ACA Changes in 2025 and Beyond: What Does the Current Administration Mean for the ACA

As we move into 2025, the future of the Affordable Care Act (ACA) is uncertain. During his successful 2024 campaign, President Trump made conflicting statements regarding the future of Obamacare. However, his record from his first term suggests that significant changes could be on the horizon, particularly if Republicans retain control of the House. His first year back in office may bring several changes to the ACA.

Let’s explore what the Trump administration’s healthcare priorities could mean for the ACA in the years to come.

1. Biden-Era Enhanced ACA Subsidies Likely to Expire in Late 2025

Under President Biden, enhanced ACA subsidies were introduced, making healthcare more affordable for millions of Americans, especially in Southern states. These subsidies are set to expire in 2025. If Congress doesn’t act to extend them, premiums could rise by 79% on average, with some states seeing increases over 100%.

• Impact on enrollment: Without these subsidies, the number of people enrolled in ACA Marketplace plans could drop from 22.8 million in 2025 to 18.9 million in 2026. By 2030, enrollment could fall even further, to just 15.4 million.

This change could be a key focus for the Trump administration, especially with its ongoing efforts to reduce government spending.

2. The Future of the ACA Depends on Congressional Control

If Republicans keep control of the House, major changes to the ACA are likely. These changes could include:

• Cutting subsidies: Republicans may push to reduce ACA subsidies, which could lead to higher premiums and fewer people able to afford coverage.
• Medicaid cuts: Medicaid funding could also be reduced, potentially limiting access to healthcare for millions of Americans.

While a full ACA repeal is unlikely without broader support, Congress could still use budget reconciliation to make significant changes to the law.

3. Trump’s Likely Healthcare Plans: More Limited Coverage and Weakened Mandates

President Trump has long advocated for dismantling the ACA. If he returns to office, we could see policies that further limit the reach and effectiveness of the ACA. These changes may include:

• Short-term plans: The administration could promote short-term, limited-duration plans, which are cheaper but provide much less comprehensive coverage compared to ACA-compliant plans.
• Weakened individual mandate: The Trump administration may seek to completely eliminate or weaken the ACA’s individual mandate, reducing the number of people signing up for ACA Marketplace plans.

4. Enhanced State Flexibility in Healthcare

One of President Trump’s key healthcare goals has been giving states more control over their healthcare systems. Under his administration, we may see:

• State-run programs: States could be allowed to create their own healthcare programs, potentially offering more affordable or flexible options for residents.
• Less federal oversight: The Trump administration may reduce federal control over state healthcare programs, allowing for more localized solutions.

5. Expanding Health Savings Accounts (HSAs)

Health Savings Accounts (HSAs) are an area where President Trump has shown strong support. He may propose changes to make HSAs more accessible, including:

• Higher contribution limits: Individuals may be allowed to contribute more to their HSAs, helping cover out-of-pocket healthcare costs.
• Employer involvement: Businesses might be incentivized to offer HSA-compatible plans to employees, shifting some healthcare costs onto individuals.

6. Impact on Medicaid Expansion

The Trump administration has opposed Medicaid expansion, a key part of the ACA. Moving forward, we may see:

• Work requirements for Medicaid: The administration could push for stricter work requirements for Medicaid beneficiaries, potentially reducing the number of people who qualify.
• Block grants: There may be continued efforts to provide fixed Medicaid funding to states, giving them more flexibility but also limiting the federal government’s financial responsibility.

7. Changes to ACA Regulations

The Trump administration is also likely to focus on changing ACA regulations, particularly how insurers operate. Potential changes include:

• Relaxing essential health benefits (EHBs): The administration may seek to reduce the number of required benefits, such as mental health and maternity care, leading to cheaper but less comprehensive plans.
• State-based insurance markets: States could be encouraged to set up their own insurance markets, which may offer less-regulated plan options compared to the ACA Marketplace.

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