The Affordable Care Act (ACA), or “Obamacare,” was enacted in 2010 and implemented in 2014. Its goal is to increase the quality and affordability of health insurance, expand Medicaid coverage, and decrease the number of uninsured Americans. The Biden-Harris Administration recently reported that 21.3 million people signed up for the plan this year, 5 million more than last year. Yet, despite the policy being more popular than ever, Republicans in Congress are committed to getting rid of it. Since its inception, they’ve voted more than 50 times to strike it down but, so far, come up short. There are ten ways a repeal will directly impact our community. Read on to learn more.
How a Second Trump Presidency May Impact This
If Donald Trump is re-elected to the presidency and eventually successfully repeals the ACA, it could cause seismic changes in the U.S. healthcare system. While Trump has never revealed exactly what his alternative plan would look like (during the campaign, he said he has “concepts of a plan”), Lisa Cooper, a professor in the Department of Health, Behavior, and Society at the Johns Hopkins Bloomberg School of Public Health, says, “if the past predicts the future, we can look at provisions targeted during his previous term and expect them to be targeted again or further diminished.”
“As president, Trump’s budget proposals included plans to convert the ACA into block grants to states, cap federal funding for Medicaid, and allow states to relax the ACA’s rules protecting people with pre-existing conditions,” says Samantha Artiga, vice president and director of the Racial Equity and Health Policy Program at KFF. “If enacted, those plans would have reduced federal funding for health care by about $1 trillion over a decade, with the trade-offs being higher out-of-pocket premiums for people, more uninsured, higher spending and greater risk for states, and restrictions in Medicaid eligibility.”
The Top Ways It May Impact Our Community
1. Tens of Millions of Americans Could Lose Their Coverage
Marketplace Subsidies: The ACA provides 40 million subsidies so middle- and low-income individuals can afford health insurance through the exchanges.
If Republicans win both chambers of Congress and the presidency, they are strongly expected to let the subsidies expire at the end of 2025.
This would likely increase copays, premiums, and out-of-pocket prescription drug costs. Insurance could become unaffordable for many, possibly leading some insurance companies to exit the market and ultimately leading to an additional 23+ million uninsured people.
Medicaid Expansion: Expanding Medicaid eligibility is one of the ACA’s most noteworthy benefits. Between 2017 and 2024, the number of states with Medicaid expansion went from 32 to 41. If it was repealed, states that expanded Medicaid could lose federal funding, meaning 69 million low-income individuals could lose their healthcare coverage.
2. Over 130 Million People with Pre-existing Conditions Could Be Denied Coverage
Under the ACA, no one can be denied coverage under any circumstance, and insurance companies cannot retroactively cancel a policy unless there is evidence of fraud. It was a different ballgame before; back then, people with pre-existing conditions could be denied coverage or charged higher premiums. Removing the ACA could lead to the return of rejections and higher costs and make it difficult or impossible for individuals with chronic conditions, cancer survivors, or anyone else with a health history to get affordable coverage.
Note: If repealed, the replacement plan could weaken pre-existing protections for individuals with one of the growing list of conditions:
- AIDS/HIV
- Alcohol/Drug Abuse
- Cerebral Palsy
- Cancer
- Heart Disease
- Diabetes
- Epilepsy
- Kidney Disease
- Sleep Apnea
- Pregnancy
- Muscular Dystrophy
- Depression
- Eating Disorders
- Bipolar Disorder
3. Women Could Be Charged More For Coverage Than Men
Before the ACA, women were often charged higher premiums than men for the same coverage. The ACA prohibits charging different premiums based on gender. It also demands that all privately purchased plans cover maternity care, which had routinely been excluded from many individually purchased plans. Most private plans must also cover preventive services (such as breast and cervical cancer screenings, prescribed contraceptives, and breastfeeding supplies) without any co-payments or other types of cost-sharing.
As a result of the ACA, findings from the Commonweath Fund show that the percentage of women who have delayed or skipped needed care because of costs has fallen to an all-time low.
Knocking down the ACA could mean a return to gender-based increased premium rates, fewer services, and worse health outcomes for American women.
