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The following is a list of plans which were considered to replace the Affordable Care Act (commonly referred to as the ACA or Obamacare) during the Donald Trump administration. The plans were considered after the Republican Party gained a federal government trifecta in 2016. "Repeal and replace" has been a Republican slogan since March 2010 when the ACA was signed into law and had been adopted by former President Donald Trump. [1]
President Donald Trump and many Republicans have vowed to repeal and replace Obamacare; President Trump signed an executive order on January 20, 2017, his first day in office, that according to White House Press Secretary Sean Spicer would "ease the burden of Obamacare as we transition from repeal and replace". Spicer would not elaborate further when asked for more details. [2] [3] [4]
On January 12, 2017, the Senate voted 51 to 48 to pass an FY2017 budget resolution, S.Con.Res. 3, that contained language allowing the repeal of the Affordable Care Act through the budget reconciliation process, which disallows a filibuster in the Senate. [5] [6] [7] [8] [9] In spite of efforts during the vote-a-rama (a proceeding in which each amendment was considered and voted upon for about 10 minutes each until all 160 were completed) that continued into the early hours of the morning, Democrats could not prevent "the GOP from following through on its repeal plans." [7] [10]
Several media outlets have reported widespread opposition in Congress and the American public against repealing the Affordable Care Act without replacing it. Barack Obama has stated that "The Republicans will own the problems with the health care system if they choose to repeal something that is providing health insurance to a lot of people". [11]
The proposed CARE Act reverts many of the benefits of the Affordable Care Act.[ citation needed ]
Senator Rand Paul had said he planned to introduce a replacement plan during the week of January 9, 2017. [12] One key provision in his plan was to offer cheaper, less robust insurance plans for people. [13]
Senators Susan Collins (Maine) and Bill Cassidy (La.) introduced their plan, the Patient Freedom Act of 2017, on January 23, 2017, which would offer states the option to retain the Affordable Care Act, if they chose, or receive a block grant to be used on an alternative plan they prefer. [14] [15]
A comprehensive plan to replace the Affordable Care Act was announced by the House Republican leadership on March 6, 2017. It retains many features of the Affordable Care Act, but replaces ACT's system of subsidies with tax credits and federally-funded Medicaid coverage with a system of block grants to states based on the nature and number of recipients served. Conservative critics such as Rand Paul characterized the plan as "Obamacare Light" and continued to advocate total repeal, while other Republicans such as Cory Gardner from states which had accepted Medicaid expansion expressed worry about whether the new plan would adequately fund services for Medicaid patients. [19]
The United States House Committee on Ways and Means approved one portion of the bill on March 9, 2017, after an all-night session. [20] The second portion of the bill was also approved March 9 by the United States House Committee on Energy and Commerce on a party-line vote. [21] On March 13 the Congressional Budget Office released its evaluation of the proposal. It projected a rise in uninsured by 24 million by 2028, but savings of $337 billion over ten years. In 2018, most of the reduction would be caused by the elimination of the penalties for the individual mandate, both directly and indirectly. Later reductions would be due to reductions in Medicaid enrollment, elimination of the individual mandate penalty, subsidy reduction, and higher costs for some persons. [22] [23] By 2016 the CBO estimates that the average amount paid for medical insurance would decrease by about 10%. That results from increased prices for older patients and reduced credits which is predicted to increase the proportion of younger people in the pool and reduce the proportion of older people. [24] [25] The bill was approved by the House Budget Committee 19 to 17 on March 16, 2017. Three members of the Freedom Caucus, Dave Brat (Va.), Mark Sanford (S.C.) and Gary Palmer (Ala.) voted against it. [26] It went next to the House Rules Committee, [26] then to the full House. [20] The bill, once it passed the House, would go to the Senate under budget reconciliation rules. Thus, only material which affects the budget can be included and only a simple majority vote will be required in the Senate. Despite his vow not to get involved into day-to-day politics former President Obama became a part of the discussion on March 23, 2017 (the seventh anniversary of ACA and one day prior to the vote on the American Health Care Act) by hailing among other things 20 million more people insured, preexisting conditions covered, young people staying on their parents' plans until 26, lowered costs for women's health care and free preventive care as progress due to the Affordable Care Act. [27] [28] On March 24, 2017, the bill was withdrawn by Speaker Paul Ryan (with the endorsement of President Donald Trump) after failing to gain enough support in the House of Representatives. [29]
On May 4, 2017, the United States House of Representatives narrowly voted to repeal the Patient Protection and Affordable Care Act and passing the American Health Care Act with a narrow vote of 217 to 213, sending the bill to the Senate for deliberation. [30] The Senate indicated they would write their own version of the bill, instead of voting on the House version. [31]
