Washington Power Has Shifted. Heres How the ACA May Shift, Too.

Published

3 months ago

November 21, 2024

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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

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Politics

Britain must ‘lead from the front’ in Ukraine and ‘tough choices to come’, says Sir Keir Starmer

Published

2 hours ago

March 3, 2025

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Britain must 'lead from the front' in Ukraine and 'tough choices to come', says Sir Keir Starmer

There are more tough choices to come on Ukraine and Britain must “lead from the front”, Sir Keir Starmer has said.

The prime minister gave a statement in parliament after he unveiled proposals for a “coalition of the willing” to enforce any peace deal in the war-torn country, and announced a plan for Kyiv to use £1.6bn of UK export finance to buy 5,000 more air defence missiles.

Politics latest: Farage says Zelenskyy ‘rude’ to Trump

He said the “tough choices that we made last week are not done” and a “lasting peace” in Ukraine “has to be our goal”.

“Britain will lead from the front for the security of our continent, the security of our country, and the security of the British people,” he said.

It follows a hectic week of diplomacy for Sir Keir, during which he held talks with Donald Trump in the White House on Thursday, hosted Ukraine’s president in Downing Street on Saturday and then a wider summit of world leaders on Sunday.

Sandwiched in between his Washington DC trip and busy weekend back home was Volodymyr Zelenskyy’s extraordinary row with the US president in the Oval Office, which cast more doubt on America’s support for Kyiv.

Sir Keir said the showdown is something “nobody wants to see” but he would not pick a side.

He called America an “indispensable” ally, adding: “We will never choose between either side of the Atlantic

“In fact, if anything, the past week has shown that that idea is totally unserious because while some people may enjoy the simplicity of taking a side, this week has shown with total clarity that the US is vital in securing the peace we all want to see in Ukraine.”

In front of the world’s cameras on Friday, Mr Trump accused the Ukrainian president of “disrespecting” the United States and “gambling with World War Three” after he expressed scepticism that Vladimir Putin could be trusted to honour ceasefire agreements.

It has intensified fears among some Western leaders that the US cannot be relied upon to continue supporting Ukraine, or provide a security guarantee to deter the Russian leader if a peace deal is struck.

After the PM’s statement, Liberal Democrat leader Sir Ed Davey said the UK needs to “reduce our dependency on the United States” as he fears President Trump is “not a reliable ally with respect to Russia”.

However, many other opposition politicians have praised Sir Keir’s diplomacy this week, with Tory leader Kemi Badenoch backing the prime minister for “working with allies in Europe and with the United States to bring peace to Ukraine and not a surrender to Russia”.

Sir Keir has been positioning himself as a peace broker between the US and Europe following Mr Trump’s ascension to the White House and his clear indication he no longer wants to bankroll NATO’s defence.

He has suggested a coalition of European allies could step up and defend a potential deal for Ukraine to “guarantee the peace” and indicated some EU nations could follow in the UK’s footsteps and increase defence spending.

However, he argues that while a security guarantee should be led by Europe, it needs US backing.

Mr Trump has not committed to such a guarantee and previously suggested a minerals deal between the US and Ukraine could act as one.

In response to a question from Reform UK leader Nigel Farage, Sir Keir told the Commons this would “not be enough on its own”.

In any case, the deal has been put on hold following Mr Trump’s row with the Ukrainian president.

Shortly after the PM finished speaking, Mr Trump hit out at Mr Zelenskyy once again, saying the US would “not put up with him” for much longer after he said the end of the war with Russia is “very far away”.

World

Long-range drone strikes weakening Russia’s combat ability, senior Ukrainian commander says

Published

2 hours ago

March 3, 2025

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Long-range drone strikes weakening Russia's combat ability, senior Ukrainian commander says

Russia is finding it “significantly” harder to conduct combat operations against Ukraine because of a rise in Ukrainian long-range drone strikes on Russian weapons supplies, ammunition depots and fuel refineries, a senior commander has said.

Brigadier General Yuriy Shchygol signalled these attacks would grow, revealing that his country plans to more than quadruple the production rate of deep strike drones – with a range of hundreds of miles – to more than 2,000 aircraft a month.

Ukraine has been intensifying the tempo of its long-range drone strikes against targets inside Russia and Russian-occupied territory since late December – demonstrating what defence sources say is a world-leading capability that the Kremlin is struggling to counter.

The mission is an example of how Kyiv remains focused on combatting Moscow’s invasion even as world attention fixates on the fallout from a row between Donald Trump and Volodymyr Zelenskyy, as well as efforts by Europe to prepare a plan for peace.

Live updates: Ukraine war latest

The comments by Brigadier Shchygol, who coordinates long-range drone strikes for Ukraine’s Defence Intelligence, offer a rare insight into the impact of the covert mission, which is also carried out by other branches of the Ukrainian military and security services.

“Russia is finding it increasingly difficult to conceal the extent of the damage,” the commander told Sky News in an interview at an undisclosed location in Kyiv.

“Headquarters have been hit, command structures weakened, and panic is spreading among their officers. Compared to a year ago, conducting full-scale combat operations has become significantly more challenging for [the Russians].”

Sky News analysis of long-range drone strikes last month found that since December, there had been a ramping up of attacks against oil refineries in Russia that are used to fuel Russian tanks, jets and warships.

The analysis took in strikes officially confirmed by the Ukrainian armed forces. Brigadier Shchygol said “far more” drone attacks by Ukraine are not publicly confirmed.

