Trump repeatedly promised a “great” or “terrific” new health‑care plan to replace Obamacare, but never delivered one:
- Going back to his 2015 campaign, Trump said he would repeal and replace the ACA with “something terrific” and “something great,” yet he never released detailed legislation.
- In office, he promised a replacement plan multiple times—e.g., five times in 2020 alone—but it never materialized
- He did roll out executive orders focused on things like price transparency and ending surprise medical billing, but did not produce a cohesive replacement framework described in his campaign rhetoric
What exists now?
Under his post-2024 administration, Trump signed a sweeping “One Big Beautiful Bill” in July 2025. It:
- Slashes Medicaid funding by over $1 trillion,
- Adds work requirements and eligibility checks,
- Rolls back ACA subsidy enhancements,
- Cuts ACA access—leading the CBO to project 17 million people losing coverage
So while the rhetoric promised “phenomenal” change, the result was major cuts to health spending, not a new universal or ACA‑style plan.
QUINNSCOMMENTARY 
When you complain about the One Big Beautiful Bill, you suggest that maintaining the status quo, with its ~$2 Trillion a year in deficits is OK – deficits that were primarily the result of President Bush II and President Obama decisions to approve dramatic expansions in taxpayer subsidized coverage without approving new tax revenues – blowing the doors off in new, unprecedented levels of vote buying. Please post again this prior comment, slightly updated:
“… It is long past time to reform Medicaid, and Medicare!
From news reports: “… After a two year investigation, the U.S. Department of Justice announced what it called the largest coordinated health care fraud takedown in its history — 324 defendants charged in sweeping schemes spanning $14.6 billion in intended losses, from shady addiction treatment clinics to medically unnecessary skin grafts and catheter orders. It’s a massive win for taxpayers. But it’s also a glaring reminder that the U.S.’s fragmented, opaque and under-regulated health care system is fertile ground for fraud — whether it’s orchestrated by international criminal rings or by well-dressed executives at some of America’s largest health insurers. …”
Look no further than Congress to identify the true culprit, and, the only opportunity for a solution – and it surely isn’t some Medicare for All system.
My favorite predictions are those who claim 12 – 17 Million Americans will lose their Medicaid coverage. OK. No one scaled back the requirements beyond Health Reform – when we had 45 – 50 – 60 – 70 or so million on Medicaid/CHIP, including one of every five seniors.
So, a senior who met the low income requirements in the past is likely to continue to meet those requirements in the future – as they did not change.
What will change, however, is that 12 – 17 Million Americans who have Medicaid today will have to enroll in taxpayer subsidized exchange coverage (or their employer sponsored plan).
And, when President Biden’s extra-Health Reform subsidies, added after COVID was all but over, when they expire at the end of 2025, those who want exchange health coverage will have to pay the appropriate premiums that were part of President Obama’s Health Reform bill. Back to the future!
So, you now have Democrats complaining that President Obama’s Health Reform bill is somehow inadequate when it comes to providing taxpayer-subsidized health coverage.
How soon people forget that one of the main reasons why we have nearly $2 Trillion a year in annual deficits was because of Health Reform – the extension of Medicaid and taxpayer subsidized exchange coverage without any significant targeted specific new revenues. Similar to Bush II and Medicare Part D, taxpayer subsidized Medicare Rx coverage, without the addition, specified, targeted new taxes / funding source.
So much crap. …”
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“What will change, however, is that 12 – 17 Million Americans who have Medicaid today will have to enroll in taxpayer subsidized exchange coverage (or their employer sponsored plan).
And, when President Biden’s extra-Health Reform subsidies, added after COVID was all but over, when they expire at the end of 2025, those who want exchange health coverage will have to pay the appropriate premiums that were part of President Obama’s Health Reform bill.”
So, you assume those millions have the ability to pay without consequences and they merely scam the system? And what is your practical alternative for every income level to assure universal coverage?
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So, you assume those millions have the ability to pay without consequences and they merely scam the system?
