Personal Finance
How Trump’s win could change your health care
Published
2 months agoon
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.
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.
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
Under the previous Trump administration, consumers saw an increase in the availability of non-ACA compliant health insurance options, including short-term plans, experts say. The same is likely to happen over the next four years.
Short-term health insurance plans offer coverage for limited amounts of time, and typically on fewer medical services than comprehensive coverage.
Proponents of these plans say they allow insurers to offer consumers lower monthly premiums because they’re not required to cover as many services. At the same time, the plans are able to reject people with pre-existing conditions or charge them more. While Trump was in office, enrollment in short-term plans spiked.
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
The Trump administration’s stance on drug pricing is murkier, health experts said.
The Inflation Reduction Act, which President Biden signed into law in 2022, introduced many drug price reforms.
Trump has vowed to roll back parts of the law, which also contains many climate-related provisions and tax breaks toward which he is hostile.
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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Personal Finance
What a second Trump administration could mean for your money
Published
16 hours agoon
January 21, 2025On the campaign trail, President Donald Trump promised lower taxes, lower prices and a stronger economy in his second term.
On Day One of his second term, Trump signed a flurry of executive orders — including a regulatory freeze pending an administration review and a directive to members of his administration to assess trade relationships with Canada and China and Mexico — to try and move some of his goals forward. But delivering on those and other promises will take additional steps, and in many cases, the support of Congress.
Here are five ways a second Trump administration could impact your finances.
The White House did not immediately respond to requests from CNBC for comment.
1.Tariffs could send prices higher
One wildcard is tariffs. There are a range of views on how Trump will use tariffs and the impact those tariffs will have on prices. Tariffs are paid by businesses buying the goods and some of the cost is typically passed to consumers.
During the campaign, Trump promised a 10% across-the-board tariff on all imports, a 25% tariff on all goods from Mexico and Canada and a tariff of up to 60% on products from China. Trump’s Day One order to assess trade relationships puts an April 30 deadline on those reviews.
“We view Trump’s decision against announcing new tariffs on his first day in office as evidence of the ongoing internal debate over how best to implement the duties, not as a sign of plans to significantly scale back or withdraw his campaign pledges to impose new duties on foreign goods,” Beacon Policy Advisors wrote in a research note.
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During his confirmation hearing last week, Trump’s pick for Treasury secretary Scott Bessent told lawmakers to think about tariffs in three ways: as a remedy for unfair trade practices, a revenue raiser and a negotiating tool. He pushed back on Democrats who said tariffs will mean higher prices for consumers.
“China, which is trying to export their way out of their current economic malaise, will continue cutting prices to maintain market share,” Bessent said.
2. Tax rates and deductions may change
Unless Congress takes action, trillions of tax breaks are scheduled to expire at the end of the year, including lower tax brackets. More than 60% of taxpayers could see higher taxes in 2026 without extensions of provisions in the Tax Cuts and Jobs Act, or TCJA, according to the Tax Foundation.
Extending those provisions is a heavy lift amid concerns over ballooning federal debt. According to the Congressional Budget Office, the federal budget deficit is expected to rise to $1.9 trillion this year, adding more onto the $36.2 trillion in outstanding debt.
TCJA provisions will cost an estimated $4 trillion dollars over the next 10 years, according to a budget model by Penn Wharton. Trump also promised to eliminate taxes on tips and Social Security, which would drive the price tag exponentially higher. That puts a lot up for negotiation as lawmakers debate spending and taxes this year.
“Fiscal pressures are going to weigh harder on the debate than they did the first time around,” Erica York, a senior economist and research director at the Tax Foundation, said at CNBC’s Financial Advisor Summit in December.
Experts predict one of the key battles will be over the state and local tax deduction, also known as SALT. Under current law those deductions are now capped at $10,000. High-tax states like California, New York and New Jersey all have top tax rates above 10%, so changes there would be meaningful for many taxpayers who itemize deductions. Putting that cap in place freed up an estimated $100 billion a year in the federal budget, helping offset other cuts.
