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How Trump’s win could change your health care

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U.S. President-elect Donald Trump arrives on November 13, 2024 at Joint Base Andrews, Maryland. 

Andrew Harnik | Getty Images

President-elect Donald Trump‘s return to the White House is poised to have big impacts on consumer health care.

Republicans may face few legislative roadblocks with their goals of reshaping health insurance in the U.S., experts said, after the party retained its slim majority in the House of Representatives and flipped the Senate, giving it control of both Congress and the presidency.

Households that get health insurance from Medicaid or an Affordable Care Act marketplace plan may see some of the biggest disruptions, due to reforms sought by Trump and Republican lawmakers, according to health policy experts.

Such reforms would free up federal funds that could be used to help pay for other Republican policy priorities like tax cuts, they said.

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Just under 8% of the U.S. population is uninsured right now — the lowest rate in American history, said Michael Sparer, a professor at Columbia University and chair of its Department of Health Policy and Management. That figure was 17% when the Affordable Care Act was enacted over a decade ago, he said.

“That rate will start going up again,” Sparer said.

Trump announced on Nov. 14 that he wants to tap Robert F. Kennedy Jr. to run the Department of Health and Human Services, which includes the Centers for Medicare and Medicaid Services. CMS, in turn, administers the Affordable Care Act marketplace and the Children’s Health Insurance Program (CHIP), among other endeavors.

Robert F. Kennedy Jr. speaks with Republican presidential nominee former President Donald Trump at a Turning Point Action Rally in Duluth, GA on Wednesday, Oct. 23, 2024. 

The Washington Post | The Washington Post | Getty Images

Kennedy, a vaccine skeptic who’s been accused of spreading conspiracy theories, has vowed to make big changes to the U.S. health care system.

A spokesperson for Trump’s transition team did not respond to a request from CNBC for comment about the President-elect’s health policy plans.

Here’s how health care could change for consumers during the incoming Trump administration, according to experts.

Affordable Care Act marketplace

A lab technician cares for a patient at Providence St. Mary Medical Center on March 11, 2022 in Apple Valley, California.

Mario Tama | Getty Images News | Getty Images

‘Betting’ premium subsidies will expire

Based on how the election went, the enhanced subsidies on the Affordable Care Act will likely not be renewed once they expire at the end of 2025, said Cynthia Cox, vice president and director of the ACA program at KFF, a health policy research organization.

“If I was going to place a bet on this, I’d be much more comfortable betting that they are going to expire,” Cox said.

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That government-backed aid, originally passed during the pandemic under the American Rescue Plan in 2021, has significantly lowered the costs of coverage for people buying health insurance plans on the ACA marketplace. Those customers include anyone who doesn’t have access to a workplace plan, such as students, self-employed consumers and unemployed people, among others.

An individual earning $60,000 a year now has a monthly premium of $425, compared to $539 before the enhanced subsidies, according to a rough estimate provided by Cox. Meanwhile, a family of four making about $120,000 currently pays $850 a month instead of $1,649.

Permanently extending the enhanced ACA subsidies could cost around $335 billion over the next 10 years, according to an estimate by the Congressional Budget Office.

“They’re concerned about the cost, and they’re going to be cutting taxes next year likely,” Cox said, of Republicans.

Still, it’s a ‘big’ gamble to forgo health insurance

Around 3.8 million people will lose their health insurance if the subsidies expire, the Congressional Budget Office estimates. Those who maintain their coverage are likely to pay higher premiums.

“The bottom line is uncertainty,” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy.

“The good news for marketplace consumers is that the enhanced [subsidies] will be available through 2025, so there should be no immediate changes,” Corlette added.

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Even if the subsidies disappear, experts say it’s important to stay enrolled if you can, even if you have to make tradeoffs on coverage to keep the costs within budget.

Enrolling in a plan, even a cheaper plan with a big annual deductible, can provide an important hedge against huge costs from unforeseen medical needs like surgery, said Carolyn McClanahan, a physician and certified financial planner based in Jacksonville, Florida.

“I can’t emphasize how big a gamble it is to go without health insurance,” said McClanahan, founder of Life Planning Partners and a member of the CNBC Financial Advisor Council.

“One heart attack easily costs $100,000” out of pocket for someone without insurance, she said. “Do you have that to pay?”

