Are we going to witness Act 3 of Donald Trump’s fierce battle against Obamacare? After having tried to dismantle it on multiple occasions without success during his first term, having promised its abolition during his lost presidential campaign of 2020, the American president could well have the keys in hand to this time finally put an end to one of the most emblematic reforms of Barack Obama’s mandate.
From its official name theAffordable Care Act, This system, implemented from 2010, allows millions of Americans, who were until now uninsured, to access social coverage at affordable rates. After a laborious launch, this project was a success: from more than 20% of Americans without health insurance in 2013, this number dropped to 10.2% in 2016. After several unsuccessful attempts by Donald Trump to eliminate it during his first passage to the White House, Joe Biden on the contrary chose to further expand his access. And this, through its major recovery plan launched in 2021, increasing the level of subsidies and the quota of people eligible for Obamacare. So much so that in 2024, more than 20 million people would have social coverage thanks toAffordable Care Actaccording to the federal agency of the US Department of Health.
During his campaign, the Republican candidate was very vague about the future he wanted to give to Obamacare. Still promising in November 2023 that Republicans “should never stop” trying to remove it, he assured in his debate against Kamala Harris last September that he had “ideas” for a plan, to transform it and not delete it. But without ever detailing what his alternative system would look like.
The complete end to subsidies
For several experts, the solution that Donald Trump and the Republicans are considering to dismantle Obamacare seems obvious: directly cut the subsidies put in place by Joe Biden. These expire at the end of 2025. Without their renewal in the American Congress, they would disappear, leaving many Americans on the sidelines who had benefited from the expansion of this system.
However, while Donald Trump has largely regained control of the Senate, and also seems to be heading towards a majority in the House of Representatives, the prospect of seeing these subsidies continue seems minimal in the eyes of some. “If the Republicans end up winning the House, in addition to the Senate and the White House, I think the chances are less than 5% that they will be extended,” assures NBC News Chris Meekins, who was a senior official in the US Department of Health during Trump’s first term.
Because these subsidies are expensive: according to the US Congressional Budget Office, sustaining them would cost nearly $335 billion over the next ten years. An argument on which the Republican camp intends to rely, despite the consequences that their non-renewal would have. Still according to this non-partisan organization providing budgetary information to American parliamentarians, nearly 4 million people would lose their social security coverage from 2026, due to lack of means to finance it.
Devious means to weaken it
However, for some, this outright rollback of Obamacare could be too perilous for Donald Trump. “It was fully integrated into people’s lives,” explainsABC News Dr. Perry Halkitis, dean of the school of public health at Rutgers University in New Jersey. It is no coincidence that candidate Trump did not call for the repeal of theAffordable Care Act a major theme of his campaign. A poll published last May showed that 60% of Americans were in favor of this system, which particularly benefits the populations of rural states in the south of the United States, who voted overwhelmingly for the Republican candidate.
However, Donald Trump and his future administration could use indirect means to undermine the sustainability of Obamacare. Several avenues are feared by its defenders, like what was done during his first mandate, whether by limiting communication around accessibility to this social coverage, or by removing certain medications and treatments from the list of refunded products. Future vice-president JD Vance, for his part, suggested the idea of placing people with chronic illnesses within another social protection system, which would logically increase their health costs. Perhaps a first idea of this “plan which will cost less to our fellow citizens, to our population, and which will offer better health care than Obamacare”, which Donald Trump had promised during his debate against Kamala Harris.