There are plenty of predictions about how the November 2024 election results could affect health care, including employer-sponsored health insurance. The truth is, we won’t know for sure until President-elect Trump takes office. Another key factor will be how quickly Congress approves his cabinet nominees or whether temporary appointments are made under the Recess Appointments Clause.

Here are three potential ways workplace health insurance could be impacted.

Affordable Care Act (ACA)

During his first term, President Trump made multiple attempts to repeal the ACA, but those efforts failed. It’s unclear how much interest there is in pursuing this again, though a few GOP members of Congress returning in 2025 have identified ACA updates as a priority.

The Biden administration increased ACA subsidies in 2022 through the Inflation Reduction Act (IRA), making marketplace coverage more affordable. However, these subsidies are set to expire in late 2025 unless Congress renews them. If they aren’t renewed, the Urban Institute estimates the uninsured rate could rise by 16%, and ACA marketplace enrollment could drop by 42% — leaving more than seven million Americans without access to subsidized plans. According to the Congressional Budget Office, premiums in 2026 could double or increase even further without these enhanced subsidies.

Repulican members of Congress may once again try to roll back parts of the ACA or repeal it entirely. They could use the “budget reconciliation” process to do so. However, with a narrow GOP majority, the effort might fail if just a few members vote against their own party. Additionally, passing a budget resolution and reconciliation could increase the federal debt unless cuts are made elsewhere.

Congress might propose changing how Medicaid is funded. Medicaid is the joint federal and state program that supports low-income and disabled individuals. Another possibility is that there’s no action, which would result in the subsidies ending in 2025. Analysts predict that states without Medicaid expansion would make up more than 60% of the enrollment drop in exchange coverage. Many of these enrollees are in areas represented by GOP members of Congress, which could lead some to oppose letting the subsidies expire.

President Trump could bypass Congress by encouraging the Department of Health and Human Services (HHS) to approve state requests for program waivers. If the Trump administration chooses not to defend the ACA against legal challenges, it could further weaken the law, including the rule requiring preventive care to be covered at no cost.

Stay tuned to see what unfolds in 2025. We’ll provide updates as the year progresses.

New Short-Term Health Plan and AHP Rules

In 2024, the Biden administration introduced new rules to protect consumers from “junk health insurance” plans, which offer limited benefits and often exclude pre-existing conditions. These plans are now capped at three months, with an optional one-month renewal, replacing the previous three-year limit under the Trump administration. In 2025, Congress and the new administration could consider extending the duration of short-term plans again.

There may also be efforts to promote “super” association health plans (AHPs). In late November, Kentucky Republican Sen. Rand Paul reintroduced a bill that would allow any membership organization to be classified as an employer. This would let these groups offer self-insured, multi-state health plans under federal ERISA rules. The proposed legislation reportedly prohibits health marketplace pools from discriminating against members based on health status. However, it does not stop insurers from using medical underwriting, which could result in higher rates for some members. A similar bill introduced by Sen. Paul in 2022 stalled in committee.

Currrenly, AHPs are not permitted in California. Nor are short-term health plans. It remains uncertain how state legislators will respond to new federal initiatives permitting both measures.

Abortion

In California, abortion is legal up to the point of fetal viability, which is determined by a doctor based on whether the fetus could survive outside the uterus without extraordinary medical intervention. Additionally, abortion remains legal if a physician determines that the pregnancy poses a risk to the life or health of the pregnant individual. California law considers abortion basic health care. Many health plans cover abortion care, although some private insurance plans do not. All Medi-Cal plans (the state’s equivalent to Medicaid) cover abortion.

The Office of the California Surgeon General states that California has taken steps to keep abortion legal. The goal is to ensure access for both residents and people traveling from states with restricted abortion rights. President-elect Trump said he will not sign a federal abortion ban because abortion policies should be decided by individual states. However, some medical experts believe his administration could still take steps to restrict abortion nationwide without directly banning it.

In his March 2024 presidential campaign, Trump expressed support for a national abortion ban after 15 weeks. During his previous term, he backed a measure to ban abortion nationwide after 20 weeks. If the new 119th Congress approves a national abortion ban, it would override protections in states like California, as well as measures passed in seven out of ten states where it was on the ballot in November 2024. However, some Republican senators may hesitate to support a federal ban, as 2024 polls showed 63% of Americans believe abortion should be legal in all or most cases.

National restrictions on abortion could also come through other avenues. The FDA could act to limit access to mifepristone, a medication used for medical abortions, or the Justice Department could choose not to defend access to abortion pills. Another possibility is enforcing the 1873 Comstock Act, which bans mailing materials intended to cause an abortion. However, this approach would likely face strong opposition.