GOP’s federal trifecta and the looming threat to U.S. healthcare

What’s next for healthcare? GOP’s agenda signals cuts and higher costs.

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The Republican Party’s consolidation of power, with control over the White House and both chambers of Congress starting in January, has reignited concerns about sweeping cuts to vital healthcare programs. This federal trifecta gives the GOP the ability to enact policies that could drastically reshape healthcare in the United States, affecting millions of Americans. Among the key targets are Medicaid, Medicare, and Affordable Care Act (ACA) tax credits—programs that provide essential coverage and financial assistance to vulnerable populations.

Republican leaders have wasted no time signaling their intentions. Rep. Jodey Arrington (R-Texas), chair of the House Budget Committee, stated that the GOP plans to use the filibuster-evading reconciliation process to pursue cuts to “mandatory programs,” which include Medicare, Medicaid, and Social Security. Arrington’s comments align with proposals from the Republican Study Committee, which has advocated eliminating ACA tax credits in its 2025 budget plan. If enacted, this move could result in approximately 4 million people losing insurance coverage.

The ACA tax credits, which help enrollees afford health insurance, are set to expire in 2025. By doing nothing, Republicans could allow the credits to lapse, further compounding the number of uninsured individuals. Bobby Kogan, senior director of federal budget policy at the Center for American Progress, noted that Republicans have historically targeted both Medicaid and ACA tax credits, often to the detriment of those who rely on these programs.

President-elect Donald Trump and House Speaker Mike Johnson (R-La.) have openly discussed their plans to revisit healthcare reform, echoing their earlier attempts to repeal the ACA during Trump’s first term. “We’re going to replace it,” Trump declared during his lone debate with Vice President Kamala Harris, though he admitted to lacking a fully developed alternative plan. Similarly, Johnson confirmed, “No Obamacare,” during a Pennsylvania campaign stop, emphasizing the need for “massive reform.”

The GOP’s healthcare agenda is reminiscent of its efforts during Trump’s first term, when the party unsuccessfully sought to repeal the ACA despite holding a federal trifecta. Those efforts sparked widespread civil disobedience and protests on Capitol Hill, ultimately preserving the ACA thanks to grassroots mobilization.

During his first term, Trump also implemented administrative changes that created barriers to coverage. These included increasing paperwork requirements for Medicaid enrollees and expanding access to short-term, limited-duration insurance plans, often labeled “junk” insurance, which lack critical consumer protections. These measures undermined coverage and eroded access to care for many low-income and vulnerable individuals.

Healthcare experts and advocates warn that the Republican agenda could lead to significant consequences for public health. Medicaid, the nation’s largest public health insurance program, is particularly vulnerable. Stephanie Armour of KFF Health News highlighted the GOP’s push to impose work requirements on Medicaid beneficiaries and cap federal funding to states, a change that critics argue would result in “draconian cuts.” Currently, the federal government reimburses states a variable percentage of Medicaid costs, a system that ensures flexibility during economic downturns and public health crises.

Medicare is also at risk. The Project 2025 agenda, developed by many members of Trump’s first administration, calls for making privatized Medicare Advantage plans the default enrollment option for seniors. Advocates warn that this move could pose an existential threat to traditional Medicare, limiting choice and access for millions of older Americans.

The Affordable Care Act is another key target. Sarah Lueck and Allison Orris of the Center on Budget and Policy Priorities cautioned that the GOP’s policies “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.” Vice President-elect JD Vance has suggested that a second Trump administration could roll back protections for people with preexisting conditions, further jeopardizing access to care.

The potential cuts to Medicaid, Medicare, and ACA tax credits could have cascading effects, increasing uninsured rates and exacerbating health inequities. Vulnerable populations, including low-income families, seniors, and individuals with preexisting conditions, would bear the brunt of these changes. Dylan Scott of Vox summarized the GOP’s healthcare agenda succinctly: “If there are a lot of details still to be filled in, the theme of the GOP’s healthcare agenda is clear: cuts. Cutting regulations. Cutting spending.”

Grassroots movements are expected to play a critical role in resisting these efforts, as they did during Trump’s first term. Advocacy groups like Social Security Works are already mobilizing to defend Medicare and Social Security from privatization and budget cuts. Alex Lawson, the group’s executive director, expressed confidence in the power of public resistance: “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.”

The Republican Party’s healthcare agenda under its newly secured federal trifecta poses a significant threat to programs that millions of Americans depend on. From Medicaid and Medicare to the Affordable Care Act, the proposed cuts and administrative changes could lead to higher costs, reduced access, and increased uninsured rates. As history has shown, however, grassroots mobilization has the power to challenge and halt these initiatives.

“Trump and Republicans will try to cut our earned benefits,” Alex Lawson warned. “But just as a grassroots movement of Americans… succeeded in saving the Affordable Care Act during Trump’s first term, we can save Social Security and Medicare.”

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