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Millions of Americans could find themselves without health coverage in 2025 as the incoming Trump administration poses a risk to existing health insurance subsidies. More than 20 million Americans depend on the individual private health insurance market for their medical needs, benefiting from federal subsidies that help lower insurance premiums. These subsidies were bolstered by President Biden’s 2021 American Rescue Plan, but they are set to expire at the end of 2025.

Research professor Sabrina Corlette of Georgetown University emphasized the severe consequences of losing health coverage. "Premiums go up for the people who do have health insurance; for the people without health insurance, it's financially devastating. The result is medical debt, garnished wages, and liens on people's homes because they can't pay off their bills," Corlette noted. She also highlighted the broader implications, stating that more uninsured individuals could lead to increased costs for those still covered and have significant effects on healthcare providers.

The American Rescue Plan not only increased the amount of assistance but also extended eligibility to a larger segment of the middle class. During the 2024 open enrollment period, an impressive 21.3 million people selected a health insurance plan through the Affordable Care Act (ACA), marking record-high enrollment rates even in predominantly Republican-voting states.

With the Republicans now in control of the presidency, Senate, and possibly the House, it is likely that Congress will not renew these coverage subsidies next year. President-elect Trump indicated during a debate that he had "concepts of a plan" to replace the ACA but has yet to provide specifics. Previous attempts to replace the ACA, such as the American Health Care Act in 2017, failed in the Senate.

The Congressional Budget Office (CBO) reported an historic low of 7.2% in the share of uninsured Americans in 2023, significantly attributed to the enhanced subsidies. The CBO also projects that nearly 4 million people could lose their coverage by 2026 if these subsidies are not extended, with middle-class Americans set to lose assistance entirely while lower-income individuals might still receive some federal support.

Despite its acknowledged flaws and contribution to medical debt, policy experts argue that the ACA remains a critical lifeline for many Americans. The 2021 subsidies helped millions afford health insurance and fostered greater financial security. For 2025, the Department of Health and Human Services has set the out-of-pocket limit for ACA marketplace plans at $9,200 for individuals and $18,400 for families, underscoring the potential financial strain on uninsured citizens.

Last month, Republican House Speaker Mike Johnson voiced opposition to the ACA, promising "massive" healthcare changes if Trump won the election. As the Trump administration prepares to take office, the fate of millions of Americans' health coverage hangs in the balance.