Around forty percent of the US population was enrolled in Medicare (60 million) or Medicaid (80 million) in 2022. Medicare requires members to be 65 or older, while Medicaid provides health insurance coverage to low-income individuals and families.

Donald Trump understands that many of his supporters are older and is careful when discussing any Medicare changes. Like other Republicans, he never addresses making cuts to the program. Instead, he promises to remove government regulation and red tape that drive up market prices.

The Republican party platform says very little about how a Trump administration would address ever-increasing healthcare costs, which for seniors make up a critical component of their monthly budget. The plan says the party will not cut a cent of Medicare or Social Security funding and falsely accuses Democrats of attempting to destroy Medicare by adding “tens of millions of new illegal immigrants to the rolls.” Undocumented immigrants are not allowed to enroll in Medicare, and no Democrat has proposed making a change to that policy. The platform does not mention Medicaid at all.

Donald Trump has attempted to distance himself from Project 2025, a conservative playbook of policy proposals, which the organization says could be used by any party. However, many of the plan’s writers, twenty-eight of 38, worked in the Trump Administration, and CBS News found that during his campaign, the GOP nominee had touted around 170 policies, or around 23 percent, included in the plan.

Imposing work requirements

As far as suggestions for how to ‘reform’ Medicaid, the plan calls on states to impose work requirements for able-bodied adults and impose “targeted time limits or lifetime caps on benefits to disincentivize permanent dependence.” Work requirements were expanded within the SNAP benefit, formally known as food stamps, during the Biden administration as a concession to Republicans to approve a funding bill to keep the government open.

The Center on Budget and Policy Priorities has criticized work requirements and their expansion because “they ignore [the] realities” of many in need of government assistance, including “the low-paid labor market, the lack of child care and paid sick and family leave, how health and disability issues and the need to care for family members affect people’s lives, and ongoing labor market discrimination. Additionally, researchers noted the lack of research to support the claim that the imposition of work requirements leads to integration into the labor market or improvements in economic well-being more generally. Such rules also fail to recognize the working poor represent an increasing share of welfare as corporations refuse to increase wages that could lift their workers out of poverty.

Targeting Planned Parenthood

Plan 2025 also calls on the federal government to “prohibit Planned Parenthood from receiving Medicaid funds.“ As a healthcare organization that provides abortion care, Planned Parenthood is a target of the right, even though it represents around three percent of its services to patients. In addition to abortion care, Planned Parenthood provides cancer screenings, gynecological check-ups, and family planning care. The authors provide no evidence that eliminating access to Planned Parenthood for Medicaid members would improve health outcomes.

The impact of the repeal of the ACA’s mandate

Also, an important indicator of how Donald Trump would govern given another term is to look back at the healthcare legislation passed during his first administration.

In 2017, the GOP-controlled Congress passed a law that repealed the individual mandate under the Affordable Care Act. The mandate imposed a penalty on those who did not purchase health insurance to incentivize healthy people to stay in the market. An insurance pool needs to include individuals who will use the services more and less; if not, the market can collapse. If young, healthy individuals leave the market, they create an imbalance, and from 2017 to 2019, the cost of health insurance shot up twenty percent. Not all of this increase can be attributed to the repeal.

The Congressional Budget Office released a report in 2019 that highlighted how insurance companies responded to the repeal of the individual mandate by increasing premiums because they assumed healthy people would leave the market.