Big question after Trump's win: What's next for health care?
President-elect Donald Trump said during the campaign that he has "concepts of a plan" to replace the 2010 law commonly known as Obamacare.. Credit: Getty Images for DNC/Tasos Katopodis
WASHINGTON — New York health care providers are weighing the future of health care under a second Trump Administration amid vows by congressional Republican leaders to overhaul the Affordable Care Act.
President-elect Donald Trump pushed unsuccessfully during his first term to repeal the Obama-era health care law when Republicans were in control of Congress. But during this year’s presidential campaign he pledged to revisit the issue, saying he had "concepts of a plan" to replace the sweeping 2010 law.
Without any detailed proposals from Trump, health care providers are looking to his past attempts to undo the Affordable Care Act and the words of his allies and advisers to prepare for possible changes to the 14-year-old law, widely known as Obamacare.
"Everybody is concerned about what proposals might come next and what impact that might have on the state of New York, and I think we're all preparing for a tough year," said Wendy Darwell, president and CEO of the Suburban Hospital Alliance of New York, a group that advocates on behalf of Long Island hospitals.
The Affordable Care Act implemented consumer protections such as barring insurance companies from denying coverage to individuals with preexisting medical conditions and helped increase the number of insured Americans.
Republican lawmakers have argued for the past 14 years that the law is flawed, asserting that it has created an outsize role for government in people’s health care decisions and has led private insurers to increase their rates to account for the larger pool of consumers they must cover.
"We want to take a blowtorch to the regulatory state," House Speaker Mike Johnson (R-La.) told a gathering of Trump supporters in Bethel, Pa., days before the election, when asked about the future of Obamacare. "It’s crushing the free market. It’s like a boot on the neck of job creators and entrepreneurs and risk takers."
In 2017, an effort by Trump and congressional Republicans to repeal the law was close to passing when then-Sen. John McCain (R-Ariz.) famously gave a late-night thumbs-down "no" vote that helped tank the effort in the narrowly split chamber. The GOP push to repeal the ACA played a factor in House Democrats gaining control of the chamber after the 2018 midterm elections, as polls continue to show that most Americans have a favorable view of the law.
After their 2018 midterm losses Republicans were less inclined to publicly call for a repeal of the ACA. Even Trump during this year's campaign softened his tone on the plan, saying on social media he was "not running to terminate" the law but wanted to make it "better."
Darwell, with the Suburban Hospital Alliance of New York, told Newsday that a key concern among local hospitals is that any attempts to change or replace the ACA would lead to a reduction in the number of insured patients, ultimately putting a strain on hospitals that are obligated to treat patients regardless of coverage.
She noted that federal subsidies Congress passed during the Biden Administration that helped reduce the cost of plans on the Affordable Care Act’s marketplaces are set to expire at the end of 2025.
Health policy experts contend that even if Trump and a GOP-led Congress don’t outright repeal and replace the Affordable Care Act, they can undercut the program by taking a hands-off approach — allowing the subsidies to expire and refusing to defend provisions of the Act from lawsuits.
Some 7 million New Yorkers are enrolled in insurance through the state’s ACA marketplace, including more than 118,000 Nassau residents and more than 132,200 Suffolk residents, according to the latest state data.
Enrollment grew by over 2 million New Yorkers between 2020 and 2023, in part because of subsidies Congress passed in 2022 as part of the Inflation Reduction Act, state health officials said.
The subsidies helped cut premium costs by about 44% for eligible enrollees, according to KFF, a nonpartisan health research organization, and spurred enrollment among previously uninsured Americans who were not eligible for Medicare but could not afford private insurance.
Cristina Freyre Batt, senior vice president for federal policy for the Healthcare Association of New York State, said health care providers across the state are closely tracking whether the subsidies get renewed next year by the Republican-majority Congress.
"In New York state, we're very fortunate to have an uninsured rate of just under 5%," Batt told Newsday in an interview. "Prior to the ACA that was at 11%, so we’ve seen tremendous gains in the ability for people to access coverage,"
Renewal of the subsidies faces an uphill climb, as House Republicans have been largely critical of any expansion of the ACA. Johnson, just days before the election said: "The ACA is so deeply ingrained. We need massive reform to make this work, and we got a lot of ideas on how to do that."
There have been more than 2,000 state and federal lawsuits filed over the past 14 years targeting the Affordable Care Act and seeking to roll back the law and its mandates, according to a study by the health research organization KFF.
The Trump Administration could decide not to defend the Act against such lawsuits, said Zachary Baron, director of Georgetown University's Center for Health Policy and the Law.
"I think it's fair to expect various twists and turns with respect to current litigation threatening the Affordable Care Act, as well as new litigation challenging future actions by the Trump Administration," Baron told Newsday.
