Senate Majority Leader Charles Schumer (D-N.Y.) (right) attends an event commemorating the 14th anniversary of the passage of the Affordable Care Act at the U.S. Capitol on March 21 with House Minority Leader Hakeem Jeffries (N.Y.) state Democrats) to talk.
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“repeal and replace“For a long time republican mantra when it comes to Affordable Care Act.
Today, the situation is less serious.
‘I will not campaign to end Affordable Care Act’, former President Donald Trump wrote In a March Truth Society post. During the presidential debate on September 10, Trump again stated that he did not plan to cancel the plan. That is, unless he can “propose a plan that will cost our people, our people, less money and provide better health care than Obamacare.”
In a remarkable shift, one candidate said in October 2016 that real change “starts with the immediate repeal and replacement of the disaster known as Obamacare.”
It also shows how entrenched former President Barack Obama’s signature health care legislation has become in American life. A recent KFF poll showed that about 60% of Americans have a favorable view of the 2010 health care law established. record numbers In 2024, more than 20 million people signed up for coverage in the ACA marketplace.
But even as the existential threat to the program appears to recede, Republicans and Democrats remain deeply divided over the future role of the health care law, he said Cynthia CoxVice President and Director of ACA Programs at KFF.
“When you ask about ways to improve the Affordable Care Act, there are a lot of different interpretations of what that might mean,” Cox said. “One person’s advancement may be another person’s weakening.”
Here’s what could happen with Obamacare, depending on who wins the White House and which parties win majorities in the House and Senate in November.
Democrats will push to expand subsidies
Cox said if Democrats manage to maintain a slim majority in the Senate or overturn the Republican-controlled House, they will likely make extending the Affordable Care Act’s enhanced subsidies a top priority. The government-backed aid, initially passed during the 2021 pandemic under the American Rescue Plan and later extended in the 2022 Inflation Reduction Act, is expected to expire at the end of 2025.
For her part, Harris Made clear she wants to keep increased financial aidwhich significantly reduces the cost of insurance for people who buy plans ACA Market. According to a rough estimate provided by Cox, monthly premiums for an individual making $60,000 a year would now be $425, compared with $539 before the enhanced subsidy. Meanwhile, a family of four making about $120,000 a year now pays $850 a month instead of $1,649.
“No matter who wins the election, it’s unclear whether these subsidies will be extended,” Cox said.
Harris campaign spokesman Joseph Costello reiterated that the vice president wants to see the increased subsidies remain unchanged.
“Vice President Harris is working to improve health care and lower costs, and part of her plan includes providing permanent credits to lower health care premiums by an average of about $800 per year for millions of Americans,” Costello said.
The Harris campaign released a report Monday that paints a dire picture of health care under a hypothetical Trump administration. The campaign’s report is based on the conservative blueprint for governing “Plan 2025” (which Trump has denied) and the complete repeal of the Affordable Care Act (which Trump has backed down). Still, the report warned that if the most restrictive policies were adopted, about 500 rural hospitals could close and millions of Americans could lose health insurance.
The Trump campaign did not respond to a request for comment.
A pedestrian walks past Leading Insurance Company, which provides coverage under the Affordable Care Act, also known as Obamacare, on January 28, 2021, in Miami, Florida.
Joe Reddell | Getty Images
If Democrats succeed in maintaining the increased subsidies, Cox said they may turn their attention to deeper relief for marketplace policyholders. Especially since deductibles remain high. KFF says that by 2024, the average ACA plan deductible, or the amount a person must spend before coverage begins, will exceed $3,000, with some plans having deductibles exceeding $7,000 established.
“That’s probably where Democrats would be interested: increasing subsidies for cost-sharing assistance to lower deductibles,” Cox said.
The remaining 10 states Experts say states that have so far rejected the ACA’s Medicaid expansion could become another focus for Democrats.
Under Obamacare, the federal government provides nearly all of the funding to states to expand their eligibility pools Free health insurance. But in 2012, Supreme Court ruling Congress exceeded its constitutional authority by requiring states to expand Medicaid, one of the primary ways the law aimed to increase coverage.
But Democratic lawmakers could encourage holdout states like Texas, Wyoming and Florida to expand Medicaid coverage by closing the federal funding gap. Sabrina ColletteCo-director of the Center on Health Insurance Reform at Georgetown University’s McCourt School of Public Policy. Currently, the federal government covers 90% of the country’s expansion costs.
“Convincing these 10 states will help millions of people afford the medical care they need,” said Mark DuganWayne and Jody Cooperman Professor of Economics at Stanford University.
Republicans may try to cut program costs
Republicans and Trump also tend to complain that the Affordable Care Act is too expensive. But Cox said their focus is on taxpayers’ bills.
“This is often a bone of contention,” she said. “Who should spend this money: the federal government, or people who are sicker or uninsured?”
The easiest way to lower the program’s costs is to let the enhanced subsidies expire, she said, adding that “that could happen if Republicans hold on to the House or Senate.”
Permanently extending enhanced subsidies could cost about $25 billion a year, according to one agency. estimate By the Congressional Budget Office.
“That’s the concern Republicans have about extending the deadline,” Cox said.
Congressional Budget Office says about 3.8 million people will lose health insurance if aid is eliminated estimate. Those who maintain coverage may pay higher premiums.
When you ask about ways to improve the ACA, there are a lot of different interpretations of what that might mean.
Cynthia Cox
KFF Vice President and ACA Project Director
Experts say the Affordable Care Act’s expansion of Medicaid coverage could be another area targeted by Republican lawmakers and Trump for cost-cutting measures.
Recent Republican proposal calls for reducing federal funding for state Medicaid, says Robin Ludowitzis KFF’s Vice President and Director of Medicaid and Uninsured Population Programs. These plans could result in lower matching rates for federal funds to expand Medicaid coverage to 50% Start with 90%.
“This would be a huge cost shift, so states may face difficult decisions to limit coverage, leaving many in the expansion group without affordable coverage options and potentially going uninsured,” Ludowitz said.
Experts say the previous Trump administration also increased the availability of health insurance options that were not compliant with the Affordable Care Act, including short-term plans. A resounding Republican victory in November could lead to a repeat of the same situation.
Supporters of these plans say they allow insurance companies to offer consumers lower monthly premiums because they don’t need to cover as many services, Cox said. At the same time, these plans can turn away people with pre-existing conditions or charge them more. During Trump’s term, enrollment rates short term plan spiked.
That’s a troubling dynamic for supporters of the Affordable Care Act, Corlette said. Collette said that’s because these programs “suck” younger, healthier people from the market.
“The risk is that Affordable Care Act plans will only serve patients, and that’s not a sustainable insurance market,” she said. “Over time, premiums for Affordable Care will continue to rise.”
Republican vice presidential candidate Sen. J.D. Vance recently hinted at creating a health care system that echoes the concerns Collette expressed.
“We’re going to actually implement some regulatory changes in the health care system that will allow people to choose the health care plan that’s right for them,” Vance said at a campaign rally in Raleigh, North Carolina, in September.
The Ohio senator said they “allow people with similar health conditions to be in the same risk pool.”
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