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President-elect Donald Trumps return to the White House could embolden Republicans who want to weaken or repeal the Affordable Care Act, but implementing such sweeping changes would still require overcoming procedural and political hurdles.

This story also ran on NPR. It can be republished for free.

Trump, long an ACA opponent, expressed interest during the campaign in retooling the health law. In addition, some high-ranking Republican lawmakers who will now have control over both the House and the Senate have said revamping the landmark 2010 legislation known as Obamacare would be a priority. They say the law is too expensive and represents government overreach.

The governing trifecta sets the stage for potentially seismic changes that could curtail the laws Medicaid expansion, raise the uninsured rate, weaken patient protections, and increase premium costs for millions of people.

The Republican plans they dont say they are going to repeal the ACA, but their collection of policies could amount to the same thing or worse, said Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a research and policy institute. It could happen through legislation and regulation. Were on alert for anything and everything. It could take many forms.

Congressional Republicans have held dozens of votes over the years to try to repeal the law. They were unable to get it done in 2017 after Trump became president, even though they held both chambers and the White House, in large part because some GOP lawmakers wouldnt support legislation they said would cause such a marked increase in the uninsured rate.

Similar opposition to revamping the law could emerge again, especially because polls show the ACAs protections are popular.

While neither Trump nor his GOP allies have elaborated on what they would change, House Speaker Mike Johnson said last month that the ACA needs massive reform and would be on the partys agenda should Trump win. Email Sign-Up

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Congress could theoretically change the ACA without a single Democratic vote, using a process known as “reconciliation.” The narrow margins by which Republicans control the House and Senate mean just a handful of “no” votes could sink that effort, though.

Many of the more ambitious goals would require Congress. Some conservatives have called for changing the funding formula for Medicaid, a federal-state government health insurance program for low-income and disabled people. The idea would be to use budget reconciliation to gain lawmakers approval to reduce the share paid by the federal government for the expansion population. The group that would be most affected is made up largely of higher-income adults and adults who dont have children rather than traditional Medicaid beneficiaries such as pregnant women, children, and people with disabilities.

A conservative idea that would let individuals use ACA subsidies for plans on the exchange that dont comply with the health law would likely require Congress. That could cause healthier people to use the subsidies to buy cheaper and skimpier plans, raising premiums for older and sicker consumers who need more comprehensive coverage.

Its similar to an ACA repeal plan, said Cynthia Cox, a vice president and the director of the Affordable Care Act program at KFF, a health information nonprofit that includes KFF Health News. Its repeal with a different name.

Congress would likely be needed to enact a proposal to shift a portion of consumers ACA subsidies to health savings accounts to pay for eligible medical expenses.

Trump could also opt to bypass Congress. He did so during his previous tenure, when the Department of Health and Human Services invited states to apply for waivers to change the way their Medicaid programs were paid for capping federal funds in exchange for more state flexibility in running the program. Waivers have been popular among both blue and red states for making other changes to Medicaid.

Trump will do whatever he thinks he can get away with, said Chris Edelson, an assistant professor of government at American University. If he wants to do something, hell just do it.

Republicans have another option to weaken the ACA: They can simply do nothing. Temporary, enhanced subsidies that reduce premium costs and contributed to the nations lowest uninsured rate on record are set to expire at the end of next year without congressional action. Premiums would then double or more, on average, for subsidized consumers in 12 states who enrolled using the federal ACA exchange, according to data from KFF.

That would mean fewer people could afford coverage on the ACA exchanges. And while the number of people covered by employer plans would likely increase, an additional 1.7 million uninsured individuals are projected each year from 2024 to 2033, according to federal estimates.

Many of the states that would be most affected, including Texas and Florida, are represented by Republicans in Congress, which could give some lawmakers pause about letting the subsidies lapse.

The Trump administration could opt to stop defending the law against suits seeking to topple parts of it. One of the most notable cases challenges the ACA requirement that insurers cover some preventive services, such as cancer screenings and alcohol use counseling, at no cost. About 150 million people now benefit from the coverage requirement.

