Trump & The Unlacing of the Affordable Care Act

Trump & The Unlacing of the Affordable Care Act
Author Information (click to view)

Christina Pazzanese, Harvard Staff Writer

Christina Pazzanese, Harvard Staff Writer (click to view)

Christina Pazzanese, Harvard Staff Writer


Harvard analysts ponder changes across the American and global landscapes.


After a grueling 18-month election that shattered conventional wisdom and longstanding norms of civility and fair play, Republican businessman Donald Trump has defeated Hillary Clinton and will become the 45th president of the United States. After eight years of a Democratic White House, change is coming on strong.

Trump’s victory appeared largely driven by voters who wanted to “send a message” by repudiating the political and economic status quo. The raucous campaign was long on tone and messaging, yet often short on policy positions. But with a GOP president and Congress and an opening on the Supreme Court, the shifts ahead could be seismic.

Scholars across Harvard spoke with the Gazette about the election’s impact on presidential politics and how Trump’s presidency is likely to change the nation in realms from foreign policy and immigration to the economy and the high court. Early on, here’s a capsule look at how scholars view the road ahead.


With the election of Donald Trump as the nation’s next president and the preservation of Republican majorities in the U.S. Senate and House, the future of efforts to reform the U.S. health care system and to achieve universal coverage now enter an arena of high uncertainty. One certainty is this: Beginning in January 2017, even before Trump’s inauguration, congressional Republicans will begin to move legislation to undo foundational elements of the Affordable Care Act (ACA).

They will use the special legislative process known as budget reconciliation that enables a bill to avoid filibusters to proceed with limited debate and to pass with only 51 votes. The major challenge with reconciliation is that a bill using this process can only include matters with significant budget impact, up or down. That will not be a problem in dismantling key ACA expansions of Medicaid and private health insurance. It will also not hinder the repeal of major ACA tax increases, especially the new Medicare payroll taxes on high-income households that took effect in 2013.

Such a bill is a twofer for Republicans by (1) repealing the reviled Obamacare law, and (2) enacting an enormous tax cut for high-income families. And we know Republicans can get such a bill through the Congress because they did so in January 2016 only to face a veto from President Obama. President Trump will sign the bill.

The catch is that some moderate Republican senators, such as Shelley Moore Capito (R-W.V.), voted for the 2016 reconciliation bill because they knew it would not become law. How will Capito, Susan Collins (R-Maine), and other less-hardline Republicans vote on a bill that would eliminate health insurance coverage for up to 20 million low- and moderate-income Americans? That’s the major uncertainty.

With what might they replace this lost coverage? House Speaker Paul Ryan unveiled a plan last summer that would encourage states to re-establish high-risk pools for individuals with pre-existing medical conditions, and to provide a flat tax credit for individuals purchasing health insurance. Many experts agree that these measures would leave many millions of currently insured Americans without options. Ryan refused to submit his ideas to the Congressional Budget Office for scoring to enable Americans to understand the impact on individuals and on the federal budget.

Though the process will start in early January, it’s uncertain how long it will take. Though Republican leaders will want to rip off this bandage as quickly as possible, this would be a momentous move backward, and the nation will be watching.

The above was pulled from “For President Trump, the road ahead,” posted by the Harvard Gazette on November 9.

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