On Wednesday, Donald Trump, the Republican candidate and former president, was elected to the highest office again, marking a return to an administration. His second term is likely to impact U.S. healthcare.

Trump has been unclear about his healthcare policy goals during his campaign. Healthcare ranked lower than issues like the economy and immigration in voter concerns.

A poll from the Associated Press found that only 8% of voters viewed healthcare as their top issue, compared to 39% who chose the economy and 20% who picked immigration. Abortion was the leading issue for 11% of voters.

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Despite his focus on “Make America Healthy Again,” millions of Americans may lose health insurance subsidies next year, depending on the political climate after the election and the Republicans’ control of the Senate.

The subsidies, expanded under the 2021 American Rescue Plan, help many, particularly the middle class, afford health insurance through the Affordable Care Act (ACA).

These subsidies are set to expire at the end of 2025, and it remains uncertain whether they will be extended under the new administration.

Trump and other Republicans have opposed continuing the subsidies.

The NBC News report, citing some analysts, suggests that the chances of extension could be less than 5% if Republicans win control of the House and the Senate.

Even if Democrats control the House, extending these subsidies seems unlikely. Without an extension, nearly 4 million Americans could lose coverage by 2026 due to unaffordable premiums.

The 2021 changes led to a surge in ACA enrollment, with 15.5 million people benefiting from subsidies across 32 states. The report adds that if the subsidies aren’t renewed, up to 15.4 million Americans could lose health coverage by 2030.

Another significant issue is Trump’s stance on Medicare. As president, he supported Medicare Advantage, a private insurer-run program that could eventually replace traditional, government-run Medicare.

The NPR report highlights that critics argue that expanding private insurers could increase costs for taxpayers and limit care, with some beneficiaries finding it difficult to switch back to traditional Medicare.

Robert Berenson, a former government official, warned that traditional Medicare could “wither on the vine.”

Medicare Advantage grew with the 2003 legislation introducing a drug benefit and expanded private insurers’ role in the program. Although private plans were expected to lower costs, they have been more expensive.

The report also says that in 2023, Medicare Advantage plans cost taxpayers about 6% — or $27 billion — more than traditional Medicare, though some research suggests they offer better care.

The future of healthcare policy in the U.S. will depend on the political dynamics in Congress and Trump’s second term.

With Republicans pushing for major changes to the ACA and Medicare, experts warn of significant shifts in how Americans access and pay for healthcare in the coming years.

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