When the subject of health care comes up, terms like “Trumpcare” and “Obamacare” often do too. These names refer to enacted or attempted health care legislation under President Donald Trump and President Barack Obama, respectively.
Trumpcare is most often associated with the American Health Care Act (AHCA), which was the initial health care legislation introduced by the Trump administration in 2017.
There have been two additional health care bills introduced since 2017, neither of which have ultimately been successful in becoming law.
Trumpcare (AHCA) vs. Obamacare (ACA)
President Trump’s health care legislation has largely targeted the Affordable Care Act (ACA), which is also called Obamacare.
President Trump campaigned on a platform to “repeal and replace” Obamacare, which referred to repealing the ACA and replacing it with a bill of his own.
Is the American Health Care Act (AHCA) in effect?
Trumpcare (the American Health Care Act) was introduced in 2017, but it did not become a law.
This bill passed through the House of Representatives but was voted down by a Republican-controlled Senate.
Below is a brief summary of some of the American Health Care Act’s features.
- Elimination of the individual mandate
The individual mandate was the cornerstone of the ACA. Obamacare’s individual mandate required people to maintain at least a minimum level of health insurance or else face a tax penalty from the IRS. - Replace subsidies with tax credits
Trumpcare aimed to replace Obamacare government subsidies to help low-income individuals afford health insurance premiums with tax credits for anyone not covered by their employer or through government health insurance. - Allow waivers for essential health benefits
Obamacare required all health insurance policies to provide coverage of “essential benefits” that included maternity care and mental health, even for beneficiaries who didn’t need those benefits.
The AHCA would have allowed states to apply for waivers to avoid providing coverage for those benefits. - Remove protections for pre-existing conditions
The ACA prevented health insurers from charging higher premiums to people with pre-existing conditions.
Trumpcare would have allowed states to obtain waivers for private insurance companies to charge people more for pre-existing conditions according to risk pools. - Increase the rate at which older adults may be charged for insurance
One potential effect of the AHCA was that insurance premiums for older adults could increase to the three times to five times the rate of healthy younger adults. - Repeal Medicaid expansion
The AHCA was set to repeal certain Medicaid expansions and replace them with a fixed amount per beneficiary or a lump-sum block grant for states.
In addition, Trumpcare would allow states to require able-bodied Medicaid recipients to work, participate in job-training programs or help with community service. - Expand contributions to Health Savings Accounts
Trumpcare proposed to nearly double the maximum contributions that could be made to HSA accounts. - Eliminate certain taxes
Trumpcare proposed to eliminate some taxes on certain health insurance plans, prescription drugs and medical devices.
Additional Trump Administration attempts for health care reform
After the AHCA failed to pass in the Senate, the Trump Administration proposed two additional health care reform bills.
The Better Care Reconciliation Act
The Better Care Reconciliation Act (BCRA) was a revised edition of the AHCA and represented the second attempt at installing Trumpcare.
This bill was similar to the AHCA but kept some of the features of Obamacare, such as tax provisions to help pay for low-income insurance premiums.
The BCRA was never voted on in its original form as it became clear the bill would not pass Congress due to opposition from several Republican senators.
The Health Care Freedom Act
The Health Care Freedom Act (HCFA) was dubbed the “skinny repeal” because it aimed to only eliminate the individual and employer mandates included in Obamacare, as opposed to a complete repeal of the ACA.
The HCFA was rejected in the Senate after three Republican senators (along with all Senate Democrats) voted against it.
Continued efforts to repeal Obamacare
After three versions of Trumpcare failed to move forward in a Republican-controlled House and Senate in 2017, Democrats regained control of the House after the 2018 midterm elections.
Without the support needed to pass a bill that would repeal and replace Obamacare, President Trump turned to other measures to chip away at the ACA.
The Tax Cuts and Jobs Act is the most notable of those efforts.
This tax reform bill was passed by President Trump in late 2017. It included the elimination of the tax penalty required for those who did not maintain health insurance, otherwise known as the individual mandate that served as the foundation of Obamacare.
Trumpcare and Medicare
The Congressional Budget Office (CBO) estimated that a full repeal of the ACA would increase Medicare spending by $802 billion between 2016 and 2025.1
The increased spending would center mostly around higher payments to health care providers and Medicare Advantage plans.
Trumpcare in 2020
With Democrats in control of the House of Representatives in 2019, President Trump has indicated that he would likely wait until after the 2020 presidential election to take another aim at health care reform.²
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