In addition, while abortion is the most prominent healthcare campaign issue, a Trump re-election could have massive implications for contraceptive care and maternal health. Professor Cooper says, “Trump has been supportive of abortion access decisions being made by states rather than Federal law guaranteeing a woman’s right to choose.
Under a second Trump administration, in the absence of Roe vs Wade protections, women who live in states with abortion bans will have less access to reproductive health care, and this would worsen the already dire racial disparities in maternal deaths among Black women.”
4. Seniors Could Get Hit with Higher Premiums
The ACA restricts how much more insurers can charge adults over 50 versus younger individuals to three times.
Repealing the law could cause older adults to get slammed with significantly higher premiums, making health insurance unaffordable for seniors between 50 and 65 since they wouldn’t yet be eligible for Medicare.
According to AARP, if insurers did what was proposed in the 2017 Republican repeal bill and charged older adults five times more for insurance, that would add an average “age tax” of $4,124 for a 60-year-old in the individual market. In addition, a 2023 study by Protect Our Care, a healthcare advocacy organization, states that “the Republicans’ plan to repeal the ACA would make 49 million seniors pay more for prescription drugs because the Medicare “donut hole” would be reopened.”
5. Essential Health Benefits Could Be Cut or Cost You More
The ACA requires insurance plans to cover preventive services, such as cancer screenings, cholesterol tests, annual check-ups, and contraceptive services, at no cost. Repealing the law could allow insurance companies to offer plans with less comprehensive care, higher out-of-pocket costs, and weakened pre-existing protections, leading to less preventative care and an increase in untreated illnesses.
6. Annual and Lifetime Coverage Limits Could Return
Before the ACA, 105 million Americans with employer coverage carried a lifetime cap on their health insurance benefits. Every year, back then, an additional 20,000 people would hit their cap and exhaust their benefits when they needed them most. The ACA stops that and prevents insurers from instituting annual or lifetime limits on essential health coverage. Without such protections in place, people with high medical costs (think: serious accidents or chronic illnesses) could run out of coverage and into personal debt or bankruptcy.
7. Millions Could Lose Access to Mental Health and Addiction Services
The ACA requires insurance plans to cover mental health and addiction treatment as part of the essential health benefits. The Kaiser Family Foundation estimates that 40 percent of people aged 18 to 65 with opioid addiction—approximately 800,00 or four in 10—are on Medicaid, and most became eligible once the ACA became law.
Insurance companies could stop covering psychiatric care, addiction treatment, and counseling services if struck down.
8. 4.9 Million Young Adults Could Lose Their Coverage
This age group was the most likely to be uninsured before the ACA was created. The law allows young adults to remain on their parent’s insurance until age 26. If repealed, this prevalent benefit could be eliminated, leading to a 76 percent increase in uninsured young adults.
9. 34 Million Children Could Lose Mental Health Services
Medicaid’s comprehensive child health coverage guarantee could be on the chopping block if the ACA is repealed. Such a move would hamper children’s access to mental health care and cause them to go without other services, like annual check-ups and speech and physical therapy.
10. Over 500 At-Risk Rural Hospitals Could Be Forced to Close
Under the ACA, Medicaid expansion has been a financial lifeline for many rural hospitals because it covers the uncompensated care costs of low-income patients. Between 2010 and 2021, nearly three-fourths of rural hospital closures were in states that have not adopted Medicaid expansion, with research showing that expansion disproportionately improved rural hospital margins and helped avert hospital closures. Repealing the ACA and reducing Medicaid funding could lead to at-risk rural hospitals closing and losing health coverage for area residents.
“Black Americans are also more likely to live in [rural] states that have not implemented ACA supported Medicaid expansion,” adds Professor Cooper. Because “these states are less likely to expand Medicaid ACA provisions, it will make health insurance less affordable to Black Americans living in those states.”
These States Have Not Expanded Medicaid
- Alabama
- Florida
- Georgia
- Kansas,
- Mississippi
- South Carolina
- Tennessee
- Texas
- Wisconsin
- Wyoming
