What will a new Trump presidency do for health care?

President-elect Donald Trump is expected to pursue a bigger agenda than he did in his first term, and pursue it faster than he did the last time he was in the Oval Office.

Health care is among the issues to be addressed during Trump’s second term, and although some of these issues will require congressional approval, the incoming president could make a number of changes through regulation or executive order.

Here is a rundown of some of the most pressing health care issues Trump will face in his new term.

• Medicare: Trump has promised to protect Medicare and said he supports funding home care benefits. He also has championed reducing Medicare prescription drug prices and may support Medicare’s authority to negotiate the price of prescription drugs.

Trump has promoted Medicare Advantage. In addition, Project 2025 – a plan of conservative policy proposals proposed by the Heritage Foundation and not endorsed by Trump – has proposed Medicare Advantage be the default option for Medicare coverage.

• Medicaid: Trump has been less specific about his intentions for Medicaid. Some health analysts said they expect Medicaid could be vulnerable to spending cuts. Those cuts could help finance the extension of the tax breaks from the 2017 Tax Cuts and Jobs Act, which expire at the end of 2025 unless Congress extends them.

Possible changes to Medicaid could include imposing work requirements on recipients in some states. The administration and Republicans in Congress could also try to revamp the way Medicaid is funded. The federal government currently pays states a variable percentage of program costs. Conservatives have long sought to cap the federal allotments to states, which critics say would lead to major cuts.

• Affordable Care Act. Trump has not been specific on his plans regarding the ACA, a law he tried to weaken during his first term.

In March, Trump said is “not running to terminate” the ACA but said he wanted to make it “better” and “less expensive,” in a post on Truth Social.

During the September presidential debate, he said he had “concepts of a plan” and said it would be “better health care,” but offered few details.

A second Trump administration could see a cut in funds for ACA enrollment outreach, allowing consumers more options to purchase health plans that don’t comply with ACA consumer protections, and allowing insurers to charge sicker people higher premiums.

The American Rescue Plan Act of 2021 provided for enhanced tax subsidies to enable more Americans to buy coverage through the ACA marketplace. The Inflation Reduction Act continued those subsidies through 2025. Trump and Congressional Republicans are expected to favor allowing those enhanced subsidies to expire next year.

• Make America Healthy Again. Trump has said he will give Robert F. Kennedy Jr. a prominent role in his administration, with the stated goal to “Make America Healthy Again.”

Kennedy launched the MAHA movement, with the goals of eliminating additives and pesticides in food, promoting alternative medicine and ending fluoridation of public water.  Although it is unclear exactly what Kennedy’s role will be in a new Trump administration, he stated on X that the Food and Drug Administration’s “war on public health is about to end.”

• Abortion/reproductive health: Trump has said decisions about abortion restrictions should be left to the states. However, he could move to restrict access to abortion medications either by withdrawing the FDA’s authorization for the drugs or by enforcing a 19th-century law, the Comstock Act, that abortion opponents say bans their shipment. Trump has said he generally would not use the law to ban mail delivery of the drugs.

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