What Is Trumpcare?
You can hardly turn on the television or open the newspaper anymore without hearing about Trumpcare.
But exactly what is Trumpcare, and what does health care under the Trump administration look like going forward?
Trumpcare is the name given to President Trump’s proposed health care plan, formally called the American Health Care Act (AHCA). Below are some things to know about the proposed new health insurance legislation.
Trumpcare Is Not Yet a Law
And in fact, it may never be — at least in its current form. After narrowly advancing through the House of Representatives in 2017, Trumpcare went on to die on the Senate floor.
Trump hinted at plans to introduce a new plan in early 2019, but Senate Majority Leader Mitch McConnell reportedly warned Trump that the Senate would not revisit major health care legislation again until after the 2020 presidential election.1
That means Trump will have to win a second term to try and make good on his campaign promise to “repeal and replace” Obamacare.
Trumpcare Was Intended to Replace Obamacare
The AHCA was intended to be the “replacement” part of President Trump’s campaign pledge to repeal and replace Obamacare, formally known as the Affordable Care Act (ACA).
Some provisions of Trumpcare directly oppose those put in place by Obamacare.
- For example, the ACA protected people with pre-existing conditions from facing higher premiums for insurance plans. But Trumpcare would potentially allow companies to charge more on the basis of a pre-existing condition.
- Obamacare also requires all Americans under 65 to have health insurance or else face a tax penalty, but Trumpcare would eliminate that “individual mandate.”
- The ACA also required companies to cover a list of essential health benefits. Under Trumpcare, states could potentially receive a waiver from covering these benefits if the state meets certain criteria.
Trumpcare Has Been Met With Political Resistance
Trumpcare was scheduled to be voted on by the House in March of 2017, but the bill was pulled at the last minute due to Republican fears that it would not get enough votes to pass.
After making some changes to the bill, it was brought before the House in early May of 2017, and it passed by a count of 217-213, with 20 Republicans voting against it. No Democrats voted for the bill.
The Senate declined to vote on the bill as it was and instead formed the aforementioned panel to make changes.
Trumpcare has also received opposition from a number of organizations including AARP, the American Medical Association, the American Nurses Association, the American Academy of Pediatrics and the American Hospital Association, among others.
Opposition of Trumpcare was spurred in part by a report released by the non-partisan Congressional Budget Office (CBO), which estimated that the number of uninsured people under the age of 65 would nearly double by 2026.2
The Bipartisan Budget Act of 2018: Impacts on American Health Care
Though not technically part of Trumpcare, the Bipartisan Budget Act of 2018 was signed into law in February of 2018, and included the following changes to health care in the United States:
- An additional four years of authorization for the Children’s Health Insurance Program (CHIP) were added, on top of the six years that were previously authorized.
- A cap that limited Medicare spending for outpatient physical and occupational therapy was removed.
- The Independent Payment Advisory Board (IPAB) was repealed. TheIPAB was part of the Affordable Care Act (Obamacare) and was set to be a 15-member council tasked with achieving specific savings in Medicare without affecting coverage or quality.
- Two years of additional subsidies were added to State Health Insurance Assistance Programs (SHIPs), Area Agencies on Aging, Aging and Disability Resource Centers and the National Center for Benefits and Outreach Enrollment.
- Funding was guaranteed for community health centers and the National Health Service Corps for 2018 and 2019.
- The Medicare Part D coverage gap, or “donut hole” was closed faster than originally scheduled.
- Medicare Special Needs Plans were permanently reauthorized.
- Testing of the Medicare Value-Based Insurance Design (VBID) Model was expanded to all states by 2020. The law also expanded the type of supplemental benefits Medicare Advantage plans can offer to chronically ill individuals beginning in 2020.
- The Gleason Enduring Voices Act was enacted, which guarantees Medicare coverage of speech-generating devices.
- The way Medicare pays for home health services was revamped.
- The Medicare Independence at Home demonstration was extended by two years, and the cap on the number of participating beneficiaries was increased.
A Trump Executive Order Ended Subsidies for Obamacare Tax Credits
Trump signed an executive order in October 2017, eliminating subsidies provided to help people pay for their health insurance.
Under Obamacare, tax credits were available to people who earn up to 250% of the federal poverty level (about $30,000 per year for a single person in 2019). These tax-credit subsidies help cover the cost of annual deductibles in Obamacare marketplace plans.
The executive order signed by Trump did away with those subsidies.
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1 Pear, R., and Haberman, M. Trump Retreats on Health Care After McConnell Warns It Won’t Happen. (April 2, 2019). New York Times. Retrieved from www.nytimes.com/2019/04/02/us/politics/obamacare-donald-trump.html.
2 Congressional Budget Office. American Health Care Act of 2017. (May, 24 2017). Retrieved from https://www.cbo.gov/publication/52752.
Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.