If the Department of Justice were to withdraw its petition after Trump takes office, the plaintiffs would not have to observe the coverage requirement which could inspire similar challenges, with broader implications. A recent Supreme Court ruling left the door open to legal challenges by other employers and insurers seeking the same relief, said Zachary Baron, a director of Georgetown Universitys Center for Health Policy and the Law.

In the meantime, Trump could initiate changes from his first day in the Oval Office through executive orders, which are directives that have the force of law.

The early executive orders will give us a sense of policies that the administration plans to pursue, said Allison Orris, a senior fellow at the Center on Budget and Policy Priorities. Early signaling through executive orders will send a message about what guidance, regulations, and policy could follow.

In fact, Trump relied heavily on these orders during his previous term: An October 2017 order directed federal agencies to begin modifying the ACA and ultimately increased consumer access to health plans that didnt comply with the law. He could issue similar orders early on in his new term, using them to start the process of compelling changes to the law, such as stepped-up oversight of potential fraud.

The administration could early on take other steps that work against the ACA, such as curtailing federal funding for outreach and help signing up for ACA plans. Both actions depressed enrollment during the previous Trump administration.

Trump could also use regulations to implement other conservative proposals, such as increasing access to health insurance plans that dont comply with ACA consumer protections.

The Biden administration walked back Trumps efforts to expand what are often known as short-term health plans, disparaging the plans as junk insurance because they may not cover certain benefits and can deny coverage to those with a preexisting health condition.

The Trump administration is expected to use regulation to reverse Bidens reversal, allowing consumers to keep and renew the plans for much longer.

But drafting regulations has become far more complicated following a Supreme Court ruling saying federal courts no longer have to defer to federal agencies facing a legal challenge to their authority. In its wake, any rules from a Trump-era HHS could draw more efforts to block them in the courts.

Some people with ACA plans say theyre concerned. Dylan Reed, a 43-year-old small-buiness owner from Loveland, Colorado, remembers the days before the ACA and doesnt want to go back to a time when insurance was hard to get and afford.

In addition to attention-deficit/hyperactivity disorder and anxiety, he has scleroderma, an autoimmune disease associated with joint pain and numbness in the extremities. Even with his ACA plan, he estimates, he pays about $1,000 a month for medications alone.

He worries that without the protections of the ACA it will be hard to find coverage with his preexisting conditions.

It’s definitely a terrifying thought, Reed said. I would probably survive. I would just be in a lot of pain. Stephanie Armour: sarmour@kff.org, @StephArmour1

Sam Whitehead: swhitehead@kff.org

Julie Rovner: jrovner@kff.org, @jrovner Related Topics Elections Health Care Costs Health Industry Insurance Obamacare Plans Trump Administration U.S. Congress Contact Us Submit a Story Tip

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World

Israel-Hamas war: ‘Vast amounts of aid needed to stave off catastrophic health crisis in Gaza,’ UN warns

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Israel-Hamas war: 'Vast amounts of aid needed to stave off catastrophic health crisis in Gaza,' UN warns

Israel has agreed to support a “one-week scale-up of aid” in Gaza – but the United Nations has warned more action is needed to “stave off famine and a catastrophic health crisis”.

UN aid chief Tom Fletcher made the remarks as Israel began limited pauses in fighting across three areas of Gaza for 10 hours a day to address the worsening humanitarian situation.

Israel cut off all supplies to Gaza’s population from the start of March. It then reopened aid centres with new restrictions in May, but said the supply had to be controlled to prevent it from being stolen by Hamas militants.

A Palestinian man in Beit Lahia carries aid that entered Gaza through Israel. Pic: Reuters
Image:
A Palestinian man in Beit Lahia carries aid that entered Gaza through Israel. Pic: Reuters

On Saturday, reports referencing US government data said there was no evidence Hamas had stolen aid from UN agencies.

Images of emaciated Palestinian children have led to widespread criticism of Israel’s actions in Gaza, including by allies who are calling for an end to the war.

Mr Fletcher said one in three people in Gaza “hasn’t eaten for days” and “children are wasting away”.

