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

December 12, 2019

The Administration has sought to distinguish between its health policies and its position in Texas v. United States, where it is asking the courts to strike down the entire Affordable Care Act (ACA) with no replacement. In reality, the lawsuit is another means to the same end the Administration has pursued since inauguration: ACA repeal with no plan for the repercussions. This chart compares steps the Administration has taken or tried to take — through executive actions; the House-passed ACA repeal bill, which the Administration endorsed; the ACA repeal plan in the its fiscal year 2020 budget; and its stance in the lawsuit — and how each would affect the health care system.

    Executive Actions House-Passed ACA Repeal Bill Administration’s 2020 Budget Repeal Lawsuit
Pre-existing conditions The ACA bans individual market plans from denying coverage or charging higher premiums based on health status 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 Would end nationwide ban, letting insurers deny coverage and charge higher premiums unless states prohibit it
Essential health benefits The ACA requires that plans cover benefits such as maternity, mental health, prescription drugs 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 Would end nationwide requirement, letting insurers exclude benefits unless states create their own standards
Medicaid eligibility The ACA expanded Medicaid to low-income adults Encouraged harsh state policies that have led nearly 1 in 4 people to lose Medicaid where implemented Would defund Medicaid expansion, ending it in most states Would end Medicaid expansion and replace with underfunded and flawed block grant Would end Medicaid expansion
Affordability ACA premium tax credits help moderate-income people afford individual market coverage 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 end premium tax credits
Coverage impacts
Non-elderly uninsured rate reached all-time low as more than 20 million people gained coverage
1-2 million more uninsured since 2016, with Administration policies a major contributor
Estimate is for a similar plan with smaller funding cuts
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