I will be the first to acknowledge that the Affordable Care Act is not perfect, what federal law is? However, it isn’t likely we will get to the eventual answer any time soon – yes, that is a form of Medicare for all.
That means we need Obamacare, tens of millions of Americans need Obamacare. What we don’t need is fifty different approaches administered by the states.
The problem is that neither Trump nor his confidants understand health insurance or health care or people, but are simply obsessed with keeping government out of the picture and naively believing consumerism, competition, and freedom of choice will solve our problems.
They haven’t and they never will!
The Affordable Care Act, aka Obamacare
One of Trump’s biggest political failures as president was his inability to persuade Congress to repeal the Affordable Care Act (ACA). However, the Trump administration did make significant changes to the ACA, including repealing the individual mandate penalty, reducing federal funding for consumer assistance (navigators) by 84% and outreach by 90%, and expanding short-term insurance plans that can exclude coverage of preexisting conditions. And, the Trump administration supported an ultimately unsuccessful lawsuit to overturn the ACA.
In one of the stranger policy twists, the Trump administration ended payments to ACA insurers to compensate them for a requirement to provide reduced cost sharing for low-income patients. At the time, Trump said this would cause Obamacare to be “dead” and “gone.” But, insurers responded by increasing premiums, which in turn increased federal premium subsidies and costs to the federal government, likely strengthening the ACA.
In the current campaign, Trump has vowed several times to try again to repeal and replace the ACA, saying he would create a plan with “much better health care.”
Although the Trump administration never released a detailed plan to replace the ACA, Trump’s budget proposals as president included plans to convert the ACA into a block grant to states, cap federal funding for Medicaid, and allow states to relax the ACA’s rules protecting people with preexisting conditions. If approved by Congress, his plans would have reduced federal funding for health care by more than $1 trillion over a decade.
In contrast, the Biden administration has reinvigorated the ACA by restoring funding for consumer assistance and outreach and by increasing premium subsidies to make coverage more affordable, resulting in record enrollment in ACA Marketplace plans. The increased premium subsidies expire at the end of 2025, so the next president will be instrumental in determining whether they get extended.
The ACA is now much more popular than before the Republican repeal effort in 2017, though not with Trump’s Republican base. It is impossible to know if his previous proposals would resurface during a second Trump presidency, or if his comments are mainly meant to rally his voters.
JAMA
Read more about the possibilities of a Trump version of health care.
QUINNSCOMMENTARY 
Sorry, since 2010 Health Reform, over the last 13 years, once we added a new entitlement to taxpayer subsidized coverage, we have added $21+ Trillion to our national debt.
Americans want the best health care YOUR money will buy.
Prior to health reform, less than 10% of the uninsured were rejected for pre-ex. Of the uninsured, less than 10% lacked the financial capability to purchase health insurance – mostly people in New York, New Jersey, and Washington and the other states that had destroyed their individual health insurance market via mandates, etc.
In fact, when they added the Pre-existing Condition Insurance Plan in 2013, they only got about 100,000 to enroll – not the tens of millions who the Obama Administration said were turned away by the Big Bad Insurance Companies.
Who profited from taxpayer subsidies? Look at health insurer profits – up dramatically – they are on the crack pipe of taxpayer subsidies.
As the former director of HHS said, health reform is inherently redistributive.
Get ready to dig deep in YOUR pockets.
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Seems like you are arguing for one risk pool, and paying for health care on a uniform income based method.
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No. Each should be responsible for everyday/regular spend – insured or self fund up to $25,009/person/year.
Socialized Stop loss with per capita monthly premium for all spend > attachment point. Social funding per capita, where excess charges over attachment limited to Medicare or Medicaid allowable expenses. No one gets free ride. All covered by default. Unpaid premiums accumulate with interest. No exceptions.
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That has never been, is not and never will be reality. So, you are saying a family with two children should be liable for up to $100,000 a year in medical bills?
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Yes, either self insure or insure. They are liable for that and even more today. They walk into the hospital and sign on as financially responsible. All you need is a few days in the hospital. A major illness and some surgery – it is why we buy insurance.