On March 7, 2017 Pete Sessions sponsored an alternate proposal to repeal and replace the Patient Protection and Affordable Care Act entitled the "World's Greatest Healthcare Plan of 2017". [32] The bill's current format removes the ACA's individual mandate, which taxed individuals without health insurance. Moreover, it maintains some aspects of the ACA including ensuring insurance coverage for pre-existing conditions, allowing children to stay on their parents' health care until they are 26 years old, and banning the use of lifetime spending limits by insurance companies. [33]
In response to the passage of the AHCA in the House, Republican leadership in the Senate stated that they would draft their own version of the legislation instead of bringing the House's version to a vote. Thirteen senators began meeting behind closed doors to draft the legislation. [34] The group was criticized for not including women senators. [35] [36] In a meeting of the Senate Finance committee, Senator Claire McCaskill asked chairman Senator Orrin Hatch why no congressional hearings had been held on the proposed legislation. [37] [38] Video of the exchange went viral. [39] In addition to forgoing normal hearings and legislative markup, Senate Republicans instituted new rules to limit the ability of reporters to ask senators about the legislation. [40] When asked if Senate Republicans planned to release the text of the bill to the public, a Senate aide told Axios, "We aren't stupid." [41] According to Don Ritchie, Historian Emeritus of the Senate, such a secretive process has not been seen in the Senate in over a hundred years. [42]
On June 16, 2017, a bi-partisan group of seven current governors sent a letter to Senate Majority and Minority Leaders Mitch McConnell and Chuck Schumer criticizing the House's legislation and requesting a bi-partisan effort in the Senate to reform healthcare. The signatories include Governors John Kasich (Ohio), Steve Bullock (Montana), Brian Sandoval (Nevada), John Bel Edwards (Louisiana), John Hickenlooper (Colorado), Charlie Baker (Massachusetts), and Tom Wolf (Pennsylvania). [43] [44]
On July 18, 2017, the healthcare bill in the Senate collapsed following the defections of Senators Mike Lee of Utah and Jerry Moran of Kansas, making them the third and fourth Republicans to defect. President Donald Trump expressed his disappointment and indicated he would "let Obamacare fail". [45]
On July 25, a procedural vote was passed by the Senate to begin debate on the healthcare bill, 51–50 with Vice President Mike Pence breaking the tie. The same day, the bill was soundly defeated 43–57, with nine Republicans defecting and no Democrats or Independents voting for the bill. As the effort to repeal and replace the Affordable Care Act was stalled, Senate Majority Leader Mitch McConnell scheduled a vote on a partial-repeal amendment. This too was defeated, 45–55, with 7 Republicans defecting. Subsequently, a "skinny repeal" of the healthcare bill was voted on in the early hours of July 28. The decisive vote against their own party's bill was cast by Senators John McCain, Susan Collins and Lisa Murkowski; their vote along with the Democrats defeated the bill 49–51.[ citation needed ]
On September 13, 2017, an amendment to the American Health Care Act, commonly known as Graham-Cassidy, was submitted. The bill is sponsored by Lindsey Graham of South Carolina, with Bill Cassidy of Louisiana as a co-sponsor. [46] A spokesman for the Senate Majority Leader Mitch McConnell said that a vote is planned for, before September 30 which is the deadline to pass bills under budget reconciliation. [47] [48] [49] Rand Paul and John McCain indicated that they would vote against the bill. [50]
On September 26, 2017, Senate Majority Leader Mitch McConnell announced that the Senate would not vote on the Graham-Cassidy bill. [51]
The Trump administration ended subsidy payments to health insurance companies, in a move expected to raise premiums in 2018 for middle-class families by an average of about twenty percent nationwide and cost the federal government nearly $200 billion more than it saved over a ten-year period. [52] The administration made it easier for businesses to use health insurance plans not covered by several of the ACA's protections, including for preexisting conditions, [53] and allowed organizations not to cover birth control. [54] In justifying the action, the administration made false claims about the health harms of contraceptives. [55]
The administration proposed substantial spending cuts to Medicare, Medicaid and Social Security Disability Insurance. Trump had previously vowed to protect Medicare and Medicaid. [56] [57] The administration reduced enforcement of penalties against nursing homes that harm residents. [58] As a candidate and throughout his presidency, Trump said he would cut the costs of pharmaceuticals. During his first seven months in office, there were 96 price hikes for every drug price cut. [59] Abandoning a promise he made as candidate, Trump announced he would not allow Medicare to use its bargaining power to negotiate lower drug prices. [60]
Shelley Wellons Moore Capito is an American politician and retired educator serving in her second term as the junior United States senator from West Virginia, a post she has held since 2015. A member of the Republican Party, Capito served seven terms as the U.S. representative from West Virginia's 2nd congressional district from 2001 to 2015. The daughter of three-term West Virginia governor Arch Alfred Moore Jr., she is the dean of West Virginia's congressional delegation.
