Former President Donald Trump, the presumptive Republican presidential nominee, is zeroing in on one familiar campaign promise: He wants to repeal the Affordable Care Act. In the months since Trump first reignited calls to “terminate” the ACA, he has repeated his public attacks at least seven times. Once again, we are facing a grave threat to American health care and to millions of families’ financial security.
Once again, we are facing a grave threat to American health care and to millions of families’ financial security.
Some have been quick to dismiss Trump’s recent comments as an empty threat. This is a mistake. During his time in office, Trump successfully undermined the law, leading to a drop in enrollment, and weakened protections for people with pre-existing conditions. He was just one vote short of total ACA repeal in 2017, and now, the Republican Party has only grown more extreme and motivated to fall in line with Trump.
Fourteen years after it was signed into law, the ACA is woven into the fabric of our lives. The law is more popular than ever: A record 21.3 million people signed up for ACA coverage for 2024. By passing the Inflation Reduction Act, President Joe Biden and Democrats in Congress helped millions of families find a plan at little to no cost. Additionally, the Biden administration made historic investments in education and outreach to make it easier for people to enroll — a stark contrast to Trump, who routinely slashed this funding during his time in office.
The ACA also includes a broad range of cost savings and protections that touch nearly every household in the country. For example, the ACA ensures that over 135 million Americans with pre-existing conditions won't be discriminated against by insurance companies, allows children to stay on their parents’ coverage until the age of 26, lowers prescription drug costs for 52 million seniors, and requires that insurance companies cover critical preventive care, such as vaccinations, contraception and cancer screening.
Through a deliberate sabotage campaign, the Trump administration weakened protections for people with pre-existing conditions, made it harder to enroll in affordable coverage, and raised health care costs for millions of people. Trump expanded access to short-term and association health plans that can deny coverage for people with pre-existing conditions. As a result, ACA enrollment fell and people were pushed into junk plans that didn’t need to cover essential care, like hospital visits or prescription drugs. Millions of people became uninsured or underinsured, leaving families with staggering bills for uncovered care.
In a hypothetical second Trump term, he would only continue this assault on health care. Even if full repeal “fails,” Trump and Republicans will still gut the law and take affordable quality health care away from millions. Under the guise of offering cheaper insurance, Republicans could revisit their efforts to expand junk plans that don’t cover pre-existing conditions. The GOP could also return to its long-time goal of cutting Medicaid through block grants and burdensome paperwork requirements, pushing people off the rolls. Other actions to undermine the ACA include cutting funding for the navigators who help people enroll in coverage, and boosting tax breaks for the wealthy through health savings accounts.
Trump could also leverage his influence in the courts. Several lawsuits are underway that could dismantle the ACA’s requirement that insurers cover lifesaving preventive care and rip away Medicare’s power from negotiating lower drug prices. While the Biden administration is fighting tirelessly to protect patients in the courts, Trump could simply decide not to defend the ACA and the Inflation Reduction Act against these legal attacks.
The bottom line is that we must take seriously Trump’s promises to repeal and sabotage the ACA.
The bottom line is that we must take seriously Trump’s promises to repeal and sabotage the ACA. He wants to reverse a loss that he describes as a “horrible thing that happened to the Republican Party.” This is personal for Trump — he wants to get back at the late Sen. John McCain, his predecessor, President Barack Obama, and other political enemies. And we know MAGA Republicans will follow him until the bitter end.
Biden has shown what it means to make health care better. He has lowered prescription drug and insurance costs, helped families enroll in coverage, and taken on big drug companies and other corporate interests. Trump’s plan to further weaken health care will only take us backward, leave millions of Americans with pre-existing conditions without affordable care, and throw the entire health care system into chaos.