Medicaid

A ‘pretty big target’ for lawmakers

Medicaid is the third-largest program in the federal budget, accounting for $616 billion of spending in 2023, according to the Congressional Budget Office. Trump campaigned on a promise not to make cuts to the two largest programs: Social Security and Medicare.

That makes Medicaid the “obvious place” for Republicans to raise revenue to finance their agenda, said Larry Levitt, executive vice president for health policy at KFF.

“Medicaid will have a pretty big target on its back,” Levitt said.

The bottom line is uncertainty.

Sabrina Corlette

co-director of the Center on Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy

Cuts would “inevitably mean” fewer households would get benefits, Levitt said. Medicaid recipients tend to be lower-income households, people with disabilities and seniors in nursing homes, he said.

Medicaid cuts were a big part of the push among Trump and other Republican lawmakers to repeal and replace the Affordable Care Act (also known as Obamacare) in 2017, Levitt said.

Those efforts were ultimately unsuccessful.

How Medicaid might be curtailed

Maskot | Maskot | Getty Images

The new Medicaid cuts may take many forms, according to experts, who cite past proposals and remarks from the Trump administration, Republican lawmakers and the Project 2025 conservative policy blueprint.

For example, the Trump administration may try to add work requirements for Medicaid recipients, as it did during his first term, said Sparer of Columbia University.

Additionally, Republicans may try to cap federal Medicaid spending allocated to states, experts said.

The federal government matches a portion — generally 50% or more — of states’ Medicaid spending. That dollar sum is uncapped.

Republicans may try to covert Medicaid to a block grant, whereby a fixed amount of money is provided annually to each state, or institute a per-capita cap, whereby benefits are limited for each Medicaid enrollee, Levitt said.

Lawmakers may also try to roll back the Medicaid expansion under the Affordable Care Act, which broadened the pool of people who qualify for coverage, experts said.

They could do this by cutting federal financing to the 40 states (plus the District of Columbia) that have expanded Medicaid eligibility. That would shift “an enormous financial risk to states, and many states as a result would drop the Medicaid expansion,” Levitt said.

Short-term health insurance plans

The U.S. Capitol building in Washington, D.C., Oct. 4, 2023.

Yasin Ozturk | Anadolu Agency | Getty Images

“The previous Trump administration and many in the GOP have called for expanding the marketing and sale of short-term plans and other insurance products that do not have to satisfy the ACA’s pre-existing condition standards and other consumer protections,” said Georgetown University’s Corlette.

She said that consumers can be attracted to the plans for their low costs, but often learn too late how thin the coverage is.

Drug prices

CMS Administrator on Medicare price negotiations: People will see benefits starting next year

It’s unclear if lawmakers would keep the drug policies intact, experts said. Trump signed executive orders in 2020 aimed at lowering costs for prescription medications, for example.

“It’s not at all clear Trump will be a friend of the pharma industry,” Sparer said.

For example, the Inflation Reduction Act gave the federal government — for the first time — the authority to negotiate prices with pharmaceutical companies over some drugs covered by Medicare.

That provision is slated to kick in for 10 drugs — some of Medicare’s “most costly and most used” medications, treating a variety of ailments like heart disease, diabetes, arthritis and cancer — in 2026, according to the Centers for Medicare and Medicaid Services.

The measure will save patients $1.5 billion in out-of-pocket costs in 2026, CMS estimates. The federal government would expand the list of medications in ensuing years.

The Inflation Reduction Act also capped Medicare co-pays for insulin at $35 a month. They were previously uncapped. The average Medicare Part D insulin user had paid $54 out-of-pocket a month per insulin prescription in 2020, according to KFF.

The law also capped out-of-pocket costs at $2,000 a year for prescription drugs covered by Medicare, starting in 2025. There was previously no cap.

About 1.4 million Medicare Part D enrollees paid more than $2,000 out-of-pocket for medications in 2020, KFF found. Those costs averaged $3,355 a person.

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Forgotten 401(k) fees cost workers thousands in retirement savings

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No access to a 401(k)?

With more Americans job hopping in the wake of the Great Resignation, the risk of “forgetting” a 401(k) plan with a previous employer has jumped, recent studies show. 

As of 2023, there were 29.2 million left-behind 401(k) accounts holding roughly $1.65 trillion in assets, up 20% from two years earlier, according to the latest data by Capitalize, a fintech firm.

Nearly half of employees leave money in their old plans during work transitions, according to a 2024 report from Vanguard.

However, that can come at a cost.

