Trump Won the Election—Here’s What That Means for Medicare

Donald Trump, who was elected the 47th president of the United States on Wednesday, would rely on deregulation and private markets to help solve Medicare’s financial troubles according to the party platform and our interviews with two conservative financial experts. Republicans have also proposed making Medicare Advantage, an alternative to Original Medicare provided by private companies, the default option for health coverage for eligible Americans. Here’s a breakdown of how Trump could change Medicare once he takes office.

Will Donald Trump Cut Medicare?

Despite Democratic claims that Trump intends to cut Medicare, fact-checking organization Politifact points to repeated promises not to do so. 

“President Trump has made absolutely clear that he will not cut one penny from Medicare or Social Security,“ the 2024 Republican party platform said. “We will protect Medicare, and ensure seniors receive the care they need without being burdened by excessive costs.”

Chris Pope, senior fellow in health policy at the conservative-leaning Manhattan Institute, said many of Medicare’s changes have historically been led by Congress, so Trump would need backing from Republican legislators to alter Medicare. Republicans will control the U.S. Senate and were leading the race to control the House as of Wednesday morning.

“Both parties want to scare the electorate that the other party will cut Medicare, but the reality is that Medicare beneficiaries are the strongest political force in America,” Pope said. “Medicare beneficiaries can sleep easy because Congress has their back. No matter the district, nobody wants to upset beneficiaries. So, I think they will keep care accessible as it has been.”

The Health of Medicare’s Budget

Republicans will have to address Medicare’s finances. The aging of the baby boomer generation, inflation, and growth in services provided are driving increases in enrollment and costs. The Medicare Payment Advisory Commission projects that Medicare spending will double from $900 billion to $1.8 trillion by 2031. 

Many Americans worry Medicare will be insolvent by the time they’re eligible. The 2024 Medicare Trustees Report projects that the Part A Hospital Insurance trust fund—fueled by payroll taxes—will become insolvent in 2036. 

According to a July 2024 Congressional Research Service report, “The insolvency date has been postponed numerous times, primarily due to legislative changes that have had the effect of restraining growth in program spending.” 

“If the Medicare trust funds run out of money, the Treasury has to cut Medicare by maybe 20%, but neither party is talking about that,” said John C. Goodman, president of the conservative-leaning Goodman Institute for Public Policy Research, primarily focusing on health care issues. 

New services and technology, like obesity drugs, are the main reasons costs are growing so fast, according to Pope.

“With every new technology, drug, medical device, and AI revolution, you wonder how Medicare will pay for that over the next decade,” Pope said.

How Republicans Would Change Medicare

Goodman said the Republican approach to Medicare would revolve around deregulation and allowing the private sector to help solve problems. He pointed to innovations resulting from deregulation, including Trump’s executive order to permit telehealth visits during the COVID-19 pandemic. Republicans have proposed loosening restrictions that prevent telehealth care across state lines and codifying the Trump order so that it becomes permanent law.

The Republican Study Committee Fiscal Year 2025 Budget Proposal includes a variety of Medicare-related ideas, including Medicare coverage for FDA-approved smartphone apps that help treat diseases such as depression and post-traumatic stress disorder. Another is “site-neutral payment policies,” making Medicare payments the same for services regardless of where they’re provided to keep hospitals from overcharging Medicare.

The 2025 RNC party platform includes a few broad policy proposals related to senior health, though they’re not directly related to Medicare, like pledges to expand access to primary care, help seniors age in place, and support unpaid family caregivers through tax credits. Republicans have advanced a bill to advance the latter goal: the bipartisan Credit for Caring Act, which would offer a $5,000 tax credit to family caregivers.  

Project 2025, a collection of policy proposals for a new Trump term created by the conservative Heritage Foundation, suggests reforming Medicare to expand patients’ choice of providers and insurance plans, reduce regulations on doctors, allow market forces to set prices, and reduce waste, fraud, and abuse through the use of artificial intelligence. One of its biggest proposals is to make private coverage through Medicare Advantage the default option for seniors as opposed to traditional Medicare.

Medicare and Immigration

The 2024 GOP platform and Trump’s Republican National Convention speech also pledge to protect Medicare’s finances from the “Democrat plan to add tens of millions of new illegal immigrants to the rolls of Medicare.” 

In his RNC speech, Trump insinuated that Democrats will “destroy Social Security and Medicare” by allowing “millions” of immigrants to enroll. Currently, only legal immigrants who meet the same work and eligibility requirements as U.S. citizens are eligible for federal benefits like Medicare.

How Republicans Will Respond to the IRA

The Biden administration’s Inflation Reduction Act (IRA) helped cap the cost of prescription drug spending for Medicare enrollees. 

“Democrats have been more able to make cuts to Medicare than Republicans,” Pope said. 

It was assumed that insurers would raise premiums to make up for these price caps, but CMS  announced a federal demonstration project in July 2024—just a few months before open enrollment—to limit drastic Part D premium increases by having the government take on on some of the risk of losses. (Demonstration projects are short-term changes to program offerings that allow the government to test potential modifications in services and determine how effective they would be if fully implemented.) 

Premiums didn’t increase as much as they would’ve otherwise. Still, the nonpartisan Congressional Budget Office released an October 2024 report estimating that “the temporary subsidies will increase federal spending for Part D in calendar year 2025 by roughly $5 billion.” 

“Beneficiaries aren’t going to see much greater costs, but the burden falls on the taxpayer,” Pope said.

Congressional Republicans have shared concerns about the program’s costs. Multiple Republican representatives wrote a letter to CMS Administrator Chiquita Brooks-LaSure raised concerns about the burden on taxpayers.

Trump campaign spokeswoman Karoline Leavitt told the New York Times that “Mr. Trump would make sure ‘that seniors are protected from the massive Medicare premium increases resulting from the Harris Inflation Reduction Act.’”

Goodman said he could see the demonstration being potentially reversed if Trump were elected, and the cuts funded instead with money Biden had pledged for green energy projects.

While in office, Trump capped monthly insulin copays at $35 for some Medicare beneficiaries as a demonstration project. He also issued a regulation allowing states to import lower-priced drugs from Canada and a rule–never implemented– requiring Part B drugs to match drug pricing in other countries.