Patrick Joseph Tiberi is an American lobbyist and politician who served as the U.S. representative for Ohio's 12th congressional district from 2001 to 2018. His district included communities north and east of Columbus. He is a member of the Republican Party, and previously served in the Ohio House of Representatives from 1993 to 2000. He briefly served as Chair of the new Republican Main Street Congressional Caucus from September 7, 2017.
Thomas Edmunds Price is an American physician and Republican Party politician who served as the U.S. representative for Georgia's 6th congressional district, encompassing the northern suburbs of Atlanta, from 2005 to 2017. While in Congress, Price chaired the House Committee on the Budget, Republican Study Committee and Republican Policy Committee. He was appointed Secretary of Health and Human Services by President Donald Trump and served in that role from February to September 2017.
Dean Arthur Heller is an American businessman and politician who served as a United States senator representing Nevada from 2011 to 2019. A member of the Republican Party, he served as the 15th secretary of state of Nevada from 1995 to 2007 and U.S. representative for Nevada's 2nd congressional district from 2007 to 2011. He was appointed to the U.S. Senate by Governor Brian Sandoval and elected to a full term in the 2012 election. Heller unsuccessfully ran for a second term in 2018, losing to Democrat Jacky Rosen. He was an unsuccessful candidate for governor of Nevada in 2022, and is currently the last Republican to win a Nevada U.S. Senate seat.
William Morgan Cassidy is an American physician and politician serving as the senior United States senator from Louisiana, a seat he has held since 2015. A member of the Republican Party, he served in the Louisiana State Senate from 2006 to 2009 and in the U.S. House of Representatives from 2009 to 2015.
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act (PPACA) and colloquially as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965.
The political positions of Paul Ryan, the U.S. representative from Wisconsin's 1st congressional district from 1999 to 2019 and the 54th speaker of the United States House of Representatives from 2015 to 2019, were generally conservative, with a focus on fiscal policy. Ryan was Chairman of the House Budget Committee from 2011 to 2015 and of Ways and Means in 2015. Ryan was the Republican nominee for Vice President as the running mate of Mitt Romney in the 2012 presidential election.
The Exchange Information Disclosure Act is a bill that would require the United States Department of Health and Human Services to submit weekly reports to Congress about how many people are using HealthCare.gov and signing up for health insurance. These reports would be due every Monday until March 31, 2015, and would be available to the public. The bill would "require weekly updates on the number of unique website visitors, new accounts, and new enrollments in a qualified health plan, as well as the level of coverage," separating the data by state. The bill would also require reports on efforts to fix the broken portions of the website.
David Edmund Young is an American politician who currently serves as a member of the Iowa House of Representatives from the 28th District, and previously served as the U.S. representative for Iowa's 3rd congressional district from 2015 to 2019. A member of the Republican Party, he is a native and resident of Van Meter, a western suburb of Des Moines. He was first elected in 2014 and reelected in 2016; he lost reelection in 2018 to Democrat Cindy Axne. Young unsuccessfully challenged Axne in 2020 in a rematch, losing by 1.3%.
Rodney Leland Blum is an American businessman and politician who served as the U.S. representative for Iowa's 1st congressional district from 2015 to 2019. A member of the Republican Party, he was first elected in 2014 and won a second term in the 2016 elections.
The 2017 United States federal budget is the United States federal budget for fiscal year 2017, which lasted from October 1, 2016 to September 30, 2017. President Barack Obama submitted a budget proposal to the 114th Congress on February 9, 2016. The 2017 fiscal year overlaps the end of the Obama administration and the beginning of the Trump administration.
The following is a list of efforts to repeal the Affordable Care Act, which had been enacted by the 111th United States Congress on March 23, 2010.
The American Health Care Act of 2017 was a bill in the 115th United States Congress. The bill, which was passed by the United States House of Representatives but not by the United States Senate, would have partially repealed the Affordable Care Act (ACA).
