The future of the Affordable Care Act (ACA), also known as Obamacare, has become a central topic in the upcoming presidential election. Former President Donald Trump, who previously sought to repeal the ACA, is now promising to improve and strengthen the law if he wins re-election in November. Trump’s comments have sparked debate with President Joe Biden, who has criticized Trump’s past attempts to dismantle the ACA and highlights his own efforts to support and enhance the landmark health reform law.
During his time in office, Trump faced challenges in replacing or substantially altering the ACA, as his powers were constrained by Congress and the positive reception of certain key provisions of the law, such as coverage for preexisting conditions and allowing young adults to stay on their parents’ insurance. While Trump made various changes to the ACA, they were mostly minor adjustments that did not significantly impact the core of the law. Despite this, the ACA exchanges stabilized during his tenure, with insurers returning to the market and premium costs declining.
The Trump administration took several actions to undermine the ACA, including reducing the open enrollment period, cutting funding for enrollment assistance, and eliminating federal subsidies that help low-income participants cover deductibles and out-of-pocket costs. Additionally, Trump expanded access to alternative insurance policies with lower premiums but fewer protections, such as short-term plans and association health plans. These actions created uncertainty in the marketplaces and drew criticism from experts for potentially weakening the ACA.
Trump’s administration also eliminated the individual mandate, which required most Americans to have health insurance, and supported a legal challenge to the ACA’s constitutionality. The Supreme Court ultimately upheld the law, and other changes implemented by Trump, such as allowing states to include work requirements for Medicaid enrollees, faced legal challenges and backlash from critics who viewed them as harmful to healthcare access. While some experts praised these changes as stabilizing the market, others argued they undermined the ACA’s goals.
As the presidential election approaches, Trump is once again promising to improve the ACA, but has not provided details on how he plans to do so. Given Biden’s reversal of many of Trump’s actions and the increasing popularity of the ACA, achieving significant changes to the law may prove difficult for Trump. With a record number of Americans now covered by the ACA through exchanges and Medicaid expansion, the law has solidified its place in the healthcare system. Experts question Trump’s ability to fulfill his promises and anticipate challenges in making substantial modifications to the ACA moving forward.
