Trump's Options

Killing Obamacare

  • Why it matters

    Why it matters

    President Obama’s health-care reforms have cut the numbers of uninsured people in America, but the policy was a polarizing one, and a raft of problems associated with it means that health care will be a major challenge for the next president.

  • Facts


    • The Affordable Care Act, which quickly became known as Obamacare, was passed in 2010 and came into full effect in 2014.
    • The act made private health insurance mandatory for all Americans, but extends government subsidies to those in lower income groups.
    • Although the number of uninsured has fallen sharply, coverage is limited for many, and premiums are rising fast – this year by an average of 25 percent across the country.
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Some like Obamacare, others don't. Source: AP Photo

President Barack Obama’s health-care reform will go down as one the biggest achievements of his eight-year tenure. But six years after it was adopted, it still remains one of the most contested.

Approved early in his term as president, Mr. Obama’s scheme made buying private health insurance mandatory for all Americans. It radically cut the numbers of uninsured adults to 11 percent this year, from close to 16 percent when it first came into effect at the start of 2014.

But there is another side. The Obamacare reforms, which also introduced online health insurance marketplaces, have proven to be complicated, patchy, and increasingly expensive.

Under a Donald Trump presidency, Obamacare would likely be abolished altogether.

“If Trump becomes president I think you’ll see a push right away to repeal Obamacare and replace it with an alternative.”

Jeffrey Anderson, health care expert, Hudson Institute

“If Trump becomes president I think you’ll see a push right away to repeal Obamacare and replace it with an alternative,” said Jeffrey Anderson, a health-care expert at the Hudson Institute, a Washington-based conservative-leaning think tank.

That stands in contrast to Hillary Clinton, the Democratic candidate, who would keep the reforms in place and has even said she wants to expand the government’s footprint in the system. She wants to make a government-run insurance option available in all state marketplaces as a counterweight to private suppliers.

If Mr. Trump wins on November 8, what would a Republican plan look like?

Mr. Anderson, who was a professor of political science at the U.S. Air Force Academy from 2001 to 2007, has already developed an alternative to Obamacare. They’ve acted as a basis for Republican plans to replace Mr. Obama’s health care reforms.

Mr. Anderson said the alternatives focus on replacing expanded government insurance programs with private alternatives, and remove the “mandatory” requirement to purchase insurance. For one thing, government-run programs like Medicaid, which offers subsidized insurance for the poor, could be cut back.

“Under an alternative I think the effort would be to get a lot of people to move from the Medicaid program onto private insurance of their own choice, giving them tax credits to make that possible, and then hopefully creating a vibrant market where people are shopping for insurance,” Mr. Anderson told Handelsblatt Global.

How much of this could a Trump administration really accomplish? If Mr. Trump becomes president, he could partially dismantle Obamacare by executive orders, because implementing elements of the health care reforms are based on the discretion of the administration.

The most important elements, however, would require legislative changes, meaning Congress will have to agree.

“It will be a complicated process but presumably at least most of Obamacare can be repealed. It’s a question of how much,” Mr. Anderson said.

How much will depend not just on whether Mr. Trump wins the election, but whether Republicans maintain control of both legislative chambers in Congress – the House of Representatives and the Senate. Whether they have a strong majority in the Senate in particular remains an open question, Mr. Anderson noted.

With a Senate majority, there would be little holding Mr. Trump and Republicans back from repealing Obamacare. The earliest he could implement a repeal would be January 2018,  Mr. Anderson said.

Of course, it all depends on Donald Trump winning on November 8.


Gilbert Kreijger is an editor with Handelsblatt Global in Berlin. To contact the author:

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