Trump’s Health Care Plan Would Do Much the Same Damage as His Effort to Repeal the ACA Through the Courts

A federal appeals court will hear oral arguments tomorrow in Texas v. Azar, the lawsuit in which the Trump Administration and 20 Republican attorneys general are asking the courts to invalidate the entire Affordable Care Act (ACA). If the courts ultimately adopt the Administration’s position, 20 million people would lose health coverage, and millions more would pay more for coverage or care. Although the Administration has sought to distinguish its stance in the lawsuit from its policy position on health care, its health care proposals would have much the same consequences.

President Trump has repeatedly promised a legislative ACA repeal plan that would maintain coverage, reduce costs, and protect people with pre-existing health conditions. But the Administration has already endorsed at least six separate ACA repeal plans.

In 2017, the President supported four separate ACA repeal plans that Congress ultimately rejected — proposals that the Congressional Budget Office (CBO) concluded would each cause millions of people to lose coverage and raise costs for many more.

The President then embraced legislation introduced by Senators Bill Cassidy, Lindsey Graham, Ron Johnson, and Dean Heller (“Cassidy-Graham”) that also would repeal the ACA. In his 2020 budget, released in March, he called on Congress to first enact legislation based on Cassidy-Graham and then cut $765 billion over ten years from health care programs.

Like the President’s push for ACA repeal through the courts, his budget proposal would:

• Cause millions to lose coverage. If the courts struck down the ACA, the number of non-elderly Americans without health insurance would rise from about 30 million under current law to 50 million, the Urban Institute estimates. Cassidy-Graham would also leave an estimated 50 million Americans uninsured. And the President’s budget proposes over $700 billion in additional cuts to federal coverage programs, compared to Cassidy-Graham.
• End nationwide pre-existing conditions protections. Cassidy-Graham would let insurers return to charging higher premiums based on pre-existing conditions, ending the ACA’s nationwide ban on that practice. That’s why patient groups, physicians, hospitals, insurers, experts, and independent fact checkers (for example, here and here) concluded that the bill would restore discrimination based on pre-existing conditions.
• End other critical consumer protections. Cassidy-Graham would also let health plans return to excluding essential health benefits — such as maternity coverage, mental health care, and substance use treatment — as many plans did before the ACA.
• End the ACA’s Medicaid expansion. Cassidy-Graham would end the Medicaid expansion to low-income adults outright, replacing it with a temporary, underfunded, and structurally flawed block grant to states.
• End or sharply cut financial assistance for individual market consumers. Cassidy-Graham would end federal financial assistance (premium tax credits and cost-sharing subsidies) altogether, replacing it, too, with a temporary, underfunded, and structurally flawed block grant to states.
• Destabilize health care markets. Striking down the ACA would throw much of the health care system into chaos. Similarly, the Cassidy-Graham legislation would “severely disrupt states’ individual insurance markets, with sharp premium increases and insurer exits likely to occur in the short term and over time,” according to 36 current and former insurance commissioners of both parties.