What Would Trump Do with the ACA? It’s Hard to Tell for Sure

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Former President Trump has certainly not made repeal of the Affordable Care Act (ACA) a centerpiece of his campaign like he did in 2016, which led to a high-profile and ultimately unsuccessful effort to replace the health law in 2017.

Listening to Trump’s comments about the ACA during the current campaign is almost like a Rorschach Test – you can interpret what he says in almost any way you want to.

December 2023: Trump said about the ACA, “I will come up with a much better, and less expensive, alternative! People will be happy, not sad!”

April 2024: Trump said he was “not running to terminate” the ACA. But, he also said the ACA “was not very good” and that he was going to make it “much better than it is right now,” which might or might not be interpreted as a vow to replace it with something else.

Presidential debate, September 2024: Trump said, “I have concepts of a plan. I’m not president right now. But if we come up with something I would only change it if we come up with something better and less expensive. And there are concepts and options we have to do that. And you’ll be hearing about it in the not-too-distant future.”

Trump might, or might not, have an ACA replacement plan. If he were to release a plan, he would no doubt frame it as much better than the status quo, but any health reform plan inevitably involves trade-offs and winners and losers.

While there’s ambiguity about what Trump is currently planning for the ACA, we do have his record. As president, Trump’s budget proposed to convert the ACA and Medicaid into block grants to states, providing “relief” from the ACA’s “insurance rules and pricing restrictions” and reducing federal spending by about $1 trillion over a decade.