In an unexpected twist, former President Donald Trump has hinted he might preserve parts of the Affordable Care Act (ACA) if a suitable replacement isn’t found.
Despite his initial determination to dismantle Obamacare, Donald Trump now faces the monumental challenge of reforming a healthcare system deeply entrenched in the lives of millions. Internal Republican conflicts and fierce opposition from both moderates and hardline conservatives had previously thwarted Trump’s attempts to repeal the ACA. Now, acknowledging the ACA’s sustained impact and the complexities involved in its overhaul, Trump appears to be moderating his stance.
Republicans’ efforts to repeal the ACA faced intense internal party conflicts. Hardline conservatives demanded changes to health insurance regulations, which lost the support of moderates. A late amendment that allowed states to define “essential health benefits” effectively undermined one of the ACA’s core protections, leading to potential destabilization of the health insurance system and higher costs. The Congressional Budget Office projected that such changes would leave 24 million Americans uninsured.
Trump’s Sabotage and ACA’s Resilience
During Trump’s first term, he took significant administrative actions to undermine the ACA, such as cutting subsidies to insurance companies and reducing enrollment opportunities. This unilateral approach deviated from the constitutional mandate to execute laws faithfully. Despite these sabotage efforts, the ACA proved resilient, with millions still enrolled. Lawsuits and resistance efforts from state attorneys general, private parties, and insurance companies played a crucial role in this resilience.
Trump’s initial attempt to replace the ACA with Trumpcare ended in failure. Despite various factions opposing the bill, the House of Representatives ultimately led to a “stinging defeat.” Efforts to repeal the ACA spanned only 63 days, starkly contrasting with the over-year-long debate to establish the ACA. Most Americans, according to polls, were skeptical, with only 17% supporting Trump’s proposal. Trump admitted that overhauling healthcare was more challenging than he anticipated.
ObamaCare is a broken mess. Piece by piece we will now begin the process of giving America the great HealthCare it deserves!
— Donald J. Trump (@realDonaldTrump) October 13, 2017
Now Trump teases a transformative approach: rather than wholesale termination, some parts of the ACA might be retained and improved. This realization perhaps acknowledges the fact that the ACA, despite its flaws, remains a critical lifeline for approximately 45 million Americans. While he frames this decision as a way to make the ACA “much, much, much better” inexpensively, it also reflects a strategic pivot as he contemplates another presidential run.
This pivot is also politically timely. Notably, Vice President Kamala Harris and Minnesota Governor Tim Walz are sharpening their focus on the ACA in their campaigns. Harris has explicitly warned against reverting to an era where insurance companies could deny coverage based on pre-existing conditions. Maintaining and improving parts of the ACA might be Trump’s way of deflecting such attacks and positioning himself as a practical problem solver ahead of the 2024 elections.