He added: “We welcome Israel’s decision to support a one-week scale-up of aid, including lifting customs barriers on food, medicine and fuel from Egypt and the reported designation of secure routes for UN humanitarian convoys.

More on Israel-hamas War

“Some movement restrictions appear to have been eased today, with initial reports indicating that over 100 truckloads were collected.

“This is progress, but vast amounts of aid are needed to stave off famine and a catastrophic health crisis. Across the UN agencies and humanitarian community, we are mobilised to save as many lives as we can.”

An aircraft drops humanitarian aid over Gaza on Sunday. Pic: Reuters
Image:
An aircraft drops humanitarian aid over Gaza on Sunday. Pic: Reuters

The Israel Defence Forces said yesterday that it is halting military operations in Muwasi, Deir al Balah and Gaza City daily from 10am to 8pm local time (8am to 6pm UK time) until further notice.

Combat operations have continued outside of this 10-hour window. Health officials in Gaza said Israeli strikes killed at least 41 Palestinians overnight into Sunday morning, including 26 seeking aid.

In a statement, the IDF said it would also establish secure routes to help the UN and aid agencies deliver food and other supplies.

A map showing the three areas of Gaza where military action has been paused
Image:
A map showing the three areas of Gaza where military action has been paused

Israel’s announcement of what it calls a “tactical pause” in fighting comes after it resumed airdrops of aid into Gaza.

While the IDF reiterated claims there is “no starvation” in the territory, it said the airdrops would include “seven pallets of aid containing flour, sugar and canned food to be provided by international organisations”.

Palestinian sources confirmed that aid had begun dropping in northern parts of the territory.

Palestinians carry aid supplies that entered Gaza through Israel, in Beit Lahia in the northern Gaza Strip, July 27, 2025. REUTERS/Dawoud Ab
Image:
Palestinians in Beit Lahia carry aid supplies that entered Gaza through Israel. Pic: Reuters

Sabreen Hasson, a Palestinian mother who travelled to an aid point near the Zikim crossing to collect supplies, said: “I came to get flour for my children because they have not tasted flour for more than a week, and thank God, God provided me with a kilo of rice with difficulty.”

But Samira Yahda, who was in Zawaida in central Gaza, said: “We saw the planes, but we didn’t see what they dropped… they said trucks would pass, but we didn’t see the trucks.”

Another Palestinian told the AP news agency that some people feared going out and having a box of aid fall on their children.

Read more:
What does recognising a Palestinian state mean?
Parents of IDF soldier taken hostage fear he’ll be one of last freed
25% of young children ‘now malnourished in Gaza’

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Baby Zainab starved to death in Gaza

Gaza is expected to be a focus during talks Sir Keir Starmer and Donald Trump in Scotland today.

Downing Street said Sir Keir will raise “what more can be done to secure the ceasefire [in the Middle East] urgently”, during the meeting at the US president’s Turnberry golf course in Ayrshire.

Reports also suggest the prime minister is planning to interrupt the summer recess and recall his cabinet to discuss the crisis on Tuesday.

Talks in Qatar over a ceasefire ended on Thursday after the US and Israel withdrew their negotiating teams.

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Bob Geldof: ‘Israeli authorities are lying’

Mr Trump blamed Hamas for the collapse of negotiations as he left the US for Scotland, saying the militant group “didn’t want to make a deal… they want to die”.

Meanwhile the exiled head of Hamas in Gaza, Khalil al Hayya, has warned ceasefire negotiations with Israel were “meaningless under continued blockade and starvation”.

In a recorded speech, he added: “The immediate and dignified delivery of food and medicine to our people is the only serious and genuine indication of whether continuing the negotiations is worthwhile.”

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Israel intercepts Gaza aid boat

During a meeting with the European Commission President Ursula von der Leyen yesterday, Mr Trump emphasised the importance of securing the release of hostages held by Palestinian militants in Gaza.

He said: “They don’t want to give them back, and so Israel is going to have to make a decision.

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Starmer says UK will help drop aid to Gaza

“I know what I’d do, but I don’t think it’s appropriate that I say it. But Israel is going to have to make a decision,” he said.

Mr Trump also repeated claims, without evidence, that Hamas was stealing food coming into Gaza and selling it.

