Donald Trump has long criticized the Affordable Care Act; He ran for and won the presidency in 2016 on a promise to “end” the Democrats' signature health care law. But after his victory, he and the GOP-controlled Congress repeatedly failed to repeal the legislation, as he promised. More recently, Trump announced on Truth Social that he remains committed to ending the law and “seriously considering alternatives,” adding: “We should never give up!”
Today, about 45 million Americans are covered under the ACA. More women — 62.4 million, according to a National Women's Law Center estimate — receive free contraception because of the law's contraceptive mandate. Before the Affordable Care Act, birth control represented 30 to 44 percent of women's out-of-pocket health care costs, according to a KFF analysis. After the legislation came into effect, the cost of all types of contraception decreased significantly, including the IUD, the cost of which decreased by 68%.
Project 2025 — the Heritage Foundation's blueprint for Trump's next term, compiled by the former president's closest allies and advisers — envisions repealing the ACA, ending the birth control benefits currently enjoyed by tens of millions of women. (Trump has repeatedly claimed, unconvincingly, that he “knew nothing” about the project.)
The 887-page policy agenda also explicitly calls for an end to free emergency contraception, on the grounds that it is a “potential abortifacient.” (This is not the case: emergency contraception interrupts ovulation to preemptively prevent pregnancy; it cannot terminate a pregnancy that is already underway.) An analysis by the Center for American Progress found that about 48 million women would lose access to emergency contraception under a conservative regime. 'He plans.
This prospect must be particularly frightening for the one in three women of reproductive age who live in states with abortion bans, for whom emergency contraception is one of the last options available to prevent an unintended pregnancy.
Elsewhere in the document, Project 2025 calls for restoring a Trump-era rule that allowed employers to opt out of birth control coverage if they had “religious or moral” objections (p. 483). It calls for changing the name of the Department of Health and Human Services to the “Department of Life,” and “explicitly rejecting the idea that abortion is health care” (p. 489). He also proposes preventing Medicaid funding from going to Planned Parenthood (p. 455).
Along with ending birth control, Trump's vice presidential nominee, Ohio Sen. J.D. Vance, has announced his and Trump's intention to end coverage for pre-existing conditions if elected.
At a campaign event in North Carolina last week, Vance said, “We will actually implement some regulatory reforms in the health care system that allow people to choose the health care plan that works for them,” adding that they envisioned a plan that would “allow people with… similar health conditions by being in the same risk groups” — meaning that sicker individuals and those with pre-existing conditions will be in different, more expensive insurance groups. (i.e. challenging the entire insurance point.)
“This is the biggest and most important thing we have to change,” Vance told the crowd.
