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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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Police foil bomb plot targeting Lady Gaga’s biggest-ever show on Copacabana beach

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Police foil bomb plot targeting Lady Gaga's biggest-ever show on Copacabana beach

Brazilian police say they foiled a bomb attack planned for a Lady Gaga concert on Rio de Janeiro’s Copacabana beach that attracted an estimated 2.1 million people.

The plot was orchestrated by a group promoting hate speech and the radicalisation of teenagers, including self-harm and violent content as a form of social belonging, according to the Civil Police of Rio de Janeiro, which worked in coordination with the country’s justice ministry.

“The suspects were recruiting participants, including minors, to carry out coordinated attacks using improvised explosives and Molotov cocktails,” the force said.

The justice ministry said the recruiters identified themselves as Gaga’s fans, known as “Little Monsters”.

It said Operation Fake Monster was based on a report by the ministry’s cyber operations lab following a tip-off from Rio state police intelligence, which uncovered digital cells encouraging violent behaviour among teenagers using coded language and extremist symbolism.

Authorities carried out over a dozen search and seizure warrants, and a man described as the group’s leader was arrested in the southern state of Rio Grande do Sul for illegal possession of a firearm, and a teenager was detained in Rio de Janeiro for storing child abuse images.

Lady Gaga performing at the huge open-air concert. Pic: Reuters
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Lady Gaga performing at the huge open-air concert. Pic: Reuters

Gaga’s biggest ever show

Some 500,000 tourists travelled to watch the concert, which was paid for by the city in an attempt to boost the struggling economy.

Saturday night’s two-hour show, which marked Gaga’s biggest ever, marked the first time she had played in Brazil since 2012, having cancelled an appearance at the Rock in Rio festival in 2017 over health issues.

Gaga, who released her seventh studio album, Mayhem, in March, opened with a dramatic, operatic edition of her 2011 track Bloody Mary, before launching into Abracadabra, a recent track.

Lady Gaga performs during her free concert on Copacabana Beach in Rio de Janeiro, Saturday, May 3, 2025. (AP Photo/Silvia Izquierdo)
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Pic: AP

Lady Gaga, centre, performs during her free concert on Copacabana Beach in Rio de Janeiro, Saturday, May 3, 2025. (AP Photo/Silvia Izquierdo)
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Pic: AP

“Brazil! I missed you. I missed you so much,” she exclaimed, before launching into Poker Face, one of her biggest hits.

The American pop star drew in a similar crowd to Madonna’s in May last year, who performed at the same beach, which is transformed into an enormous dance floor for the shows.

Addressing the crowd in English and through a Portuguese translator, Gaga became emotional as she said: “I’m so honoured to be here with you tonight.

People attend Lady Gaga's open concert at Copacabana beach in Rio de Janeiro, Brazil, May 3, 2025. REUTERS/Tita Barros
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Gaga addresses the crowd. Pic: Reuters

Gaga seen performing on giant screens set up across the beach. Pic: Reuters
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Gaga seen performing on giant screens set up across the beach. Pic: Reuters

“Tonight we’re making history, but no one makes history alone. Without all of you, the incredible people of Brazil, I wouldn’t have this moment. Thank you for making history with me.

“The people of Brazil are the reason I get to shine today. But of all the things I can thank you for, the one I most am grateful for is this: that you waited for me. You waited more than 10 years for me.”

She said it took so long to come back because she was “healing” and “getting stronger”. The pop sensation cancelled many of her shows in 2017 and 2018 due to her fibromyalgia condition, which can cause pain and fatigue.

It is estimated Gaga’s show will have injected around 600 million reais (£79.9m) into the economy, nearly 30% more than Madonna’s show.

People gather to attend Lady Gaga's open concert, in Copacabana beach in Rio de Janeiro, Brazil May 3, 2025. REUTERS/Pilar Olivares
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Pic: Reuters

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The large-scale free shows are set to continue annually until at least 2028, always taking place in May, which is considered the economy’s “low season”, according to the city’s government.

A hefty security plan was in place, including the presence of 3,300 military and 1,500 police officers, along with 400 military firefighters.

‘A dream come true’

Fans find a spot to watch the show. Pic: AP
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Pic: AP

The city has been swarmed with Gaga fans since her arrival on Tuesday, with some even keeping vigil outside of the hotel she has been staying at.

