Registration for ‘Obamacare’ opens as Republicans threaten the health insurance program used by millions

WASHINGTON (AP) — Americans can get started to register Friday for health care coverage offered through the Affordable Care Act marketplace for 2025, days before a presidential election that could jeopardize eligibility and raise costs for millions of people in the program.

The future of “Obamacare” has emerged as a key issue in the final days of the presidential campaign, with a top Republican Party leader promising this week to overhaul the program if Republican Donald Trump wins the presidency.

Billions of dollars in tax credits are also at stake. Established during the COVID-19 pandemic, the fund has expanded eligibility to millions of Americans, made health insurance more affordable for many and dramatically increased enrollment.

Nearly all of the 21 million people in the program have benefited from these subsidies, which expire next year, U.S. Health and Human Services Secretary Xavier Becerra said in an interview with The Associated Press.

“Americans can actually look at health care not as a privilege, but now as a right,” said Becerra, who heads to the political swing state of Arizona on Friday to mark the start of open enrollment. “I don’t think anyone wants their right to affordable health insurance taken away from them.”

But major changes to the program are almost certain if Trump wins the White House and Republicans take control of Congress in Tuesday’s contentious elections. They are threatening to roll back “Obamacare,” a signature achievement of former President Barack Obama, a Democrat.

On Monday, a key Trump ally said, Speaker of the House of Representatives Mike Johnsondeclared “No Obamacare” during a campaign stop in Pennsylvania and promised “massive reforms” under a Trump presidency with a Republican-controlled Congress.

“Health care reform will be a big part of the agenda,” Johnson said in a video first obtained by NBC News.

Johnson’s office later issued a statement saying he had no plans to completely repeal the landmark legislation, but the comments still underscored how Johnson is working closely with Trump to potentially reshape the federal government and its social programs if the Republicans come to power.

Trump has said only that he has “concepts for a plan” to change the Affordable Care Act, which he was unable to successfully overturn during his previous term. In recent months, Republicans have raised concerns about spending and fraud.

Enrollments soared under the Biden administration, after years of declines during the Trump administration, and fell to a low of 11 million under Trump’s leadership. But taxpayers have had to put billions of dollars more into the Affordable Care Act to achieve that increase. That money helped pay for subsidies to cut premiums by nearly half for many of those enrolled in the program.

Congress would have to pass a new law to continue offering these subsidies, which could cost the same amount $335 billion in the coming decade. Some Republicans have already rejected that figure.

Democrats have warned voters that Republicans will try to revive an effort to repeal the Affordable Care Act altogether, with the warnings becoming increasingly dire as Election Day approaches.

In Wisconsin, Vice President Kamala Harris issued another warning, telling reporters that Johnson’s comments prove Republicans plan to cut health care coverage. “It’s been part of Donald Trump’s agenda for a long time,” Harris said. “He has made dozens of attempts to get rid of the Affordable Care Act. And now we have further validation of that agenda from its supporter, the Speaker of the House of Representatives.”

The Biden administration has expanded the program in other ways that Harris will likely continue but Trump will surely back away from. For example, the government has put more money into hiring health insurers to help people sign up for coverage.

The White House also implemented a new one rule That expands eligibility for the program to immigrants brought to the U.S. as children. About 100,000 of these immigrants, known as “Dreamers,” are expected to sign up for coverage for the first time during enrollment this year.

Republican attorneys general in fifteen states have done so indicted to block their registration.

Open enrollment for coverage ends on January 15, but to have coverage in the new year you must enroll by December 15.

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AP reporters Lisa Mascaro and Stephen Groves contributed to this story.