In September, the Biden Administration filed a petition asking the Supreme Court to weigh in on a Texas lawsuit that seeks to eliminate the ACA requirement that insurers cover the cost of preventive services like annual physicals, birth control and cancer screenings.
The lawsuit — Braidwood Management v. Becerra — was brought forward by a Christian-owned business that argues the mandate is unconstitutional and violates its religious freedoms.
The Trump Administration could decide to withdraw the Biden Administration’s petition, ultimately preserving a conservative lower court ruling that the plaintiffs in the case do not need to abide by the ACA’s coverage mandate, Baron said.
He added that such a move would open the door for other employers and insurers to seek the same relief. "That could leave millions of Americans exposed to higher out-of-pocket costs for a wide array of evidence-based preventive services that they currently enjoy today," Baron said.
Trump has nominated environmental lawyer and vaccine skeptic Robert F. Kennedy Jr. to lead the Department of Health and Human Services and television personality Dr. Mehmet Oz to lead the Centers for Medicare and Medicaid Services.
Kennedy has not given recent public statements on the Affordable Care Act. But he has called for sweeping changes to country’s health care system and suggested that Medicare, the government-run health care program for seniors, should fund gym memberships and healthy food instead of prioritizing payments for prescription drugs.
Oz previously praised the ACA when it was unveiled. But during an unsuccessful 2022 run for U.S. Senate in Pennsylvania, he backed away from that initial support, saying "The American health care system is in need of improvement."
As Trump leans to his team of advisers to weigh the future of the Affordable Care Act, and the expanded subsidies' expiration date nears, New York health care advocates say they're prepared to take their fight to Capitol Hill.
"Congress looks at dollars and cents and they may have other priorities on where they spend money," Darwell said. "So it's our job to make sure they understand, on behalf of the patients we're serving, what that really means."
WASHINGTON — New York health care providers are weighing the future of health care under a second Trump Administration amid vows by congressional Republican leaders to overhaul the Affordable Care Act.
President-elect Donald Trump pushed unsuccessfully during his first term to repeal the Obama-era health care law when Republicans were in control of Congress. But during this year’s presidential campaign he pledged to revisit the issue, saying he had "concepts of a plan" to replace the sweeping 2010 law.
Without any detailed proposals from Trump, health care providers are looking to his past attempts to undo the Affordable Care Act and the words of his allies and advisers to prepare for possible changes to the 14-year-old law, widely known as Obamacare.
"Everybody is concerned about what proposals might come next and what impact that might have on the state of New York, and I think we're all preparing for a tough year," said Wendy Darwell, president and CEO of the Suburban Hospital Alliance of New York, a group that advocates on behalf of Long Island hospitals.
WHAT NEWSDAY FOUND
- New York health care providers are weighing the future of health care under an upcoming second Trump Administration amid vows by congressional Republican leaders to overhaul the Affordable Care Act.
- Without any detailed proposals from Trump, health care providers are looking to his past attempts to undo the Affordable Care Act and the words of his allies to prepare for possible changes to the 14-year-old law, widely known as Obamacare.
- Republican lawmakers for the past 14 years have argued that the law is flawed, asserting that it has created an outsize role for government and has led private insurers to increase their rates to account for the larger pool of consumers they must cover.
The Affordable Care Act implemented consumer protections such as barring insurance companies from denying coverage to individuals with preexisting medical conditions and helped increase the number of insured Americans.
Republican lawmakers have argued for the past 14 years that the law is flawed, asserting that it has created an outsize role for government in people’s health care decisions and has led private insurers to increase their rates to account for the larger pool of consumers they must cover.
"We want to take a blowtorch to the regulatory state," House Speaker Mike Johnson (R-La.) told a gathering of Trump supporters in Bethel, Pa., days before the election, when asked about the future of Obamacare. "It’s crushing the free market. It’s like a boot on the neck of job creators and entrepreneurs and risk takers."
In 2017, an effort by Trump and congressional Republicans to repeal the law was close to passing when then-Sen. John McCain (R-Ariz.) famously gave a late-night thumbs-down "no" vote that helped tank the effort in the narrowly split chamber. The GOP push to repeal the ACA played a factor in House Democrats gaining control of the chamber after the 2018 midterm elections, as polls continue to show that most Americans have a favorable view of the law.
After their 2018 midterm losses Republicans were less inclined to publicly call for a repeal of the ACA. Even Trump during this year's campaign softened his tone on the plan, saying on social media he was "not running to terminate" the law but wanted to make it "better."
Darwell, with the Suburban Hospital Alliance of New York, told Newsday that a key concern among local hospitals is that any attempts to change or replace the ACA would lead to a reduction in the number of insured patients, ultimately putting a strain on hospitals that are obligated to treat patients regardless of coverage.
