After eight years of threatening to repeal the Affordable Care Act, better known as Obamacare, former President Donald Trump still doesn't have a comprehensive plan to replace it.
Experts doubt that will happen under a second Trump administration, given the difficulty of crafting a policy that will satisfy all parties and the former president's lack of a concrete plan.
“It’s hard to find any meat on the bones,” said John A. Graves, a professor of health policy and medicine at Vanderbilt University School of Medicine. “It’s just bluster and can-kicking.”
For Tuesday Debates In a conversation with Vice President Kamala Harris, Trump said he had a “concept plan” to replace the health care law, promising to do so at a lower cost.
“We're working on it. We're going to do it. We're going to replace it,” Trump said. “We're looking at different plans. If we can come up with a plan that's cheaper for our people, for our population, and better than Obamacare, then I would do it.”
His latest idea, a more affordable health care law, may seem compelling, especially given how much health care costs in the United States are growing faster than the economy as a whole. People in the USA pay about twice as much for health care than any other nation on earth.
But is it possible to create a new health care law that will reduce rising costs?
“Right now, Obamacare is the status quo in health care,” said Larry Levitt, executive vice president of health policy at KFF, a nonprofit group that researches health policy issues. “Any plan to replace the ACA will involve compromises, winners and losers, and you can bet the losers will be screaming.”
A significant amount of money
The Affordable Care Act has provided health insurance to about 50 million Americans — about one in seven people — over the past 10 years, according to data. US Department of the Treasury. In 2024 A record 21 million people signed up for the ACA, including more than 5 million people who were newly covered.
And there is widespread support for this.
Under the health care law, the federal government pays for expanded Medicaid coverage and premium subsidies that make monthly out-of-pocket costs more affordable. Under the Inflation Reduction Act signed into law in 2022, those subsidies were expanded to include middle-income people — those whose incomes are four times the poverty level, or $103,280 for a family of three in 2024.
All of this costs the government “a significant amount of money,” Levitt said.
The health care law is expected to cost the federal government about $631 billion over the next five years, according to Congressional Budget Office.
“Republicans and Trump have talked in the past about cutting the amount the government spends on the ACA, but the downside of that would be that families would end up paying more and fewer people would have health insurance,” Levitt said.
Republicans in Congress have several competing plans to change or repeal the law, Graves said.
This includes The plan was published in March The Republican Study Committee, a caucus of conservative House members, would repeal the ACA’s subsidies and rules aimed at expanding coverage. It would also transform Medicaid from an entitlement program to a block grant system. Block grants give states more flexibility in how they run their programs, but they also typically provide limited funding and can limit eligibility for enrollees.
The study committee estimated that its plan would save the federal government more than $4.5 trillion over 10 years.
Gerard Anderson, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, said the idea of repealing the ACA and implementing a block grant system has been around for a long time. Under the Republican plan, “states would get less and less money as health care grows faster than inflation.”
Graves said this would have “huge implications for patients.”
Center for Budget and Policy PrioritiesThe think tank estimates that this could result in the loss of coverage for tens of millions of Medicaid recipients, as well as 4 million people covered by the Affordable Care Act.
It's unclear how else Trump plans to cut spending during his new term, Graves said.
A look into the past
Jill Horwitz, the David Sanders Professor of Law and Medicine at the University of California, Los Angeles School of Law, said it's possible to gauge how Trump could save money by looking at the actions he's taken during his administration.
“We've already seen the Trump movie, so voters should expect more of what we've already seen,” Horwitz said.
Under the Trump administration, the number of uninsured people has increased by more than 2.3 million, and grants to groups that help people get health insurance have been cut. Out-of-pocket costs have risen, and the number of short-term health insurance plans, which often offer lower monthly premiums for less coverage, has expanded, Horwitz said.
“She hasn’t focused on fixing the problems with the Affordable Care Act, on increasing coverage, on making care more efficient and effective, like most administrations have,” Horwitz said. “Instead, she has spent resources weakening protections for access to care for some of the most vulnerable people in the country.”
Graves said the winner would need to extend the expanded subsidies under the Affordable Care Act, which expire at the end of 2025 unless Congress extends them again. Harris has pledged to extend the subsidies; Trump has remained silent.
Levitt said it would be difficult to come up with a replacement that “makes everyone happy and doesn't make things worse for many.”
“Trump has always wanted to sprinkle fairy dust on Obamacare and make it better for everyone, but that's just not possible,” Levitt said.
This article was originally published on NBCNews.com