The future of Obamacare is in jeopardy with the 2024 election

”repeal and replace“for a long time republican mantra Then Affordable Medical Care Act.

Not so much these days.

Former President Donald Trump: “I’m not running to repeal the ACA” I wrote In a March Truth Social post. During the presidential debate on September 10, President Trump reiterated that he has no intention of abolishing the program. That is, unless he can “come up with a plan that will reduce the burden on our people, our people, and provide better health care than Obamacare.”

This is a surprising turnaround from a candidate who said in October 2016 that real change “starts with immediately repealing and replacing the disaster known as Obamacare.”

It also shows how ingrained former President Barack Obama’s signature health care law is in American life. About 60% of Americans have a favorable opinion of the 2010 health care law, according to a recent KFF poll. Found. record numbers In 2024, more than 20 million people enrolled in ACA Marketplace coverage.

But even as existential threats to the program appear to be receding, Republicans and Democrats remain deeply divided over what the future role of the health care law should be, he said. Cynthia CoxVice President and Director of KFF’s ACA Program.

“When you ask how to improve the ACA, there are different interpretations of what that means,” Cox says. “What is an improvement for one person may be a deterioration for another.”

Who controls the White House and which party wins the House and Senate majorities in November will tell us what’s in store for Obamacare.

Cox said Democrats would likely make expanding ACA subsidies a top priority if they maintain their narrow majority in the Senate or flip the Republican-controlled House. This federal aid, originally passed during the pandemic under the American Rescue Plan of 2021 and then extended in the Inflation Control Act of 2022, is scheduled to expire at the end of 2025.

Mr. Harris is made it clear that they wanted to maintain the increased financial aid.which has significantly reduced the cost of coverage for people purchasing plans. ACA Marketplace. According to a rough estimate provided by Cox, monthly premiums for an individual earning $60,000 a year are now $425, compared to $539 before the enhanced subsidies. Meanwhile, a family of four earning about $120,000 a year now pays $850 a month instead of $1,649.

“It’s unclear whether these subsidies will be renewed no matter who wins the election,” Cox said.

Harris campaign spokesman Joseph Costello reiterated that the vice president wants the enhanced subsidies to continue.

“Vice President Harris is committed to improving health care and lowering costs, and part of her plan includes creating a permanent credit that will lower health insurance premiums for millions of Americans by an average of about $800 a year,” Costello said. It is included.”

The Harris campaign released a report Monday that paints a dire picture of health care under a hypothetical Trump administration. The campaign bases its report on Project 2025, a conservative governance plan that Trump has disavowed, and a complete repeal of the ACA, which Trump has backed away from. Still, the report warned that under the most aggressive policy, about 500 local hospitals could close and millions of Americans could lose their health insurance.

The Trump campaign did not respond to requests for comment.

Cox said if Democrats succeed in preserving the enhanced subsidies, they could focus on providing even more generous relief to policyholders in the marketplace. In particular, deductibles remain high. According to KFF, the average deductible for ACA plans, the amount a person must pay before coverage kicks in, will exceed $3,000 in 2024, with some plans having deductibles as high as $7,000. exceeds. Found.

“That’s where we might see more interest from Democrats: increasing cost-sharing assistance subsidies to lower deductibles,” Cox said.

remaining 10 states The public, which has so far rejected the ACA’s Medicaid expansion, is likely to become a new focus for Democrats, experts say.

Under Obamacare, the federal government provides nearly all of the funding for states to expand Obamacare eligibility. free health insurance. But in 2012, The Supreme Court ruled Congress argued that it exceeded its constitutional authority by requiring states to expand Medicaid. This was one of the main ways the law aimed to increase coverage.

But Democratic lawmakers could encourage holdout states like Texas, Wyoming and Florida to expand Medicaid coverage by closing the gap in federal funding, he said. Sabrina Corlettco-director of the Center on Health Insurance Reform at Georgetown University’s McCourt School of Public Policy. Currently, the federal government covers: 90% of state expansion costs.

“If we convince 10 states, millions of people will have access to the health care they need.” Mark DugganWayne and Jody Cooperman Professor of Economics at Stanford University.

Republicans and President Trump also tend to complain that the ACA is too expensive. But they are focused on the taxpayers’ tab, Cox said.

“This is something that’s often debated,” she says. “Who should be spending the money? The federal government or the people who are sick and uninsured?”

He said the easiest way to reduce the cost of the program would be to let the enhanced subsidies expire, adding: “That’s likely to happen if Republicans retain either the House or the Senate.”

Permanently extending the enhanced subsidies could cost about $25 billion a year, one report said. estimate By the Congressional Budget Office.

“That’s the concern with the Republican extension,” Cox said.

About 3.8 million people will lose health insurance if aid is cut off, Congressional Budget Office says estimate. Those who maintain coverage may pay higher premiums.

Expanding the ACA’s Medicaid coverage will likely be another area that Republican lawmakers and President Trump will target with cost-cutting measures, experts say.

He said recent Republican proposals call for cutting federal funding to states for Medicaid. Robin LudowitzKFF’s vice president and director of Medicaid and uninsured programs. These plans could lead to lower federal funding match rates for Medicaid coverage expansion. 50% From 90%.

“This represents a significant cost change, and states may face difficult decisions to limit coverage, leaving many people in expanded groups without affordable coverage options and potentially uninsured. is high,” Ludowitz said.

The former Trump administration also expanded non-ACA-compliant health insurance options, including short-term plans, experts say. If the Republicans win big in November, the same thing is likely to happen again.

Cox said proponents of these plans argue that they can offer lower monthly premiums because insurers don’t have to cover as many services for consumers. At the same time, the plan can also deny people with pre-existing conditions or charge them extra. During President Trump’s term, short term plan spiked.

This is a troubling dynamic for ACA supporters, Corlett said. That’s because these plans are “siphoning” young, healthy people from the market, Corlett said.

“The risk is that ACA plans end up serving only sick people. That’s not a sustainable insurance market,” she says. “Over time, ACA premiums will continue to rise.”

Sen. J.D. Vance, the Republican vice presidential candidate, recently suggested similar concerns about the health care system that Corlett expressed.

“We’re going to actually implement health care regulatory reform so people can choose the health plan that’s right for them,” Vance said at a campaign rally in Raleigh, North Carolina, in September.

The Ohio senator said it would “allow people with similar health conditions to be in the same risk pool.”