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Jimmy Williams
As open enrollment for health care through the Affordable Care Act (ACA) marketplace begins Friday, Americans face uncertainty over the program’s future, as the upcoming presidential election may determine access and affordability for millions. The ACA, a key issue in the campaign’s closing days, could see significant restructuring if Donald Trump wins the presidency and Republicans gain control of Congress.
In recent years, expanded tax credits created during the COVID-19 pandemic have made ACA coverage affordable for millions of Americans, increasing enrollment to 21 million. These subsidies, due to expire next year, must be renewed by Congress to continue helping low-income families afford insurance. According to Health and Human Services Secretary Xavier Becerra, most enrollees benefit from these subsidies, which have cut premiums in half for many.
“Americans can actually look at health care not as a privilege, but now as a right,” Becerra said, adding that removing these benefits would be “yanking away” affordable health coverage from millions. Becerra is set to promote open enrollment in Arizona on Friday, underscoring its importance in a political swing state.
While enrollment surged under the Biden administration, Trump and other Republicans have expressed interest in scaling back or reforming the ACA, also known as “Obamacare.” House Speaker Mike Johnson, a strong Trump ally, recently said, “Health care reform’s going to be a big part of the agenda” under a Trump-led administration, promising “massive reform” to the ACA.
Although Johnson clarified there are no current plans to repeal the ACA outright, the comment signals a broader Republican strategy to reshape social programs if they regain control in Washington. Trump has previously criticized the ACA as “lousy,” although he has yet to propose a detailed alternative.
Democrats are raising alarms about the potential risks, pointing to Trump’s multiple past attempts to dismantle the ACA. Vice President Kamala Harris echoed these concerns in a recent appearance in Wisconsin, stating, “Trump has made dozens of attempts to get rid of the Affordable Care Act. And now we have further validation of that agenda from his supporter, the speaker of the House.”
Among the ACA expansions introduced under President Biden are measures to make health insurance accessible to Dreamers — immigrants brought to the U.S. as children. This change, expected to add 100,000 enrollees, faces legal challenges from Republican attorneys general in 15 states.
Open enrollment, which ends on Jan. 15, is a crucial period for those dependent on ACA benefits. For coverage beginning on Jan. 1, the enrollment deadline is Dec. 15. The Biden administration continues to promote the program, which could see more expansions under a Harris administration, including added resources for navigators who assist people in signing up.
With billions in subsidies at stake, the future of affordable health care coverage now hangs in the balance, dependent on the election outcome.
