuals who have done nothing wrong. Moreover, states and providers have incentives to comply with the rules to maintain their steady stream of federal funding.
IV: North Carolina, with over 3 million residents enrolled in Medicaid and nearly a million accessing healthcare through the ACA’s exchanges, is particularly vulnerable to cuts, according to a recent MarketWatch article. How might these cuts affect the state and its residents?
AC: North Carolina’s unique situation as a non-expansion state adds another layer of complexity. Only 65% of its poor adults qualify for Medicaid, compared to the national average of 79%. If federal funding for Medicaid and ACA is reduced, more low-income North Carolinians could fall through the cracks.we must consider that healthcare access is intricately linked to employment and productivity. Harming healthcare could ultimately hinder the state’s economic growth.
IV: Some stakeholders have proposed choice funding sources for tax reform. What are your thoughts on these potential shifts in financing?
AC: Diversifying funding sources can be beneficial, especially if it means maintaining essential services. However, we must ensure that any new sources are stable, predictable, and won’t burden the middle class or those struggling to make ends meet. We’ve seen from past experiences that overly relying on one-time revenue or unchecked cuts can lead toinstability, hurting individuals and families over time.
IV: Dr. Care, what steps can policymakers take to navigate these uncertain times regarding healthcare access and affordability?
AC: I urge policymakers to engage in open, bipartisan dialog about our healthcare system’s strengths and weaknesses. We must prioritize data-driven decisions and consider the real-life impacts of proposed changes. Most importantly, we should remember that behind every policy debate lies a person. We must strive to protect, maintain, and strengthen access to healthcare for all Americans.
IV: Thank you, Dr. Care, for your insightful outlook. That’s all for today’s interview.
AC: My pleasure.
