To hear Republican nominee Donald Trump and his running mate JD Vance tell it, he wasn’t trying to eliminate the Affordable Care Act as president. He “saved” it.
In the presidential debate and in recent TV interviews, Trump and Sen. Vance, R-Ohio, have depicted the former president as selflessly choosing to protect the ACA, or “Obamacare,” during his four years in office as a way to put country over politics.
“Obamacare was lousy health care. Always was. It’s not very good today. … I had a choice to make when I was president: Do I save it and make it as good as it can be? Never going to be great. Or do I let it rot? And I felt I had an obligation, even though politically it would have been good to just let it rot and let it go away,” Trump said at the recent ABC News debate with Vice President Kamala Harris, the Democratic nominee. “And I saved it. I did the right thing.”
On NBC’s “Meet The Press” on Sunday, Vance echoed his remarks by saying Trump “actually protected those 20 million Americans from losing their health coverage” and “chose to build upon” the ACA when he “could’ve destroyed” it. Vance added: “It illustrates Donald Trump’s entire approach to governing, which is to fix problems.”
Both Trump and Vance are misrepresenting the facts.
As president, Trump fought to repeal and undo the ACA using executive action, legislation and lawsuits.
Decision 2024
“Trump was not successful as president in undoing the ACA, but it was not for lack of trying,” said Larry Levitt, executive vice president for health policy at KFF, a nonpartisan research group. “Trump encouraged congressional efforts to repeal and replace the ACA, and then took administrative steps to try to weaken it when the legislative route failed.”
On his first day in office, Trump signed an executive order proclaiming: “It is the policy of my Administration to seek the prompt repeal of the Patient Protection and Affordable Care Act.”
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He ordered agencies to “exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation” of provisions they deemed burdensome.
Trump made good on his promise to pursue repeal. It was the first major item on the Republican-led Congress’ agenda in 2017. In May, the House passed the American Health Care Act, a bill to undo ACA subsidies and regulations, which was projected by the nonpartisan Congressional Budget Office to lead to 23 million fewer people with insurance. Trump celebrated its passage in a triumphant Rose Garden ceremony alongside House Republicans.
“Make no mistake: This is a repeal and replace of Obamacare,” Trump said at the time.
The effort fell one vote short in the Senate as three Republicans — Sens. Lisa Murkowski of Alaska, Susan Collins of Maine and John McCain of Arizona — joined Democrats to vote it down. Trump has since repeatedly criticized McCain for his now-iconic thumbs down on the Senate floor.
The legislative push was never revived, with one exception: Trump and Republicans succeeded at zeroing out the ACA’s tax penalty for most Americans who failed to buy insurance.
But Trump persisted in seeking other ways to take aim at the ACA.
He leaned on his executive power and his administration slashed funding for programs to advertise and promote ACA sign-ups. Enrollment dipped the following year, in 2018, with some blaming the cuts in funding.
“He cut outreach by 90% and funding for community-based navigators by 84%, making it harder for people to sign up,” Levitt said, referring to individuals who helped Americans sign up for Obamacare plans. “He expanded short-term insurance plans that do not have to follow the ACA’s rules, including coverage of pre-existing conditions.”
That fall, Democrats put a dagger in the legislative efforts to undo President Barack Obama’s signature achievement when they won control of the House, in part by campaigning on protecting the ACA.
But even as other Republicans sought to abandon what they came to see as a losing political fight, Trump was undeterred.
In 2020, he endorsed a lawsuit that would have wiped out the ACA entirely. The case made it all the way to the Supreme Court, and the Trump administration formally asked the justices to rule for the challengers and terminate the law, despite the political risks as he sought re-election.
The court upheld the ACA the following year. By then, Trump had lost the election and Joe Biden was president.
Now, as he seeks a comeback in 2024, Trump has occasionally brought up his desire to revisit the ACA battle, calling for replacing the law last fall and declaring that “Obamacare Sucks.” This year, Trump’s campaign has softened its rhetoric against the ACA while still calling for alternatives.
Trump admitted he doesn't have a replacement plan.
“I have concepts of a plan,” Trump said at last week's debate, adding that there are “concepts and options” for a better and cheaper system that he’ll outline “in the not-too-distant future.”
Asked when Trump will roll out his plan, campaign spokesperson Karoline Leavitt did not provide a timeline. “As President Trump said, he will release more details but his overall position on health care remains the same: bring down costs and increase the quality of care by improving competition in the market place," Leavitt said. "This is a stark contrast to Kamala Harris’ support for a socialist government takeover of our health care system which would force people off their private plans and result in lower quality care.”
Harris is running on a platform of preserving the ACA, without offering specifics on how she would make good on her call for expanding coverage. She has abandoned her 2019 position of putting all Americans in Medicare. On the campaign trail, the Democratic nominee is seizing on Trump’s debate remarks.
“He has ‘concepts of a plan.’ Concepts of a plan,” she said Thursday at a rally in Greensboro, North Carolina. “Which means no actual plan.”
“And 45 million Americans are insured through the Affordable Care Act,” she said. “So, understand what that means. He’s going to end it based on a concept and take us back when folks were suffering.”
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