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Technology

Samsung Electronics signs $16.5 billion chip-supply contract in boost to foundry business; shares rise

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Samsung Electronics signs .5 billion chip-supply contract in boost to foundry business; shares rise

A Samsung flag flies outside the company office in Seoul, South Korea on February 05, 2024.

Chung Sung-jun | Getty Images News | Getty Images

Samsung Electronics has entered into a $16.5 billion contract for supplying semiconductors to a major company, a regulatory filing by the South Korean company showed Monday.  

The memory chipmaker, which did not name the counterparty, mentioned in its filing that the effective start date of the contract was July 26, 2024 — receipt of orders — and its end date was Dec. 31, 2033.

Samsung declined to comment on details regarding the counterparty.

The company said that details of the deal, including the name of the counterparty, will not be disclosed until the end of 2033, citing a request from the second party “to protect trade secrets,” according to a Google translation of the filing in Korean.

“Since the main contents of the contract have been not been disclosed due to the need to maintain business confidentiality, investors are advised to invest carefully considering the possibility of changes or termination of the contract,” the company said. Its shares were up nearly 3% in early trading.

Local South Korean media outlets have said that American chip firm Qualcomm could potentially place an order for Samsung’s 2 nanometer chips.

While Qualcomm is a possibility, given its potential 2 nanometer project with Samsung, Tesla seems the more probable customer, Ray Wang, research director of semiconductors, supply chain and emerging technology at The Futurum Group, told CNBC

Samsung’s foundry service manufactures chips based on designs provided by other companies. It is the second largest provider of foundry services globally, behind Taiwan Semiconductor Manufacturing Company.

The company said in April that it was aiming for its foundry business to start mass production of its next-generation 2 nanometer and secure major orders for the advanced product. In semiconductor technology, smaller nanometer sizes signify more compact transistor designs, which lead to greater processing power and efficiency.

Samsung, which is set to deliver earnings on Thursday, expects its second-quarter profit to more than halve. An analyst previously told CNBC that the disappointing forecast was due to weak orders for its foundry business and as the company has struggled to capture AI demand for its memory business.

The company has fallen behind competitors SK Hynix and Micron in high-bandwidth memory chips — an advanced type of memory used in AI chipsets.

SK Hynix, the leader in HBM, has become the main supplier of these chips to American AI behemoth Nvidia. While Samsung has reportedly been working to get the latest version of its HBM chips certified by Nvidia, a report from a local outlet suggests these plans have been pushed back to at least September.

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Sports

Ichiro shows funny side, joins CC, Wagner in HOF

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Ichiro shows funny side, joins CC, Wagner in HOF

COOPERSTOWN, N.Y. — Ichiro Suzuki became the first Japanese-born player to be enshrined into the National Baseball Hall of Fame on Sunday, one of five new members of baseball’s hallowed institution.

After enduring the baseball tradition known as a rain delay, the five speeches went off without a hitch as the deluge subsided and the weather became hot and humid. Joining Suzuki were pitchers CC Sabathia and Billy Wagner, and sluggers Dick Allen and Dave Parker, both of whom were enshrined posthumously.

“For the third time, I am a rookie,” Suzuki said, delivering his comments in English despite his long preference for conducting his public appearances in Japanese with the aid of an interpreter.

For the American audience, this provided a rare glimpse into Suzuki’s playful side. Teammates long spoke of his sense of humor behind the closed doors of the clubhouse — something the public rarely saw — but it was on full display Sunday.

When Hall voting was announced, Suzuki fell one vote shy of becoming the second unanimous selection for the Hall. He thanked the writers for their support — with an exception.

“Three-thousand [career] hits or 262 hits in one season are achievements recognized by the writers,” Suzuki said. “Except, oh, one of you.”

After the laughter subsided, Suzuki mentioned the gracious comments he made when balloting results were announced, when he offered to invite the writer who didn’t vote for him home for dinner to learn his reasoning. Turns out, it’s too late.

“The offer to the one writer to have dinner at my home has now … expired!” Suzuki said.