The maximum child tax credit was also doubled under the TCJA, from $1,000 to $2,000. On the campaign trail, Vice President JD Vance said he wants to increase the credit to $5,000. Trump has said he supports the credit, but has not specified an amount. Both are costly in budget terms.
3. Health care costs may increase
To keep Trump’s campaign promise to protect Social Security and Medicare, cuts to other health care programs become a way to fund tax proposals. House Republican lawmakers have identified $2.3 trillion in cuts to Medicaid, according to a document made public by Politico.
Subsidies to lower the cost of health insurance under the Affordable Care Act are also at risk. Without an extension by Congress, the subsides expire at end of 2025. Some individuals could see their premiums significantly increase. Because policy changes under the budget reconciliation process are limited, some analysts expect those subsidies to run out.
“It’s unfortunate because there are any number of compromises that could be crafted to better target the subsidies in exchange for extending them and stabilizing the market,” said Kim Monk, a partner at Capital Alpha Partners.
4. Credit card rates could move lower
People with credit card balances could benefit if Trump makes good on his proposal for a temporary 10% cap on credit card interest rates. Senator Bernie Sanders, I-Vt., said on Thursday he was drafting legislation to do exactly that. The catch: If enacted, experts say, it could also make it harder for people to get credit.
While analysts say a cap is unlikely, the attention to the issue puts it on the watch list.
“It means there is risk that Trump could intervene with credit card policy even if it is not a draconian interest rate cap,” said Jaret Seiberg, a financial policy analyst at TD Cowen.
5. Markets may be more volatile
Traders work on the New York Stock Exchange (NYSE) floor in New York City.
Spencer Platt | Getty Images
With so many policy changes expected and so much uncertainty with how they will unfold, experts predict that markets could be volatile.
“This first year here, 2025, it’s going to be super volatile,” said Dan Casey, an investment advisor at Bridgeriver Advisors in Bloomfield Hills, Michigan.
The key for individuals is to understand their personal financial situation so they don’t have to sell if the market is down.
“It’s knowing your numbers and whatever money you have in the market,” Casey said.
For long-term goals like retirement, he said, “hold your nose and not open up the statements for a while, because it can get that ugly.”
Personal Finance
Mortgage rates aren’t likely to fall any time soon — here’s why
Published
17 hours agoon
January 21, 2025The Good Brigade | Digitalvision | Getty Images
Mortgage rates have risen in recent months, even as the Federal Reserve has cut interest rates.
While those opposing movements may seem counterintuitive, they’re due to market forces that seem unlikely to ease much in the near term, according to economists and other finance experts.
That may leave prospective homebuyers with a tough choice. They can either delay their home purchase or forge ahead with current mortgage rates. The latter option is complicated by elevated home prices, experts said.
“If what you’re hoping or wishing for is an interest rate at 4%, or housing prices to drop 20%, I personally don’t think either one of those things is remotely likely in the near term,” said Lee Baker, a certified financial planner based in Atlanta and a member of CNBC’s Financial Advisor Council.
Mortgage rates at 7% mean a ‘dead’ market
Rates for a 30-year fixed mortgage jumped above 7% during the week ended Jan. 16, according to Freddie Mac. They’ve risen gradually since late September, when they had touched a recent low near 6%.
Current rates represent a bit of whiplash for consumers, who were paying less than 3% for a 30-year fixed mortgage as recently as November 2021, before the Fed raised borrowing costs sharply to tame high U.S. inflation.
“Anything over 7%, the market is dead,” said Mark Zandi, chief economist at Moody’s. “No one is going to buy.”
Mortgage rates need to get closer to 6% or below to “see the housing market come back to life,” he said.
The financial calculus shows why: Consumers with a 30-year, $300,000 fixed mortgage at 5% would pay about $1,610 a month in principal and interest, according to a Bankrate analysis. They’d pay about $1,996 — roughly $400 more a month — at 7%, it said.
