**Millions of Americans at Risk of Losing ACA Subsidies Amid GOP Opposition**

Millions of Americans could face the loss of vital subsidies that help them afford health insurance due to President-elect Donald Trump's recent election victory and the Republican party's success in the Senate. These subsidies, critical to making health insurance more affordable under the Affordable Care Act (ACA), are set to expire at the end of 2025 as per the American Rescue Plan of 2021. Additionally, the 2021 plan significantly increased the financial assistance available and extended eligibility to many middle-class citizens.

However, the expiration of these subsidies poses a challenge to the new Congress and the incoming president, who will need to decide on their extension. Currently, President-elect Trump and congressional Republicans have indicated a lack of support for such measures, according to Chris Meekins, a health policy research analyst at Raymond James and former senior HHS official during Trump's first term. Meekins estimates the odds of extension at less than 5% if Republicans dominate the House, Senate, and Presidency.

House Republicans have already secured 209 seats as of Thursday afternoon, just short of the majority needed for control, leaving several races undecided. In 2024, more than 20 million people secured health insurance through the ACA, confirmed by the Centers for Medicare and Medicaid Services. Growing enrollment in ACA plans, especially across southern red states, has been notably driven by these subsidies since their implementation, explained Cynthia Cox from KFF, an impartial health care policy research organization.

The subsidies' potential termination threatens the coverage of roughly 15.5 million people from 32 states, relying on these financial aids, according to KFF. Without further extension, the Congressional Budget Office (CBO) estimates nearly 4 million could lose coverage by 2026, with enrollment continuing to dwindle down to 15.4 million by 2030.

There remains a slim chance of extension during the current Congress's lame-duck session, but Cox believes this is unlikely. In her view, the election results have considerably diminished this prospect, forecasting premium costs to rise by more than 75% for many, with some experiencing a doubling of costs.

The CBO projects that a permanent extension of the subsidies could cost around $335 billion over a decade, a financial burden that makes it a tough sell to Republicans, noted Meekins. Moreover, Trump and Republicans have already expressed intentions for dramatic changes to the current health care law.

Lawrence Gostin from Georgetown University's O'Neill Institute for National and Global Health Law suggests that a full Republican control could lead to significant cuts in ACA outreach and Medicaid funding, ultimately impacting public awareness and enrollment in ACA plans. Legal challenges to the ACA's preventive services mandate, which covers crucial services like cancer screenings at no cost to the patient, are also ongoing.

Both Cox and Gostin anticipate a continued Republican effort to dismantle the ACA, reminiscent of Trump's first administration's actions, which included nullifying the penalty associated with the individual mandate. Although the complete elimination of the ACA seems unlikely, a "bare-bones version" might be all that survives, according to Gostin.