Since its passage 15 years ago, the Affordable Care Act (ACA) has become the bedrock of American health care, with millions relying on its coverage and protections. But undoing the ACA and its protections for over 100 million people with pre-existing conditions has been one of Donald Trump’s core fixations since announcing his presidential campaign ten years ago. He spearheaded a failed attempt to repeal and replace the law in 2017, supported efforts to overturn it in court, and spent his first term working to undermine the ACA at every turn by ending outreach, limiting enrollment, and promoting plans circumventing the law. Now in his second term, Trump has picked up right where he left off in 2020, working overtime to revoke Biden-era executive protections, slash outreach, and limit enrollment once again. But he isn’t stopping there. This time, he is determined to target the law’s core features – including Medicaid expansion and free coverage for preventive services like vaccines – and is even working to gut the very agency that ensures the ACA is properly administered, implemented, and enforced. The Trump-led plan to gut health care will only take us backward and throw the entire health care system into chaos.
The Second Trump Administration’s First Executive Actions Have Targeted the ACA. The second Trump administration has relentlessly targeted the ACA’s consumer protections and health care coverage provisions that provide affordable care to millions of Americans. In January 2025, within days of retaking office, Trump revoked a Biden administration order that prioritized protecting and strengthening the Affordable Care Act by pushing federal agencies to extend enrollment periods and dedicate extra funding for the third-party Navigators that help people enroll in ACA insurance. Trump also revoked a Biden administration executive order that aimed to lower prescription drug costs for people on Medicaid – including those enrolled thanks to Medicaid expansion – by analyzing new payment models.
The Trump Administration Is Gutting ACA Enrollment Outreach. In February, the Trump administration officially cut nearly 90 percent of ACA Navigator funding, mirroring a similar move in 2017 that coincided with a dramatic reduction in ACA Marketplace enrollment throughout the first Trump administration. On March 1, the White House unilaterally designated English as the official language of the U.S., rescinding requirements that government entities provide language assistance to individuals who do not speak English. Although the order does not direct agencies to change existing policies or programs, the action could limit outreach to consumers seeking health care with limited English proficiency.
The Trump Administration Is Working To Curb ACA Enrollment By Shorting The Enrollment Period, Imposing New Requirements, and Barring ‘Dreamers’ From Marketplaces. In March, the administration announced new rules designed to significantly curb enrollment by shortening the enrollment period, taking away low-income families’ ability to sign up for coverage outside of the six-week enrollment period, imposing more paperwork burdens for enrolling and proving eligibility for tax credits, and barring immigrants with ‘Dreamer’ status from enrolling in ACA Marketplace plans. In 2017, the Trump administration similarly halved the duration of Open Enrollment, reducing the period from three months to just 45 days.
The Trump Administration Is Slashing The Federal Workforce Overseeing Open Enrollment. Trump and Elon Musk are working to cut the bureaucratic apparatus that ensures that the ACA continues to be enforced and implemented without interruption. They fired around 1,900 probationary workers from the Department of Health and Human Services, and the Trump administration hinted they could fire as many as 5,200.
The Trump Administration Endorsed Plans To Cut ACA Medicaid Expansion Funding. In February, President Trump endorsed a budget resolution later passed by House Republicans that included budget cuts of nearly $1 trillion – a threshold that would require cuts to Medicaid. One of the proposed cuts includes reducing the federal match rate for Medicaid expansion under the ACA, which would force states to spend more than 25 percent more to foot the bill to the tune of nearly $50 billion. Reducing the federal match rate would threaten state budgets and would even end Medicaid expansion automatically in states with “trigger laws” designed to rescind Medicaid expansion if the federal match rate drops below a certain level.
The Trump Administration Is Targeting Services Covered Under the ACA. The Trump administration is undermining preventive services covered through the ACA by postponing the Advisory Committee on Immunization Practices (ACIP) meeting – which offers guidance on vaccine approvals and influences which shots insurers are required to cover under the ACA. Additionally, new rules introduced by the Trump administration in March include a ban on ACA Marketplace insurers covering gender-affirming care as an essential health benefit.