Meanwhile, the Fed began cutting interest rates in September as inflation has throttled back. The central bank reduced its benchmark rate three times over that period, by a full percentage point.
Despite that Fed policy shift, mortgage rates are unlikely to dip back to 6% until 2026, Zandi said. There are underlying forces that “won’t go away quickly,” he said.
“It may very well be the case that mortgage rates push higher before they moderate,” Zandi said.
Why have mortgage rates increased?
The first thing to know: Mortgage rates are tied more closely to the yield on 10-year U.S. Treasury bonds than to the Fed’s benchmark interest rate, said Baker, the founder of Claris Financial Advisors.
Those Treasury yields were about 4.6% as of Tuesday, up from about 3.6% in September.
Investors who buy and sell Treasury bonds influence those yields. They appear to have risen in recent months as investors have gotten worried about the inflationary impact of President Donald Trump’s proposed policies, experts said.
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Policies like tariffs and mass deportations of immigrants are expected to increase inflation, if they come to pass, experts said. The Fed may lower borrowing costs more slowly if that happens — and potentially raise them again, experts said.
Indeed, Fed officials recently cited “upside risks” to inflation because of the potential effects of changes to trade and immigration policy.
Investors are also worried about how a large package of anticipated tax changes under the Trump administration might raise the federal deficit, Zandi said.
There are other factors influencing Treasury yields, too.
For example, the Fed has been reducing its holdings of Treasury bonds and mortgage securities via its quantitative tightening policy, while Chinese investors have “turned more circumspect” in their buying of Treasurys and Japanese investors are less interested as they can now get a return on their own bonds, Zandi said.
Mortgage rates “probably won’t fall below 6% until 2026, assuming everything goes as expected,” said Joe Seydl, senior markets economist at J.P. Morgan Private Bank.
The mortgage premium is historically high
Grace Cary | Moment | Getty Images
Lenders typically price mortgages at a premium over 10-year Treasury yields.
That premium, also known as a “spread,” was about 1.7 percentage points from 1990 to 2019, on average, Seydl said.
The current spread is about 2.4 percentage points — roughly 0.7 points higher than the historical average.
There are a few reasons for the higher spread: For example, market volatility had made lenders more conservative in their mortgage underwriting, and that conservatism was exacerbated by the regional banking “shock” in 2023, which caused a “severe tightening of lending standards,” Seydl said.
“All told, 2025 is likely to be another year where housing affordability remains severely challenged,” he said.
That higher premium is “exacerbating the housing affordability challenge” for consumers, Seydl said.
The typical homebuyer paid $406,100 for an existing home in November, up 5% from $387,800 a year earlier, according to the National Association of Realtors.
What can consumers do?
In the current housing and mortgage market, financial advisor Baker suggests consumers ask themselves: Is buying a home the right financial move for me right now? Or will I be a renter instead, at least for the foreseeable future?
Those who want to buy a home should try to put down a “significant” down payment, to reduce the size of their mortgage and help it fit more easily in their monthly budget, Baker said.
Don’t subject the savings for a down payment to the whims of the stock market, he said.
“That’s not something you should gamble with in the market,” he said.
Savers can still get a roughly 4% to 5% return from a money market fund, high-yield bank savings account or certificate of deposit, for example.
Some consumers may also wish to get an adjustable rate mortgage instead of a fixed rate mortgage — an approach that may get consumers a better mortgage rate now but could saddle buyers with higher payments later due to fluctuating rates, Baker said.
“You’re taking a gamble,” Baker said.
He doesn’t recommend the approach for someone on a fixed income in retirement, for example, since it’s unlikely there’d be room in their budget to accommodate potentially higher monthly payments in the future, he said.
Personal Finance
Student loan relief most at risk under Trump, experts say
Published
19 hours agoon
January 21, 2025US President Donald Trump holds up outgoing President Joe Biden’s letter as he signs executive orders in the Oval Office of the WHite House in Washington, DC, on Jan. 20, 2025.
