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Trump Administration’s ACA Repeal Suit Stance Is in Line With Its Health Care Agenda

UPDATED
February 21, 2020

The Administration has sought to distinguish between its health policies and its litigation position urging the courts to strike down the entire Affordable Care Act (ACA). In reality, the lawsuit is another means to the same end the Administration has pursued since inauguration: ACA repeal with no meaningful replacement. This chart compares steps the Administration has taken or tried to take — through its stance in the lawsuit; its executive actions; the House-passed ACA repeal bill it endorsed; and its budgets — and how each would affect the health care system.

  Repeal Lawsuit Executive Actions House-Passed ACA Repeal Bill President’s 2019, 2020 Budgets President’s 2021 Budget
Pre-existing conditions:
The ACA bans individual market plans from denying coverage or charging higher premiums based on health status
Would end nationwide ban, letting insurers deny coverage and charge higher premiums unless states prohibit it Created a parallel market that skirts ACA ban, letting insurers deny coverage and charge higher premiums Would end nationwide ban, letting states let insurers charge arbitrarily high premiums Would end nationwide ban, letting states let insurers charge arbitrarily high premiums No plan to reinstate protections if lawsuit prevails
Essential health benefits:
The ACA requires that plans cover benefits such as maternity, mental health, prescription drugs
Would end nationwide requirement, letting insurers exclude benefits unless states create their own standards Created a parallel market that skirts ACA standards, letting plans exclude essential benefits Would end nationwide requirement, letting states permit skimpier coverage Would end nationwide requirement, letting states permit skimpier coverage No plan to reinstate protections if lawsuit prevails
Medicaid eligibility:
The ACA expanded Medicaid to low-income adults
Would end Medicaid expansion Encouraged harsh state policies leading nearly 1 in 4 people to lose Medicaid where implemented; urging more cuts through block grant waivers Would defund Medicaid expansion, ending it in most states Would end Medicaid expansion and replace with underfunded and flawed block grant Would cut $1 trillion from Medicaid, ACA (2021-2030)
Affordability:
ACA premium tax credits help moderate-income people afford individual market coverage
Would end premium tax credits Cut premium tax credits; cut outreach; created new barriers to getting financial help Would raise costs an average of $3,600 per marketplace enrollee — more for low-income and older people Would end premium tax credits and replace with underfunded and flawed block grant Would cut $1 trillion from Medicaid, ACA (2021-2030)
Coverage impacts:
10.4% uninsured

Non-elderly uninsured rate reached all-time low as more than 20 million people gained coverage

18.3% uninsured

20 million people would lose coverage

11.1% uninsured

1-2 million more uninsured since 2016, with Administration policies a major contributor

18% uninsured

18% uninsured

Estimate is for a similar plan with smaller funding cuts

Long-run coverage losses likely similar to ACA lawsuit, since long-run budget cuts would be nearly as large as from repeal
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