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For starters, 41% of workers are unaware that they are paying 401(k) fees at all, a 2021 survey by the U.S. Government Accountability Office found.

In most cases, 401(k) fees, which can include administrative service costs and fees for investment management, are relatively low, depending on the plan provider. 

But there could be additional fees on 401(k) accounts left behind from previous jobs that come with an extra bite.

Fees on forgotten 401(k)s

Jelena Danilovic | Getty Images

Former employees who don’t take their 401(k) with them could be charged an additional fee to maintain those accounts, according to Romi Savova, CEO of PensionBee, an online retirement provider. “If you leave it with the employer, the employer could force the record keeping costs on to you,” she said.

According to PensionBee’s analysis, a $4.55 monthly nonemployee maintenance fee on top of other costs can add up to nearly $18,000 in lost retirement funds over time. Not only does the monthly fee eat into the principal, but workers also lose the compound growth that would have accumulated on the balance, the study found.

Fees on those forgotten 401(k)s can be particularly devastating for long-term savers, said Gil Baumgarten, founder and CEO of Segment Wealth Management in Houston.

That doesn’t necessarily mean it pays to move your balance, he said.

“There are two sides to every story,” he said. “Lost 401(k)s can be problematic, but rolling into a IRA could come with other costs.”

What to do with your old 401(k)

When workers switch jobs, they may be able to move the funds to a new employer-sponsored plan or roll their old 401(k) funds into an individual retirement account, which many people do.

But IRAs typically have higher investment fees than 401(k)s and those rollovers can also cost workers thousands of dollars over decades, according to another study, by The Pew Charitable Trusts, a nonprofit research organization.

Collectively, workers who roll money into IRAs could pay $45.5 billion in extra fees over a hypothetical retirement period of 25 years, Pew estimated.

Another option is to cash out an old 401(k), which is generally considered the least desirable option because of the hefty tax penalty. Even so, Vanguard found 33% of workers do that.

How to find a forgotten 401(k) 

While leaving your retirement savings in your former employer’s plan is often the simplest option, the risk of losing track of an old plan has been growing.

Now, 25% of all 401(k) plan assets are left behind or forgotten, according to the most recent data from Capitalize, up from 20% two years prior.

However, thanks to “Secure 2.0,” a slew of measures affecting retirement savers, the Department of Labor created the retirement savings lost and found database to help workers find old retirement plans.

“Ultimately, it can’t really be lost,” Baumgarten said. “Every one of these companies has a responsibility to provide statements.” Often simply updating your contact information can help reconnect you with these records, he advised.   

You can also use your Social Security number to track down funds through the National Registry of Unclaimed Retirement Benefits, a private-sector database.

In 2022, a group of large 401(k) plan administrators launched the Portability Services Network.

That consortium works with defined contributor plan rollover specialist Retirement Clearinghouse on auto portability, or the automatic transfer of small-balance 401(k)s. Depending on the plan, employees with up to $7,000 could have their savings automatically transferred into a workplace retirement account with their new employer when they change jobs.

The goal is to consolidate and maintain those retirement savings accounts, rather than cashing them out or risk losing track of them, during employment transitions, according to Mike Shamrell, vice president of thought leadership at Fidelity Investments, the nation’s largest provider of 401(k) plans and a member of the Portability Services Network.

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‘What’s the point’ of saving money

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Xavier Lorenzo | Moment | Getty Images

Gen Z seems to have a case of economic malaise.

Nearly half (49%) of its adult members — the oldest of whom are in their late 20s — say planning for the future feels “pointless,” according to a recent Credit Karma poll.

A freewheeling attitude toward summer spending has taken root among young adults who feel financial “despair” and “hopelessness,” said Courtney Alev, a consumer financial advocate at Credit Karma.

They think, “What’s the point when it comes to saving for the future?” Alev said.

That “YOLO mindset” among Generation Z — the cohort born from roughly 1997 through 2012 — can be dangerous: If unchecked, it might lead young adults to rack up high-interest debt they can’t easily repay, perhaps leading to delayed milestones like moving out of their parents’ home or saving for retirement, Alev said.

But your late teens and early 20s is arguably the best time for young people to develop healthy financial habits: Starting to invest now, even a little bit, will yield ample benefits via decades of compound interest, experts said.

“There are a lot of financial implications in the long term if these young people aren’t planning for their financial future and [are] spending willy-nilly however they want,” Alev said.

Why Gen Z feels disillusioned

That said, that many feel disillusioned is understandable in the current environment, experts said.

