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When people say “TrumpCare” they are essentially referring to all healthcare changes made (or being made) under President Trump. This includes:
The House bill to repeal and replace ObamaCare, the American HealthCare Act (AHCA),
The Senate’s Better Care Reconciliation Act of 2017 (this link explains the latest version of bill) and its revisions, including the “the Ted Cruz Amendment.” NOTE: The Senate version of the repeal and replace plan replaced the House bill. The Senate bill needed 51 votes which it did not get. It was followed up by the similar Graham-Cassidy Proposal.
The January 2017 Executive Order that takes some wind out of the individual mandate’s sails,
The April 2017 Regulations that allow for narrow networks and shorter open enrollment periods,
The October 2017 Executive Order on Association Health Plans, Short-Term Coverage, and HRAs,
The October 2017 cuts to Cost Sharing Reduction assistance payments to insurers who provide cost-sharing reduction assistance those with lower incomes,
The October 2017 changes to the employer mandate to cover birth control that make it so religious employers don’t have to cover contraceptives,
The November 2017 changes to Medicaid expansion that make it so states can implement work requirements for Medicaid,
Tom Price’s plans as shown on HHS,
The TrumpCare as presented on DonaldJTrump.com (which includes provisions that are not in the current bill such as “selling across state lines;” that one isn’t scheduled until “phase 3”), and
Past promises Trump has made (such as the unlikely to be implemented “insurance for everybody” and the much more likely to be implemented “selling insurance across state lines“).
In other words, “TrumpCare” is a term that describes health care reform under Donald Trump. This is especially true given that a repeal and replace plan did not pass and instead Trump has been reshaping the healthcare system using executive orders and changes done via HHS.
With the above in mind, we examine all things TrumpCare below and describe how TrumpCare is different from ObamaCare. To do this we will compare Trump’s plan on his site, to the House bill, to the Senate bill that replaces the House bill and discussing the executive orders and changes done via HHS.
UPDATES ON THE VOTE TO REPEAL AND REPLACE THE ACA: On July 25, 2017 Congress voted for a “motion to proceed” with voting on an ObamaCare repeal and replace plan. With that in mind, no repeal and replace bill was passed (all measured failed to get the 51 votes needed outside of the initial measure to proceed). Get updates on the ObamaCare Repeal and Replace Vote in Congress.
TrumpCare as Found On DonaldJTrump.com, compared to the HealthCare Bills Passed in the House and Senate
The following is a short version of Trump’s plan on his website (see the full version with a cost analysis below), the sections in red have not been addressed yet.
In other words, most of what Trump promised didn’t make it into “phase 1 of the American HealthCare Act/Better Care Reconciliation Act,” or the new rules, with the exception of a few items like repealing the mandate’s fee and beefing up HSAs.[1]
NOTE: There has been many, many attempted and actual changes to the Affordable Care Act during Trump’s time in office. The repeal and replace plans did not pass, but many changes did occur (these were done via HHS and executive orders). This page focuses on what Trump promised on his site and the repeal and replace plans. See the links above for the orders and HHS changes, we’ll work on weaving them into here shortly. With that said, many planks from the bills got done via orders and HHS, and another repeal and replace plan with similar provisions is likely, so the rest is worth a read from that perspective.
Completely repeal Obamacare. TIP: ObamaCare isn’t completely repealed under TrumpCare (as it stood when it passed the House), but there are notable changes. Under TrumpCare, the mandates are replaced with a 30% fee for 12 months for re-entering the market in the House version (there is no 30% fee in the Senate version, just a 6 month wait for coverage after you enroll if you have a gap in coverage), out-of-pocket cost assistance is eliminated, tax credits are based on age instead of income in the House version (the Senate version offers tax credits based on both age and income for those making between 0% and 350% FPL), and Medicaid expansion funding is frozen (plus there are additional cuts to funding). Meanwhile, while bans on discriminating against preexisting conditions are kept, some essential health benefits can be excluded from plans on a state level by using a state-based waiver (although there is a high-risk pool that pairs with this, there are issues of funding).
Modify existing law that inhibits the sale of health insurance across state lines.
Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. TIP: The income threshold for medical expenses is reduced from 10% to 5.8% under the AHCA, this isn’t directly related, but is noteworthy.
Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. TIP: Health savings accounts were already in effect and tax-free under the Affordable Care Act, the wording of this aside. With that in mind the BCRA decreases the penalty for withdrawal for non-healthcare related purposes from 20% to 10%. UPDATE: The July 13th update to the BCRA includes a promised Trump provision of allowing people to pay for premiums tax-free via an HSA.
Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals.
Block-grant Medicaid to the states.
Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.
With Trump’s plan in-theory covered, below we examine TrumpCare in-action as it is found in the Paul Ryan inspired American HealthCare Act (the one that has passed the House but not the Senate) to see how it is different from ObamaCare (the Affordable Care Act).
TIP: The Better Care Act is being done as a budget reconciliation bill so it can pass with fewer votes than a full repeal and replace. This also helps explain why some [not all] of Trump’s promises like “selling across state lines” aren’t in the bill. It does not explain why other promises, like the promise to “cover everybody,” didn’t make it into the bill. Consider, the CBO currently projects 49 million without coverage by 2026 under the Better Care Act (which will be “TrumpCare” if it passes).
TrumpCare and Pre-existing conditions: The waivers, paired with reduced cost assistance, a fee for re-entering the market, less employers offering health plans, and the freezing of Medicaid expansion could lead to many being effectively excluded from insurance due to having a preexisting condition despite the high-risk pools (the effect is indirect, not direct). We explain TrumpCare and Pre-Existing Conditions in detail here to help clear up the confusion. In words, TrumpCare weakens protections on pre-existing conditions, but it doesn’t eliminate them.