Many arrived at the beach at the crack of dawn on Saturday to secure good spots on the beach, despite the show not starting until 9.45pm.

An aerial view shows fans gathering on Copacabana beach ahead of Lady Gaga's arrival. Pic: Reuters
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An aerial view shows fans gathering on Copacabana beach ahead of Lady Gaga’s arrival. Pic: Reuters

Ana Lara Folador, who attended with her sister, said it was “a dream come true”, and that Gaga had “really shaped a part of my personality, as a person and an artist”.

Ingrid Serrano, a 30-year-old engineer who made a cross-continent trip from Colombia to Brazil to attend the show, turned up in a T-shirt featuring Lady Gaga’s outlandish costumes over the years.

“I’ve been a 100% fan of Lady Gaga my whole life,” she said, adding the 39-year-old megastar represented “total freedom of expression – being who one wants without shame”.

A fan dons an unusual face mask. Pic: AP
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A fan dons an unusual face mask. Pic: AP

A fan strikes a pose. Pic: AP
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A fan strikes a pose. Pic: AP

Matheus Silvestroni, 25, an aspiring DJ and a Gaga fan since the age of 12, endured an eight-hour bus ride from Sao Paulo for the show.

He said it was Gaga who had inspired him to embrace his sexuality and pursue his dream of becoming an artist.

“I was bullied because I was a fat, gay kid, so I was an easy target,” he said. “Gaga was very important because she sent a message that everything was okay with me, I wasn’t a freak, because I was ‘Born This Way’.”

Rio is known for holding massive open-air concerts, with Rod Stewart holding a Guinness World Record for the four million-strong crowd he drew to Copacabana beach in 1994.

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John Lithgow on JK Rowling’s trans stance backlash: ‘She’s handled it fairly gracefully’

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John Lithgow on JK Rowling's trans stance backlash: 'She's handled it fairly gracefully'

John Lithgow is a man well aware of cancel culture and its ability to destroy careers in the blink of an eye.

The Oscar-nominated actor tells Sky News: “It is terrible to be so careful about what you say. Even in an interview like this. It goes into the world, and you can get misconstrued and misrepresented and cancelled in [the click of a finger].”

Pic: Johan Persson
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Roald Dahl is the subject of West End play Giant, by Mark Rosenblatt. Pic: Johan Persson

It’s a theme that runs parallel with his latest work – the stage show Giant – which through the lens of one explosive day in children’s author Roald Dahl‘s life, poses the question, should we look for moral purity in our artists?

The writer of great works including The Witches, Matilda and The BFG, Dahl revolutionised children’s literature with his irreverent approach, inspiring generations of readers and selling hundreds of millions worldwide. But his legacy is conflicted.

Lithgow describes Dahl as “a man with great charm, great wit and literary talent. A man who really cared about children and loved them. But a man who carried a lot of demons.”

Specifically, the play – which explores Palestinian rights versus antisemitism – deals with the fallout from controversial comments the children’s author made over the Israeli invasion of Lebanon in 1982. Its themes couldn’t be more timely.

Lithgow explains: “Things are said in the play that nobody dares to say out loud… But God knows this is a complicated and contradictory issue.”

More on Jk Rowling

Pic: Johan Persson
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John Lithgow plays Dahl – a man capable of ‘great compassion’ and ‘enormous cruelty’. Pic: Johan Persson

‘It didn’t start as an idea about Roald Dahl at all’

So controversial are some of the play’s themes, the 79-year-old star admits his own son warned him: “Prepare yourself. There’ll be demonstrations in Sloane Square outside the Royal Court Theatre.”

Indeed, the play’s first run carried an audience warning flagging “antisemitic language; graphic descriptions of violence; emotional discussion of themes including conflict in the Middle East, Israel and Palestine; and strong language”.

But it didn’t put audiences off. Following a sold-out run at the Royal Court, the role won Lithgow an Olivier. Now, it’s transferring to London’s West End.

The play was written by Mark Rosenblatt, a seasoned theatre director but debut playwright.

He tells Sky News: “It didn’t start as an idea about Roald Dahl at all. It was about the blurring of meaningful political discourse with racism, specifically when, in 2018, the inquiry into antisemitism in the Labour Party started to come out.”