In a sign of the importance placed on long-range drones, he said Kyiv’s ability to manufacture this weapon has already jumped 100-fold since late 2022 to more than 500 per month.

While the officer would not say how many of these drones are then deployed on operations, he noted: “Nothing is just sitting in storage unused.”

He said recent operations had targeted several storage sites for Russia’s Iranian-designed Shahed one-way attack drones – used by the Russian armed forces against Ukrainian military and civilian targets.

More than 3,000 Shahed unmanned aerial vehicles were destroyed, according to the officer, who said: “As a result, their deployment of these drones has significantly decreased.”

Top secret drone mission

Sky News was given rare access to view a drone mission last week at a top-secret area.

As night fell, soldiers dressed in black – all members of the Defence Intelligence of Ukraine, an elite branch of the armed forces – prepared a line of about 10 drones.

Each aircraft looked like a giant, grey metal mosquito.

The model is called “Lutti”, which is Ukrainian for “Fury”.

One by one, the drones burst into life, a propeller on the back whirring, pushing the aircraft forward at ever greater speed until it took off into the darkness.

We were told their target was an ammunition depot inside Russia.

“Vector”, the commander on the ground, said his drones have a success rate of 70 to 80%.

He said Ukraine’s deep strike operations are “very important”.

“We change the war with these drones,” Vector said, speaking with a balaclava pulled up to his eyes to protect his identity.

“We can show [Russia] that the war can come in their houses, in their towns, cities.”

Russia’s sheer size makes it vulnerable

Using drones to strike targets hundreds of miles inside Russia is a complex challenge.

But the sheer size of their enemy’s country works in Ukraine’s favour. The Russian military has weapons sites, ammunition storage areas, oil refineries and military headquarters dotted across its territory and lacks the air defences to be able to protect them all.

“We are reaching those targets. The slowing pace of their offensives – and in some places, even Ukrainian counter-offensives reclaiming territory – proves that our strikes are effective and growing more so,” Brigadier Shchygol said.

A huge planning and reconnaissance effort underpins Ukraine’s long-range drone strikes.

It identifies targets and coordinates attacks between the different teams.

Varying volumes of drones are required for each mission – with some of the most complex strikes needing 100 unmanned aircraft.

From farm aircraft to fighter drone

The brigadier was speaking in a large room inside a disused building in Kyiv where five examples of different Ukrainian long-range drones were on display.

They tell the story of the evolution of vital battlefield technology that began life on a farm.

The earliest form of the long-range drone looks like an ordinary light aircraft, with rectangular wings and two propellers. It is a lot smaller than a manned plane but much larger than a regular drone – probably about the length of a car, with a similar wingspan.

This model, fitted with a camera and a large fuel tank to fly for long periods, had been used for surveillance for agricultural purposes.

It was adapted after Russia’s full-scale invasion to conduct reconnaissance and even bombing missions.

The idea was then modified further to develop similar-sized drones that look more like fighter jets, with pointed noses and triangular wings. These were designed to hold explosives in the main body of the plane.

Some of the drones are remotely piloted, others work via autopilot.

Russia’s war has forced Ukraine to use technology and innovation to fight back against its far more powerful foe.

It has accelerated the use of autonomous machines in an irreversible transformation of the warzone that everyone is watching and learning from.

Brigadier Shchygol said: “Right now, Ukraine’s battlefield experience is essentially a manual for the world.”

Environment

Tesla owners get creative to distance themselves from Elon with new car logos & projectors

Published

2 hours ago

March 3, 2025

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Tesla owners get creative to distance themselves from Elon with new car logos & projectors

Tesla owners are finding creative ways to distance themselves from Elon Musk. They are now removing Tesla logos from their vehicles, replacing them with badging from other automakers, and even using projections on a Cybertruck in one case.

We previously reported on the surge in sales of stickers reading variations of “I bought this car before I knew Elon was crazy.” One particular business selling such stickers claimed to be selling hundreds per day as Tesla owners are looking to distance themselves from the automaker’s CEO.

Things have escalated since then, and the hate against Tesla has ramped up quite a bit. Some Tesla owners are even worried about people vandalizing their vehicles.

Now, some Tesla owners have found some more creative, tongue-in-cheek ways to distance their Tesla ownership from Elon Musk than slapping a sticker on their bumper.

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For example, Tesla vehicles are being spotted de-badged with the Tesla logos replaced with badges from other automakers (pictures via Stonk King):

It’s not exactly a new phenomenon, but lately, more of these Tesla vehicles with other automaker logos have been spotted.

But here’s an even more creative and clearer example of a Tesla owner trying to distance themselves from Musk.

A Tesla Cybertruck projecting images on its tailgate has been spotted several times in the last week:

It displays pleas not to graffiti the vehicle and adds things like “this truck already makes me look stupid enough.”

The short video is signed “Mussk production,” with the “ss” referencing the Schutzstaffel, a Nazi paramilitary group.

Electrek’s Take

Obviously, these are somewhat tongue-in-cheek examples, but between these, Tesla protests worldwide, and declining sales, it is genuinely mindboggling to see the destruction of Tesla’s brand in such a short period of time.

I have been covering Tesla for roughly 15 years and I remember when it was completely unknown brand, loved only by a handful of EV nerds, like myself, and hated by fossil fuel propagandists.

It took a great deal of work from Tesla employees and the EV community to build Tesla into an incredibly beloved global EV brand. A deep social media addiction, purchasing of Twitter, a move into politics, a few salutes, and now most of that incredible work is gone.

It takes years to build a reputation and seconds to destroy it.

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