Opinion - Trump is Increasing Health Care Costs Again

As 2025 comes to a close, many Americans are expressing concern about the affordability of health care while sending New Year wishes to loved ones. A recent AP-NORC survey found that 60% of respondents are "extremely" or "very" worried about rising health care costs.

Significant reductions to Medicaid under the Trump administrations One Big Beautiful Bill, combined with Republican refusal to renew Affordable Care Act (ACA) tax credits, are projected to leave approximately 31 million Americans uninsured by 2027. Millions more are expected to face higher bills for coverage through ACA, Medicaid, Medicare, and private insurers.

Federal spending on Medicaid, which provides care for 72 million Americans and accounts for 20% of U.S. health care expenditures and half of long-term care costs, is forecast to decrease by $911 billion over the next decade. An estimated 7.5 million people nationwide could lose coverage. Low-income workers with frequent job changes, their children, and mobile young adults are most vulnerable to the effects of new work requirements and eligibility recertification rules, which are already in effect in several states.

Administrative costs for monitoring these new Medicaid rules are substantial. For example, Georgia spent $54 million on administration this yeardouble what it paid for direct patient care. With Medicaid reimbursement rates lower than Medicare, additional cuts may prompt more providers to stop accepting Medicaid patients.

Medicare will raise its Standard Part B Premium in 2026 to $202.90 per month, a 9.7% increase, with the annual deductible increasing to $283. About 7 million Medicare beneficiaries spend 10% or more of their annual income on Part B premiums, excluding dental and long-term care costs.

The ACA, which covers over 20 million Americansmany near the federal poverty levellimits costs on a sliding income-based scale. If subsidies expire in 2026, average premiums could jump 114%. For example, an individual earning $18,000 could see premiums rise from $0 to $378, and an income of $28,000 could increase from $325 to $1,562, leaving an additional 3.8 million Americans uninsured. Emergency care costs for the uninsured can average $5,800 for treatment or $30,000 for a three-day hospital stay. Reduced participation in ACA plans could further drive up premiums.

Hospitals are already under strain from low patient volumes, physician shortages aggravated by immigration policies, rising non-labor costs, and increasing uncompensated care. Rural hospitals are particularly vulnerable, as one in four adults in these areas rely on Medicaid. In 2023, 48% of rural hospitals operated below breakeven, with 300 on the verge of closure. By 2034, an estimated 1.8 million rural patients may lose coverage, and the $50 billion subsidy included in the One Big Beautiful Bill is unlikely to suffice.

Emergency rooms nationwide face similar pressures. Federal law requires hospitals to treat all patients, absorbing costs when payment is not possible. Currently, 2535% of ER patients wait at least four hours for a bed, and 5%around 2.3 million peoplewait 24 hours or more, a figure expected to rise with more uninsured Americans.

Despite repeated promises to repeal and replace the ACA, President Trump has not succeeded. The law remains popular with most Americans, and Medicaid cuts are widely opposed. Trump recently proposed distributing $2,000 per person from tariff revenue to help Americans purchase private health care, though this plan faces significant implementation challenges and congressional hurdles.

As ACA open enrollment nears its end, a new health care plan announcement was postponed after conservative Republicans opposed a proposed two-year extension with tighter eligibility caps. Current AP-NORC polling shows only 34% of Americans approve of President Trumps handling of health care.

Glenn C. Altschuler is The Thomas and Dorothy Litwin Emeritus Professor of American Studies at Cornell University.

Author: Sophia Brooks