The Republican-led U.S. Congress has repeatedly tried and failed to repeal and replace Obamacare. Since taking office in 2017, they have had an ally in President Trump, whose administration has attempted to dismantle the health care law, one step at a time.
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Here are highlights of steps taken by the White House:
August 2017: The Trump administration slashes grants to ACA “navigators,” trained advisors who help people enroll in the individual marketplace, from $62.5 million to $36 million. It also cut advertising promoting ACA enrollment from $100 million to $10 million.
“This is – pure and simple – a part of this administration’s ongoing attempt to sabotage the Affordable Care Act,” Craig Obey of Families USA, a nonprofit consumer health advocacy organization, said at the time. “The President has made no secret of the fact that he wants the ACA to fail and with this action the administration is making this a self-fulfilling prophecy.”
October 2017: Trump announces plans to end Obamacare subsidies to insurers of about $7 billion a year that help reduce out-of-pocket costs for low-income enrollees in the ACA.
"The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!" Trump tweets.
Insurers, required under the ACA to offer the subsidies, respond by raising premiums.
December 2017: Trump signs a $1.5 trillion tax cut measure that also ends the mandate that individuals buy insurance or pay a fine. Health experts say the mandate is essential to ensure enough healthy young people sign up for insurance, keeping overall costs down. The ACA requirement that adults pay a tax penalty of $695, or 2.5 percent of their income, if they fail to purchase insurance, expires in 2019.
"We essentially repealed Obamacare because we got rid of the individual mandate, which was terrible. And that was a primary source of funding of Obamacare,” Trump says.
According to a 2016 analysis by the Kaiser Family Foundation, about 52 million Americans under the age of 65 could find their access to health insurance jeopardized because of a wide range of preexisting conditions.
June 19, 2018: Trump rolls out final rules opening the door to association health plans, allowing businesses and groups of individuals to buy insurance that skirts ACA requirements for coverage for maternity and emergency care, prescription drugs, mental-health services and other benefits. “You’re going to save massive amounts of money and have much better health care,” Trump said.
The plans may be cheaper, but they also provide fewer benefits and could leave the sick and older enrollees exposed to high medical costs. Some analysts note that association plans – around since the 1970s – have a history of fraud and deception, with a former Labor Department fraud lawyer telling The New York Times: “Fraudulent association health plans have left hundreds of thousands of people with unpaid claims. They operate in a regulatory never-never land between the Department of Labor and state insurance regulators.”
Aug. 1, 2018: The Trump administration issues new insurance rules to allow more Americans to buy short-term health plans that do not have to cover pre-existing conditions and can limit coverage for mental health treatment and other expensive services. Human Services Secretary Alex Azar says the short-term plans "provide a much more affordable option for millions of the forgotten men and women left out by the current system.”
A New York state government financial official tells a gathering of the National Association of Insurance Commissioners, “These are substandard products” sold on the premise that “junk insurance is better than nothing” for people who cannot afford comprehensive coverage.