The labor market has been tough lately for new entrants and those looking to switch jobs, experts said.

The U.S. unemployment rate is relatively low, at 4.2%. However, it’s much higher for Americans 22 to 27 years old: 5.8% for recent college grads and 6.9% for those without a bachelor’s degree, according to Federal Reserve Bank of New York data as of March 2025.

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Young adults are also saddled with debt concerns, experts said.

“They feel they don’t have any money and many of them are in debt,” said Winnie Sun, co-founder and managing director of Sun Group Wealth Partners, based in Irvine, California. “And they’re wondering if the degree they have (or are working toward) will be of value if A.I. takes all their jobs anyway. So is it just pointless?”

About 50% of bachelor’s degree recipients in the 2022-23 class graduated with student debt, with an average debt of $29,300, according to College Board.

The federal government restarted collections on student debt in default in May, after a five-year pause.

The Biden administration’s efforts to forgive large swaths of student debt, including plans to help reduce monthly payments for struggling borrowers, were largely stymied in court.

“Some hoped some or more of it would be forgiven, and that didn’t turn out to be the case,” said Sun, a member of CNBC’s Financial Advisor Council.

Meanwhile, in a 2024 report, the New York Fed found credit card delinquency rates were rising faster for Gen Z than for other generations. About 15% had maxed out their cards, more than other cohorts, it said.

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It’s also “never been easier to buy things,” with the rise of buy now, pay later lending, for example, Alev said.

BNPL has pushed the majority of Gen Z users — 77% — to say the service has encouraged them to spend more than they can afford, according to the Credit Karma survey. The firm polled 1,015 adults ages 18 and older, 182 of whom are from Gen Z.

These financial challenges compound an environment of general political and financial uncertainty, amid on-again-off-again tariff policy and its potential impact on inflation and the U.S. economy, for example, experts said.

“You start stacking all these things on top of each other and it can create a lack of optimism for young people looking to get started in their financial lives,” Alev said.

How to manage that financial malaise

Patricio Nahuelhual | Moment | Getty Images

“This is actually the most exciting time to invest, because you’re young,” Sun said.

Instituting mindful spending habits, such as putting a waiting period of at least 24 hours in place before buying a non-essential item, can help prevent unnecessary spending, she added.

Sun advocates for paying down high-interest debt before focusing on investing, so interest payments don’t quickly spiral out of control. Or, as an alternative, they can try to fund a 401(k) to get their full company match while also working to pay off high-interest debt, she said.

“Instead of getting into the ‘woe is me’ mode, change that into taking action,” Sun said. “Make a plan, take baby steps and get excited about opportunities to invest.”

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Personal Finance

Trump admin seeks Education Department layoff ban lifted

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A demonstrator speaks through a megaphone during a Defend Our Schools rally to protest U.S. President Donald Trump’s executive order to shut down the U.S. Department of Education, outside its building in Washington, D.C., U.S., March 21, 2025.

Kent Nishimura | Reuters

The Trump administration on Friday asked the Supreme Court to lift a court order to reinstate U.S. Department of Education employees the administration had terminated as part of its efforts to dismantle the agency.

Officials for the administration are arguing to the high court that U.S. District Judge Myong Joun in Boston didn’t have the authority to require the Education Department to rehire the workers. More than 1,300 employees were affected by the mass layoffs.

The staff reduction “effectuates the Administration’s policy of streamlining the Department and eliminating discretionary functions that, in the Administration’s view, are better left to the States,” Solicitor General D. John Sauer wrote in the filing.

A federal appeals court had refused on Wednesday to lift the judge’s ruling.

In his May 22 preliminary injunction, Joun pointed out that the staff cuts led to the closure of seven out of 12 offices tasked with the enforcement of civil rights, including protecting students from discrimination on the basis of race and disability.

Meanwhile, the entire team that supervises the Free Application for Federal Student Aid, or FAFSA, was also eliminated, the judge said. (Around 17 million families apply for college aid each year using the form, according to higher education expert Mark Kantrowitz.)

The Education Dept. announced its reduction in force on March 11 that would have gutted the agency’s staff.

Two days later, 21 states — including Michigan, Nevada and New York — filed a lawsuit against the Trump administration for its staff cuts at the agency.

After President Donald Trump signed an executive order on March 20 aimed at dismantling the Education Department, more parties sued to save the department, including the American Federation of Teachers.

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