Senate Majority Leader Charles Schumer (D-NY) (R) talks with House Minority Leader Hakeem Jeffries (D-NY) while attend an event to mark the 14 anniversary of the passage of the Affordable Care Act at the U.S. Capitol on March 21, 2024 in Washington, DC.
Chip Somodevilla | Getty Images
“Repeal and replace” has long been the Republican mantra when it comes to the Affordable Care Act.
These days, not so much.
“I’m not running to terminate the ACA,” former President Donald Trump wrote in a Truth Social post in March. During the Sept. 10 presidential debate, Trump again said he did not plan to eliminate the program. That is, unless he could “come up with a plan that’s going to cost our people, our population, less money and be better health care than Obamacare.”
It’s a remarkable about-face coming from a candidate who said in Oct. 2016 that real change, “begins with immediately repealing and replacing the disaster known as Obamacare.”
It also shows how entrenched former President Barack Obama’s signature health-care legislation has become in American life. Around 60% of Americans hold a favorable opinion of the 2010 health care law, a recent KFF poll found. A record number of people — over 20 million — signed up for coverage on the ACA marketplace in 2024.
But even as existential threats to the program appear to recede, Republicans and Democrats are still deeply divided over what the health care law’s role should be in the future, said Cynthia Cox, vice president and director of the program on the ACA at KFF.
“When you’re asking about ways to improve the ACA, there’s a lot of different interpretations of what that might mean,” Cox said. “One person’s improvement might be another person’s weakening.”
Depending on who takes the White House, and which parties win majorities in the House and Senate in November, here’s what could be in store for Obamacare.
Dems would push to expand subsidies
If Democrats manage to hold their narrow majority in the Senate, or flip the GOP-controlled House, they’ll likely make extending the ACA’s enhanced subsidies a top priority, Cox said. The government-backed aid, originally passed during the pandemic under the American Rescue Plan in 2021, and then prolonged in The Inflation Reduction Act in 2022, is set to expire at the end of 2025.
For her part, Harris has made clear she wants to keep in place the boosted financial assistance, which has significantly lowered the costs of coverage for people buying plans on the ACA marketplace. An individual earning $60,000 a year now has a monthly premium of $425, compared to $539 before the enhanced subsidies, according to a rough estimate provided by Cox. Meanwhile, a family of four making about $120,000 currently pays $850 a month instead of $1,649.
“Whoever wins the elections, it’s not clear whether these subsidies would be renewed or not,” Cox said.
Joseph Costello, a spokesperson for the Harris campaign, reiterated that the vice president wants to see the enhanced subsidies stay in place.
“Vice President Harris is fighting to improve health care and lower costs, and part of her plan includes making permanent credits that are lowering health care premiums by an average of about $800 a year for millions of Americans,” Costello said.
The Harris campaign released a report on Monday that paints a dire picture of health care under a hypothetical Trump administration. The campaign based the report on the conservative governing blueprint Project 2025, which Trump has disavowed, and on a full repeal of the ACA, which Trump has backed away from somewhat. Still, the report warned that under the most hardline policies, around 500 rural hospitals could close and millions of Americans could lose their health insurance.
The Trump campaign did not reply to a request for comment.
A pedestrian walks past the Leading Insurance Agency, which offers plans under the Affordable Care Act (also known as Obamacare) on January 28, 2021 in Miami, Florida.
Joe Raedle | Getty Images
If Democrats prove successful in maintaining the enhanced subsidies, they may then turn their attention to delivering even deeper relief to marketplace policy holders, Cox said. Deductibles, in particular, remain high. The average ACA plan deductible, or amount a person must spend before their coverage kicks in, was over $3,000 in 2024, with some plan deductibles exceeding $7,000, KFF found.
“That might be where you see additional interest for Democrats: To increase subsidies for cost-sharing assistance to lower deductibles,” Cox said.
The remaining 10 states that have so far refused to adopt the ACA’s Medicaid expansion are likely to be another focus point for Democrats, experts say.
Under Obamacare, the federal government provides nearly all of the funding for states to widen their eligibility pool…
Read More: Obamacare’s future hangs in the balance in 2024 election