Yes, they have the ability to pay, per the Health Reform rules. It was President Obama and the Democrats who decided what is “affordable” – not you and not me.
The consequences?
Well heck, they will have to prioritize health coverage if they want it … might have to forego a tatoo or two.
And what is your practical alternative for every income level to assure universal coverage?
I firmly believe in an individual mandate where everyone who is lawfully present must have coverage and must pay for health coverage, just as everyone should have to pay income taxes if they have income, sales taxes if they buy something, etc.
You’ve seen my proposal – it is better than any crap the idiot Trump could come up with. And, it is certainly better than the status quo Obama/Biden mess.
The goal would be to STOP adding to our annual deficits and national debt. Here’s how:
Universal coverage: Taxpayers fund a stop loss with a per capita premium with an annual, per person, attachment point of $25,000. That would likely cost about $25 a month, per person, $300 a year, generating a little over $100 billion a year. It would include every lawfully present American – including those in Medicare, Medicaid, public exchange, VA, individual coverage, employer plans.
Expenses in excess of the attachment point would be paid using Medicare allowable rates. Employers could pay the stop loss premium on behalf of their employees, spouses and dependents. Otherwise, every individual must pay the premium. Unpaid premiums are itemized on the annual return, and they become a tax due. As a tax, the sum is not dischargeable in bankruptcy. So, it will accumulate interest at the IRS until it is paid. IRS will automatically place a levy on all future wages until paid.
Basic coverage: Employer sponsored plans would continue, as would Medicare and Medicaid. Exchange coverage would continue. Individual coverage would continue. VA coverage would continue.
The minimum coverage would be a HSA-capable Exchange option – individual coverage with a $2,000 a year deductible, then 80%/20% coinsurance. Preventive, primary care, pediatrics, and OB/GYN physician services as well as generic Rx expenses all paid at 100% Medicare allowable.
The premium for the default coverage would be age rated in five year quinquennial cohorts. Because of the deductible and the stop loss, as well as the universal coverage requirement, there won’t be any anti-selection, so the cost of that coverage should be less than $100 a month for individuals under age 30, less than $200 a month for individuals ages 30 – 39, less than $300 a month for individuals ages 40 – 49, $400 a month for individuals ages 50 – 59 and $500 a month for individuals ages 60+.
Exchange premiums would be 100% federal income tax deductible, above the line, where any unused deduction would carry forward to a future tax year.
Remember that, as recently as 2021, the median out of pocket medical spend per person per year was less than $200. https://www.healthsystemtracker.org/indicator/access-affordability/out-of-pocket-spending/#Share%20of%20population%20by%20amount%20of%20out-of-pocket%20spending,%202021
Every American would be defaulted into the HSA-capable exchange option. Any American who can prove that they have other coverage (Medicare, Medicaid, VA, military, employer, individual) could opt out of the exchange coverage. Individuals eligible for an employer sponsored plan are not eligible to opt out and enroll in Exchange coverage. There is no employer mandate – existing tax preferences for employer-sponsored coverage remain in effect.
Any American who could post a $25,000 bond or who could show a $25,000 HSA account balance could elect to waive basic coverage and self-insure up to the stop loss attachment point.
Eligibility for Medicaid would be returned to pre-Health Reform levels – living below the poverty line (adjusted for household size). Medicaid would not be available to able bodied adults – even if a full time student, a parent, etc.
The individual coverage mandate would apply to all “lawfully present” in America – as defined in Health Reform.
Anyone who is not lawfully present would not be eligible for coverage, and, they would be excluded from EMTALA – the Emergency Medical Treatment and Labor Act requirements for hospitals to treat anyone/everyone. Hospitals could still voluntarily treat anyone they want, but there would be no state or federal funds.
So, hospitals and physicians would have the certainty of receiving payment for services rendered, albeit sometimes at rates less than they prefer to charge.
Sounds tough compared to the stupidity of President’s Obama and Biden, but, still better than what was in place prior to Health Reform.
Best part, universal coverage will immediately start to lower annual deficits.
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