Froma Harrop

Donald Trump tried to kill Obamacare. If elected to a second term, he would try to kill it again.

No, the former president didn’t save the Affordable Care Act, as his running mate J.D. Vance said at the vice-presidential debate. That was a bald-faced lie.

Here’s what happened: During the 2016 campaign Trump vowed to replace the popular health care reforms with “something terrific.” As president, Trump never came up with a replacement. On the contrary, he began poisoning the program dose by sneaky dose.

Early on, Trump slipped an effective repeal of the “individual mandate” into his tax cut legislation. The mandate required most Americans to have health insurance or pay a penalty. By removing the penalty, fewer healthy people bought coverage. That led to higher ACA marketplace premiums to cover a riskier pool of individuals.

He expanded access to short-term plans that didn’t have to meet basic ACA requirements, such as covering preexisting conditions. Many people opted for these cheaper plans, again leaving the ACA marketplaces burdened with a sicker population.

He shortened the annual ACA enrollment period and cut its advertising budget by 90%. This further reduced enrollment by younger and healthier people.

You see the theme here. The economic model for insurance, whether for medical care or auto collision, is to diversify the risk. That means establishing a balanced pool of clients, some who put in large claims, some who put in small or no claims.

My family had first-hand experience with skimpy coverage. For decades, we had all been “healthy people.” Then one member came down with a serious cancer and — this was pre-ACA — we had to fight the insurer for adequate care.

Trump came close to deep-sixing Obamacare in 2017. The Congressional Budget Office estimated that the “skinny repeal” would have stripped 16 million Americans of their coverage by 2026. The Republican Senate would have passed it but for a single thumbs-down vote cast by Sen. John McCain. The Arizona Republican objected to the trickery being played on working Americans.

Trump also supported lawsuits seeking to eliminate the ACA. One was Texas v. United States, which argued that since the individual mandate penalty was repealed, the entire ACA should be struck down. The program was saved by the Supreme Court in 2021.

Through these actions, the Trump administration created uncertainty and instability in the ACA marketplaces, reducing the number of participants and eroding some of the law’s protections. Enrollment fell during Trump’s presidency from almost 13 million Americans to 11.4 million. Under Joe Biden, it has grown 86% to a record 21.3 million.

Trump in a second term would finish the demolition job. He presumably wouldn’t be running again for president and so would not face the voters’ wrath once they figured out what he had done. The loss of Medicaid expansion and marketplace subsidies would hit home.

The ACA provided health care security for those not covered by their employer or who couldn’t afford coverage because of preexisting conditions, and has been a godsend to working-class and low-income people, particularly in the rural and conservative states that voted MAGA. Trump might assume that his fan base would put up with anything he dishes. By then, however, he would no longer need their love.

Plans to cannibalize protections afforded by the ACA are all there in Project 2025, the blueprint for another Trump term. Coverage for preexisting conditions would come under special attack. Knives would also be out for Medicare. Many drug prices, for one, would soar.

Trump’s claim to have “concepts of a plan” is just an updated version of his never-existed “something terrific” plan to replace Obamacare. The plan is to kill it.

Froma Harrop can be reached at fharrop@gmail.com.