She noted that federal subsidies Congress passed during the Biden Administration that helped reduce the cost of plans on the Affordable Care Act’s marketplaces are set to expire at the end of 2025.
Health policy experts contend that even if Trump and a GOP-led Congress don’t outright repeal and replace the Affordable Care Act, they can undercut the program by taking a hands-off approach — allowing the subsidies to expire and refusing to defend provisions of the Act from lawsuits.
Allowing subsidies to sunset
Some 7 million New Yorkers are enrolled in insurance through the state’s ACA marketplace, including more than 118,000 Nassau residents and more than 132,200 Suffolk residents, according to the latest state data.
Enrollment grew by over 2 million New Yorkers between 2020 and 2023, in part because of subsidies Congress passed in 2022 as part of the Inflation Reduction Act, state health officials said.
The subsidies helped cut premium costs by about 44% for eligible enrollees, according to KFF, a nonpartisan health research organization, and spurred enrollment among previously uninsured Americans who were not eligible for Medicare but could not afford private insurance.
Cristina Freyre Batt, senior vice president for federal policy for the Healthcare Association of New York State, said health care providers across the state are closely tracking whether the subsidies get renewed next year by the Republican-majority Congress.
"In New York state, we're very fortunate to have an uninsured rate of just under 5%," Batt told Newsday in an interview. "Prior to the ACA that was at 11%, so we’ve seen tremendous gains in the ability for people to access coverage,"
Renewal of the subsidies faces an uphill climb, as House Republicans have been largely critical of any expansion of the ACA. Johnson, just days before the election said: "The ACA is so deeply ingrained. We need massive reform to make this work, and we got a lot of ideas on how to do that."
Potential legal inaction
There have been more than 2,000 state and federal lawsuits filed over the past 14 years targeting the Affordable Care Act and seeking to roll back the law and its mandates, according to a study by the health research organization KFF.
The Trump Administration could decide not to defend the Act against such lawsuits, said Zachary Baron, director of Georgetown University's Center for Health Policy and the Law.
"I think it's fair to expect various twists and turns with respect to current litigation threatening the Affordable Care Act, as well as new litigation challenging future actions by the Trump Administration," Baron told Newsday.
In September, the Biden Administration filed a petition asking the Supreme Court to weigh in on a Texas lawsuit that seeks to eliminate the ACA requirement that insurers cover the cost of preventive services like annual physicals, birth control and cancer screenings.
The lawsuit — Braidwood Management v. Becerra — was brought forward by a Christian-owned business that argues the mandate is unconstitutional and violates its religious freedoms.
The Trump Administration could decide to withdraw the Biden Administration’s petition, ultimately preserving a conservative lower court ruling that the plaintiffs in the case do not need to abide by the ACA’s coverage mandate, Baron said.
He added that such a move would open the door for other employers and insurers to seek the same relief. "That could leave millions of Americans exposed to higher out-of-pocket costs for a wide array of evidence-based preventive services that they currently enjoy today," Baron said.
Health policy nominees
Trump has nominated environmental lawyer and vaccine skeptic Robert F. Kennedy Jr. to lead the Department of Health and Human Services and television personality Dr. Mehmet Oz to lead the Centers for Medicare and Medicaid Services.
Kennedy has not given recent public statements on the Affordable Care Act. But he has called for sweeping changes to country’s health care system and suggested that Medicare, the government-run health care program for seniors, should fund gym memberships and healthy food instead of prioritizing payments for prescription drugs.
Oz previously praised the ACA when it was unveiled. But during an unsuccessful 2022 run for U.S. Senate in Pennsylvania, he backed away from that initial support, saying "The American health care system is in need of improvement."
As Trump leans to his team of advisers to weigh the future of the Affordable Care Act, and the expanded subsidies' expiration date nears, New York health care advocates say they're prepared to take their fight to Capitol Hill.
"Congress looks at dollars and cents and they may have other priorities on where they spend money," Darwell said. "So it's our job to make sure they understand, on behalf of the patients we're serving, what that really means."
Laura Figueroa Hernandez is the White House correspondent and previously covered New York City politics and government. She joined Newsday in 2012 after covering state and local politics for The Miami Herald.
'A spark for them to escalate the fighting' A standoff between officials has stalled progress, eroded community patience and escalated the price tag for taxpayers. Newsday investigative editor Paul LaRocco and NewsdayTV's Virginia Huie report.
'A spark for them to escalate the fighting' A standoff between officials has stalled progress, eroded community patience and escalated the price tag for taxpayers. Newsday investigative editor Paul LaRocco and NewsdayTV's Virginia Huie report.
