Eight years after former President Donald Trump threatened to repeal the Affordable Care Act, better known as Obamacare, he still has no comprehensive replacement.
Experts say it’s difficult to come up with policies that please all political parties, and given the former president’s lack of a concrete plan, it’s unlikely a second Trump administration would achieve that.
“It’s kind of hard to put meat on the bones,” said John A. Graves, a professor of health policy and medicine at the Vanderbilt University School of Medicine. “It’s just bluffing and procrastination.”
During Tuesday night’s debate with Vice President Kamala Harris, President Trump claimed he had a “vision plan” to replace the health care law and promised to do it at a lower cost.
“We’re working on it right now. We’re going to do it. We’re going to replace it,” Trump said. “We’re looking at different plans. If we can come up with a plan that’s less expensive for our people, our citizens, and better than Obamacare, I would certainly do it.”
His latest proposal, the Affordable Care Act, specifically calls for the U.S. to pay $1.2 billion in medical costs. It’s growing faster than the economy as a whole. People of the United States Pay almost twice as much for medical expenses More than any other country on earth.
But is it feasible to enact a new health care law that will reduce soaring health care costs?
“Obamacare is the status quo in health care right now,” said Larry Levitt, executive vice president of health policy at KFF, a nonprofit that studies health policy issues. “Any ACA replacement comes with trade-offs and winners and losers, and the losers are sure to be the loudest.”
A considerable amount
The Affordable Care Act has provided health insurance to about 50 million Americans (about 1 in 7) over the past decade. Ministry of Finance. By 2024 A record 21 million people signed up The ACA’s coverage includes more than 5 million people who are newly insured.
And it has widespread support.
Under the health care law, the federal government pays for the expansion of Medicaid coverage and premium subsidies to lower monthly out-of-pocket costs. Under the inflation-control law of 2022, those subsidies are limited to middle-income earners, or those who earn more than four times the poverty level. $103,280 for a family of three in 2024.
All of this will cost the government a “significant amount of money,” Levitt said.
The health law is expected to cost the federal government about $631 billion over the next five years. Congressional Budget Office.
“Republicans and President Trump have talked in the past about reducing government spending on the ACA, but the flip side of that would mean families would pay more and fewer people would have health insurance,” Levitt said.
Graves said congressional Republicans have offered several competing plans to amend or repeal the law.
This includes Plans announced in March The bill, introduced by the Republican Study Committee, a caucus of conservative House Republicans, would repeal ACA subsidies and regulations designed to expand insurance coverage. It would also convert Medicaid from a benefit system to a block grant system, which gives states more flexibility in running their programs but typically has limited funding and can limit who can enroll.
The study committee estimates that the plan could save the federal government more than $4.5 trillion over 10 years.
The idea of watering down the ACA and replacing it with block subsidies has been around for a while, said Gerald Anderson, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. Under the Republican plan, “states would continue to get less and less funding as health care costs rise faster than the rate of inflation.”
Graves said this “means a lot to patients.”
Center on Budget and Policy PrioritiesThe think tank study said the bill could cause tens of millions of Medicaid recipients to lose their insurance and up to 4 million people covered by the Affordable Care Act.
Graves said it was unclear what other ways Trump might try to cut costs during his new term.
Looking back
Jill Horowitz, the David Sanders professor of law and medicine at the UCLA School of Law, said actions taken under the Trump administration may indicate how much money he can save.
“We’ve seen Trump movies before, so voters should expect more of what we’ve seen,” Horowitz said.
Under Trump, the number of uninsured people increased by more than 2.3 million, subsidies to groups that help people get health insurance were cut, out-of-pocket costs increased and the number of short-term health insurance plans, which often have lower monthly premiums and less coverage, grew, Horowitz said.
“He didn’t focus, as most administrations do, on fixing the problems with Obamacare, expanding coverage, or making health care more effective and efficient,” Horowitz said. “Instead, he spent resources hollowing out health care access protections for the nation’s most vulnerable people.”
Graves said whoever wins will need to extend enhanced subsidies under the Obamacare law, which are set to expire at the end of 2025 unless Congress extends them again. Harris has pledged to extend the subsidies, while Trump has remained silent.
Levitt said it would be difficult to find an alternative that “pleases everyone and doesn’t disadvantage a lot of people.”
“Trump has always wanted to sprinkle magic dust on Obamacare and make it better for everyone, but that’s not possible,” Levitt said.