Jim Watson | AFP | Getty Images
With President Donald Trump back in the White House and Republicans in control of Congress, experts worry that a number of student loan programs may now be in jeopardy.
At-risk programs include the U.S. Department of Education’s new repayment option for borrowers — called the Saving on a Valuable Education, or SAVE, plan — and the Biden administration’s more lenient bankruptcy policy.
Meanwhile, House Budget Committee Republicans are floating proposals that would reduce or eliminate more student loan programs, including the Biden administration-era rules that made it easier for borrowers to get debt relief when they’re defrauded by their schools, Politico reported last week.
Consumer advocates are worried for borrowers based on Trump’s comments about student loan relief on the campaign trail. At one rally, he called the Biden administration’s debt forgiveness efforts “vile” and “not even legal.”
The White House did not immediately respond to a request for comment.
More than 40 million Americans carry federal student loans, and the outstanding debt exceeds $1.6 trillion, according to higher education expert Mark Kantrowitz.
Here are the programs experts think are most at risk under the Trump administration.
SAVE plan
When SAVE launched in 2023, the Biden administration called its new repayment plan for federal student loan borrowers “the most affordable student loan plan ever.” SAVE cut many borrowers’ monthly bills in half and shortened the timeline to loan forgiveness for those with smaller balances.
It quickly proved popular. To that point, around 8 million borrowers signed up for the new income-driven repayment, or IDR, plan, the White House had said.
But the plan also quickly ran into legal troubles.
Republican attorneys general in Kansas and Missouri, who led the legal challenges against SAVE, argued that President Joe Biden was essentially trying to find a roundabout way to forgive student debt after the Supreme Court blocked its sweeping debt cancellation plan in June 2023. Due to those legal actions, the plan has been on hold since last year.
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The plan is unlikely to survive a second Trump term, Kantrowitz said.
“There are several methods the Trump administration could use to kill the SAVE repayment plan,” he said. “They could abandon the defense of the repayment plan in the pending lawsuits.”
“They could issue new regulations to revoke the repayment plan,” or Congress could pass a law to do away with the plan, Kantrowitz added.
Currently, SAVE enrollees are excused from making payments while the plan is tied up in the courts. That reprieve may soon end, too, experts said.
Bankruptcy protections
For decades, student loan borrowers found it next to impossible to walk away from their federal student debt in bankruptcy. The Biden administration changed that.
In the fall of 2022, the Department of Education and the Department of Justice jointly released updated bankruptcy guidelines to make the bankruptcy process for student loan borrowers less arduous. The Biden administration’s updated policy treated student loans like other types of debt in bankruptcy court, experts said.
Trump is likely to rescind that guidance, Kantrowitz said.
“There may be more of a scorched earth approach to opposing all attempts to discharge federal student loans in bankruptcy,” he said.
However, Malissa Giles, a consumer bankruptcy attorney in Virginia, said she was hopeful that the guidance will remain in place.
Still, her concern is that many jurisdictions will have new assistant U.S. attorneys, “and we may see a shift in the approach based on changing politics and pressures of more Republican-aligned U.S. attorneys.”
For now, she said she was being more conservative in what student loan bankruptcy cases she took on.
Other student loan aid at risk
Among the recent ideas floated by House Budget Committee Republicans is the partial repeal of the Biden administration’s Borrower Defense regulations, which made it easier for borrowers to get their debt excused when their school engaged in misconduct.
The GOP members are also reviewing reforms to Public Service Loan Forgiveness, including the possibility of “limiting eligibility for the program,” according to the document obtained by Politico.
They’re also considering eliminating the student loan interest deduction. That tax break allows qualifying borrowers to deduct up to $2,500 a year in interest paid on eligible private or federal education debt. Before the Covid pandemic, nearly 13 million taxpayers took advantage of the deduction, according to Kantrowitz.
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