Rosenblatt describes Dahl’s Revolting Rhymes and Dirty Beasts as the “wallpaper” of his childhood, and says he had no desire to “smash the Roald Dahl pinata”.

But despite the fond recollections, he was conflicted: “Understanding that [Dahl] also, possibly, didn’t like someone like me because I’m Jewish felt complicated.” It was Rosenblatt’s exploration of “how you hold those two things at the same time” that led to Dahl becoming the play’s focus.

Elliot Levey plays Dahl's Jewish publisher, and Aya Cash plays an American Jewish sales executive. Pic: Johan Persson
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Elliot Levey plays Dahl’s Jewish publisher, and Aya Cash plays an American Jewish sales executive. Pic: Johan Persson

‘He’s not cancelled in our home’

Rosenblatt describes him as “a complex man, capable of great compassion, great passionate defence of oppressed people, and also capable of enormous cruelty and manipulation. He was many things at once”.

And as for Dahl’s place in his life now? Rosenblatt says: “I still read his books to my kids. He’s certainly not cancelled in our home.”

It’s likely that Dahl’s comments, if uttered today, would lead to swift social media condemnation, but writing in a pre-social media age, the judgment over his words came at a much slower pace.

Dahl died in 1990, and his family later apologised for antisemitic remarks he made during his lifetime. But the debate of whether art can be separated from the artist is still very much alive today.

Earlier this month, Lithgow found himself drawn into a different row over artists and their opinions – this time concerning author JK Rowling.

Author and Lumos Foundation founder J.K. Rowling attends the HBO Documentary Films premiere of ...Finding the Way Home" at 30 Hudson Yards on Wednesday, Dec. 11, 2019, in New York. (Photo by Evan Agostini/Invision/AP)
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JK Rowling in 2019. Pic:AP

‘A matter of nuance’

Soon to play Dumbledore in the Harry Potter TV series, he has been criticised by some fans for working with the author known for her gender critical beliefs.

Lithgow told Sky News: “It’s a question I’m getting asked constantly. I suppose I should get used to that, but JK Rowling has created an amazing canon of books for kids…

“I have my own feelings on this subject. But I’m certainly not going to hesitate to speak about it. Just because I may disagree… It’s a matter of nuance… I think she’s handled it fairly gracefully.”

The actor ignored calls not to take the role.

He goes on: “Honestly, I’d rather be involved in this than not. And if I’m going to speak on this subject, I’m speaking from inside this project and very much a partner with JK Rowling on it.”

Demanding an eight-year commitment and a move to the UK for the part, the stakes are high.

And with a legion of Harry Potter fans watching on from the wings, only time will tell if the Lithgow-Rowling partnership will prove a magical one.

Giant is playing at the Harold Pinter Theatre in London until Saturday, 2 August.

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Lorraine Kelly says she will undergo surgery to remove ovaries

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Lorraine Kelly says she will undergo surgery to remove ovaries

Lorraine Kelly has revealed she is undergoing surgery to remove her ovaries and fallopian tubes.

The 65-year-old TV presenter posted a video of her in a hospital bed on Instagram, and said “I’ve not been feeling all that well for a little while”.

Kelly added she “had a little scan and I have to have my ovaries and my tubes taken out” with keyhole surgery.

She said that the procedure is “purely preventative,” and that “I’m going to be totally fine, see you soon”.

According to the NHS, keyhole surgery – also called laparoscopic surgery – is carried out using several small incisions.

The procedure can take between one and two hours, and doctors recommend staying off work for two to four weeks after the surgery.

In the caption, the ITV presenter wrote she felt “very lucky to be treated so well” and thanked gynaecologist Dr Ahmed Raafat and hospital staff.

More on Lorraine Kelly

Good Morning Britain presenter Susanna Reid said she was “sending you all the love in the world”, while TV presenter Julia Bradbury added: “Wishing you a speedy recovery Lorraine, and good luck with the post op rehab.”

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Kelly has been in television since 1984, starting her career on TV-am as an on-screen reporter covering Scottish news.

In 1990, she began her presenting career on Good Morning Britain, before hosting her own show, Lorraine, from 2010.

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