The "Jimmy Kimmel test" is a political litmus test used in political discourse in the United States during 2017 efforts to repeal the Affordable Care Act. First proposed by United States Senator Bill Cassidy, the test was used throughout 2017 to frame political debate over health care reform, and Cassidy's use of it in September 2017 prompted comedian and late-night talk show host Jimmy Kimmel to publicly attack a Senate health care bill co-sponsored by Cassidy. The resulting public debate contributed to the failure of the Senate bill.
Graham–Cassidy or Graham–Cassidy–Heller–Johnson is the common name for Senate Amendment 1030 to the American Health Care Act of 2017. S.Amdt. 1030 was introduced on September 13, 2017, sponsored by Lindsey Graham (R-SC), with Bill Cassidy (R-LA) as a co-sponsor, after whom the amendment is named. The other three co-sponsors are Dean Heller (R-NV), Ron Johnson (R-WI), and Roy Blunt (R-MO). The amendment would repeal the Affordable Care Act (ACA), also known as Obamacare. It would also return control of the Medicaid program to the states and cap the program's funding. The amendment would also redistribute federal money differently to different states, with some states that expanded Medicaid under the ACA losing federal money to states that did not.
The Executive Order Promoting Healthcare Choice and Competition, also known as the Trumpcare Executive Order, or Trumpcare, is an Executive Order signed by Donald Trump on October 12, 2017, which directs federal agencies to modify how the Patient Protection and Affordable Care Act of the Obama Administration is implemented. The order included a directive to federal agencies to end rules forbidding employers from using health reimbursement arrangements (HRAs) to pay individual insurance premiums.
The Bipartisan Health Care Stabilization Act of 2017 was a 2017 proposed compromise reached by senator and HELP Committee chairman Lamar Alexander and senator and HELP Committee ranking member Patty Murray to amend the Affordable Care Act to fund cost-sharing reductions subsidies. The plan will also provide more flexibility for state waivers, allow a new "Copper Plan" or catastrophic coverage for those under 30, allow interstate insurance compacts, and redirect consumer fees to states for outreach. President Trump had stopped paying the cost sharing subsidies and the Congressional Budget Office estimated his action would cost $200 billion, cause insurance sold on the exchange to cost 20% more and cause one million people to lose insurance.
The cost sharing reductions (CSR) subsidy is the smaller of two subsidies paid under the Patient Protection and Affordable Care Act (ACA) as part of the healthcare system in the United States. The subsidies were paid from 2013 to 2017 to insurance companies on behalf of eligible enrollees in the ACA to reduce co-payments and deductibles. They were discontinued by President Donald Trump in October 2017. The nature of the subsidy as discretionary spending versus mandatory was challenged in court by the Republican-controlled House of Representatives in 2014, although payments continued when the ruling in favor of the GOP was appealed by the Obama administration. The non-partisan Congressional Budget Office (CBO) estimated that ending the payments would increase insurance premiums on the ACA exchanges by around 20 percentage points, resulting in increases in the premium tax credit subsidies, thereby adding nearly $200 billion to the budget deficits over the following decade. Critics argued the decision was part of a wider strategy to "sabotage" the ACA.
The Patient Protection and Affordable Care Act, often shortened to the Affordable Care Act (ACA) or nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965. Once the law was signed, provisions began taking effect, in a process that continued for years. Some provisions never took effect, while others were deferred for various periods.
California v. Texas, 593 U.S. 659 (2021), was a United States Supreme Court case that dealt with the constitutionality of the 2010 Affordable Care Act (ACA), colloquially known as Obamacare. It was the third such challenge to the ACA seen by the Supreme Court since its enactment. The case in California followed after the enactment of the Tax Cuts and Jobs Act of 2017 and the change to the tax penalty amount for Americans without required insurance that reduced the "individual mandate" to zero, effective for months after December 31, 2018. The District Court of the Northern District of Texas concluded that this individual mandate was a critical provision of the ACA and that, with a penalty amount equal to zero, some or all of the ACA was potentially unconstitutional as an improper use of Congress's taxation powers.
A concurrent resolution setting forth the congressional budget for the United States Government for fiscal ...
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: CS1 maint: numeric names: authors list (link)The House Republican plan to repeal and replace the Affordable Care Act would raise the number of people without health insurance by 24 million within a decade, but would trim $337 billion from the federal deficit over that time, the nonpartisan Congressional Budget Office said on Monday.
CBO and JCT estimate that enacting the legislation would reduce federal deficits by $337 billion over the 2017-2026 period. CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.
The C.B.O. estimates that the price an average 64-year-old earning $26,500 would need to pay after using a subsidy would increase from $1,700 under Obamacare to $14,600 under the Republican plan.