Suzuki’s attention to detail and unmatched work ethic have continued into the present day, more than five years since he played his last big league game. That was central to his message Sunday, at least when he wasn’t landing a joke.

“If you consistently do the little things, there’s no limit to what you can achieve,” Suzuki said. “Look at me. I’m 5-11 and 170 pounds. When I came to America, many people said I was too skinny to compete with bigger major leaguers.”

After becoming one of the biggest stars in Japanese baseball, hitting .353 over nine seasons for the Orix BlueWave, Suzuki exploded on the scene as a 27-year-old rookie for the Seattle Mariners, batting .350 and winning the AL Rookie of the Year and MVP honors.

Chants of “Ichiro!” that once were omnipresent at Mariners games erupted from the crowd sprawled across the grounds of the complex while the all-time single-season hits leader (262 in 2004) posed with his plaque alongside commissioner Rob Manfred and Hall of Fame chairman Jane Forbes Clark.

Despite his late start in MLB, Suzuki finished with 3,089 hits in the majors and 4,367 including his time in Japan. Suzuki listed some of his feats, such as the hit total, and his 10 Gold Gloves.

“Not bad,” he said.

Sabathia’s weekend got off to a mildly rough start when his wife’s car broke down shortly after the family caravan departed for Cooperstown. They arrived in plenty of time though, and Sabathia was greeted warmly by numerous Yankees fans who made the trip.

After breaking in with Cleveland at age 20, Sabathia rocketed to stardom with a 17-5 rookie season. Alas, that came in 2001, the same year that Suzuki landed in the American League.

“Thank you most of all to the great players sitting behind me,” Sabathia said. “I am so proud and humbled to join you as a Hall of Famer, even Ichiro, who stole my Rookie of the Year Award in 2001.”

Sabathia focused the bulk of his comments on the support he has received over the years from his friends and family, especially his wife, Amber.

“The first time we met was at a house party when I was a junior in high school,” Sabathia said. “We spent the whole night talking, and that conversation has been going on for 29 years.”

Parker, 74, died from complications of Parkinson’s disease on June 28, less than a month before the induction ceremony. Representing him at the dais was his son, Dave Parker II, and though the moment was bittersweet, it was hardly somber.

Parker II finished the speech with a moving poem written by his father that, for a few minutes, made it feel as if the player nicknamed “The Cobra” were present.

“Thanks for staying by my side,” Parker’s poem concluded. “I told y’all Cooperstown would be my last rap, so the star of Dave will be in the sky tonight. Watch it glow. But I didn’t lie in my documentary — I told you I wouldn’t show.”

Parker finished with 2,712 hits and 339 homers, won two Gold Gloves on the strength of his legendary right-field arm and was named NL MVP in 1978. He spent his first 11 seasons with the Pittsburgh Pirates and entered the Hall representing the Bucs.

Wagner, whose 422 career saves ranks eighth on the all-time list, delivered an emotional but humorous speech about a small-town guy with a small-for-a-pitcher 5-foot-10 stature who made it big.

“I feel like my baseball life has come full circle,” Wagner said. “I was a fan before I could play. Back when baseball wasn’t so available on TV, every Saturday morning I watched Johnny Bench and so many of the other greats on a show ‘The Baseball Bunch.'”

In one of the moments of baseball serendipity that only Cooperstown can provide, the telecast flashed to Bench, sitting a few feet away from where Wagner was speaking.

Allen’s widow, Willa, delivered a touching tribute to her late husband, who died in 2020 after years of feeling overlooked for his outstanding career. The 1964 NL Rookie of the Year for the Phillies, Allen won the 1972 AL MVP for the Chicago White Sox.

“Baseball was his first love,” Willa said. “He used to say, ‘I’d have played for nothing,’ and I believe he meant it. But of course, if you compare today’s salary, he played almost for nothing.”

Willa focused on the softer side of a player who in his time was perhaps unfairly characterized for a contentious relationship with the media.

“He was devoted to people, not just fans, but especially his teammates,” Willa said. “If he heard someone was sick or going through a tough time, he’ll turn to me and say, ‘Willa, they have to hear from us.'”

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