What I am saying is that society should not be responsible for first dollar – all expenses should not be socialized – same as for food, housing, transportation, incomes, etc.
I reject “from each according to his ability to each according to his needs.”
The individual can lower the “attachment” point be buying health insurance.
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If we’re going to socialize medicine, then let’s stop pretending that we are the “Land of the Free” and just do it. It’ll make government even more powerful and there will be more opportunities for abuse and fraud at the same time, but let’s stop pretending and at least force government to be honest about where they are leading this country. And at the same time, let’s see where we are after all the rich people move somewhere else and we run out rich people to tax.
Let’s also force people to take better care of themselves by making preventive care – eating right, exercise, stress management, stuff like that – a mandatory part of Obamacare. You want government help? Then take better care of yourself. It’s past time for us to stop letting people eat at a fast-food restaurant three times a day while they eat a million grams of sugar between meals, then telling them that their poor health isn’t their fault while the medical system and Big Pharma rake in the profits for their pills.
Show some true leadership if you want more of my hard-earned money to pay for you to stay in power, politicians. Make people do the right thing. I’ll be happy to see people get help for medical conditions that happened in spite of people taking care of themselves but am tired of tax money going to treat stuff that could have easily been prevented if you stayed away from the mall food court.
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We are not going to socialized medicine. But we need one system that automatically covers everyone. The individual decision not to be insured is not valid as the cost of care is always going to be paid by someone
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I am really curious where the rich people will run to? It is a legitimate problem for some countries in the EU with high tax rates, but in the U.S. we have record low tax rates, both compared to historical U.S. standards and other OECD countries.
I agree with you about asking more from the public in terms of their own health. Unfortunately this is a non starter for the libertarian crowd who wants to have their cake and eat it too (literally)
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I don’t know anything about the ACA since it came along after I was on Medicare and I didn’t have a dog in that hunt. All I know since is anecdotal stuff from relatives and a few friends. From what I can understand when they speak of this plan or that, is that they pay exorbitant fees for what is not any improvement over where they were before. I also know that the states were exhorted to expand Medicaid to a larger population when the plan was in final stages. None of this made a favorable impression of ACA on me. What is it that makes it such a centerpiece of the Obama administration and the Democratic Party?
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Because it significantly decreased the amount of Americans with no health insurance, which is absolutely life changing in some cases.
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Your blog is always interesting and insightful. Many of my friends assert they don’t believe in “socialized” medicine. When I ask them: “so when will you be declining Medicare?” (I am 70). I usually get wide eyes and a blank stare in response!
In your commentary today, you note that the ACA is not popular with the Trump base. given the socio-economic status of some of those voters do you have any idea if or how they are funding their healthcare? Or, are they just praying they don’t get sick? Living without some sort of a safety net has got to be incredibly stressful and could lead one down a lot of rabbit holes of relying on false hope and empty promises.
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That is a great point. With Trump supporters skewing to lower income and less educated individuals, there seems like a natural fault line between Trump’s stated willingness to cancel programs beneficial to these groups to support more tax cuts for the rich.
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ACA is even farther from socialized medicine than Medicare which also is not socialized medicine.
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Thank you. I know I say that to be provocative. Yet, I can’t help but think that many Americans are just getting their news and information from their preferred news silos without exercising any independent thought. For me, I would love a referral to a source that explains these differences (socialized, Medicare, ACA). Again. thank you.
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It’s quite simple. Medicare is government run insurance, not controlling health care being provided, not setting budgets for hospitals, etc. and relying in part on private insurance – Medigap coverage, Medicare Advantage, Part D. ACA is merely an insurance aggregator to ease purchase of private insurance with no control over care and limited over the insurance offered.
Socialized medicine is what they have in England where virtually all providers are paid by government, where services and resources are controlled by government. Nobody is actually proposing that for the USA.
Anyone who says Medicare is socialized medicine has no idea what they are talking about.
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When trump was first elected with control of the house and senate I thought we’d finally see that republican plan to replace the ACA that the house was so passionate about that they voted 40 times under Obama to repeal and replace. Now the always a few weeks into the future health plan is right next to infrastructure month on the shelf of empty promises.
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