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Jimmy Williams
After nearly a decade of pledging to repeal the Affordable Care Act (ACA), also known as Obamacare, former President Donald Trump still lacks a comprehensive plan to replace it. Experts suggest that the promise of a more affordable healthcare law, which Trump floated again during Tuesday night’s debate with Vice President Kamala Harris, is unlikely to materialize.
Trump’s claim that he has “concepts of a plan” to replace the ACA at a lower cost has been met with skepticism. “It’s kind of hard to find any meat on the bones,” said John A. Graves, a professor of health policy at Vanderbilt University School of Medicine. “It’s just kind of bluster and can kicking.”
Despite the ongoing increase in healthcare costs in the U.S., which outpace other developed nations, experts question whether a new plan that reduces costs while maintaining coverage is feasible. “Right now, Obamacare is the status quo,” said Larry Levitt, executive vice president of health policy at KFF. “Any ACA replacement would involve trade-offs, and you can bet the losers would scream loudly.”
The ACA has provided health insurance to approximately 50 million Americans over the last decade. In 2024, a record 21 million people enrolled, thanks in part to premium subsidies and expanded Medicaid coverage under the ACA and its extension through the Inflation Reduction Act. However, maintaining this level of coverage comes at a high cost to the federal government—$631 billion over the next five years, according to the Congressional Budget Office.
Some Republicans in Congress, like the Republican Study Committee, have proposed plans to roll back ACA subsidies and shift Medicaid to a block grant system, which would give states more flexibility but limit funding. These proposals would significantly reduce federal spending but could result in millions of people losing their coverage. “States would have less money as healthcare costs rise faster than inflation,” noted Gerard Anderson, a professor at Johns Hopkins University.
Looking back at Trump’s first term offers insight into how he might approach healthcare. Jill Horwitz, a professor at UCLA School of Law, pointed out that during Trump’s presidency, the number of uninsured Americans grew by over 2.3 million, and the administration slashed grants to groups that help people access coverage. “Voters should expect more of what we’ve seen before,” Horwitz said, adding that Trump’s policies “hollowed out protection for some of the most vulnerable people.”
As the debate over the future of the ACA continues, Harris has committed to extending the law’s enhanced subsidies beyond 2025. Meanwhile, Trump has remained vague about how he would cut costs if elected for a second term. According to Levitt, Trump’s desire to “spray magic pixie dust” over Obamacare and improve it for everyone is unrealistic. “That’s just not possible,” he said.
