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The Numbers Behind Trump’s Repeal and Replace Proposal

This week, Trump’s focused once again on the Affordable Care Act.

By Dwyer Gunn


Donald Trump delivers remarks about the Affordable Care Act on November 1st, 2016, in Valley Forge, Pennsylvania. (Photo: Chip Somodevilla/Getty Images)

At a campaign rally in Pennsylvania on Tuesday—the day this year’s open enrollment period for the Affordable Care Act’s individual exchanges began—Republican presidential nominee Donald Trump vowed that, if elected, he would resort to drastic measures to repeal the Affordable Care Act.

“I will ask Congress to convene a special session so we can repeal and replace,” Trump promised. “And it will be such an honor for me, for you, and for everybody in this country because Obamacare has to be replaced. And we will do it, and we will do it very, very quickly. It is a catastrophe.”

Trump was joined by running mate Mike Pence, who also sharply criticized the ACA, calling it an “albatross on the economy.” The two described its repeal as “one of the single most important reasons why we must win on November 8th,” and promised to replace it with “much better health care at a much less expensive cost.”

Setting aside the question of why exactly a special session like Trump proposed would be required for such an action (Congress will be in session both after the election and after the next president is inaugurated), his critique of the law is well-timed. A number of large insurers announced plans to pull out of the ACA’s individual health-care exchanges over the summer, and, last week, the Obama administration confirmed that consumers on these exchanges will face fewer choices and higher premiums next year. In Pennsylvania, where the speech occurred, average premiums for benchmark silver plans will increase 53 percent next year.

The proposals that Trump and Pence outlined in the speech aren’t new—they’re straight from the candidates’ health-care plan, which was unveiled earlier this year. Their plan calls for repealing the ACA and instituting a number of free-market reforms, such as making health insurance premiums tax-deductible, allowing people to purchase insurance across state lines, conferring new tax advantages on Health Savings Account contributions, increasing health-care pricing transparency, block-granting Medicaid, and allowing Americans to purchase cheaper prescription drugs from abroad.

A few of these changes might indeed reduce health-care premiums for some people. For example, the ACA imposed a number of requirements on health insurance plans and insurers — it eliminated lifetime coverage caps, forbid insurers to deny coverage due to pre-existing conditions, and required plans to cover a variety of preventative services (without cost-sharing). While advocates of such provisions argue they protect consumers, they do make health insurance more expensive, so repealing the ACA (and thus eliminating those requirements) would likely reduce premiums for young, healthy people. Likewise, allowing drug imports would likely reduce health-care spending and premiums as well.

In Pennsylvania, where the speech occurred, average premiums for benchmark silver plans will increase 53 percent next year.

But the Trump campaign’s plan, as it’s currently written, fails on two major fronts: It’s not clear that it will save money, and it doesn’t come close to providing universal health insurance coverage. In May, the Committee for a Responsible Federal Budget, a non-partisan Washington, D.C., think tank that advocates for deficit reduction and counts both prominent Republicans and Democrats on its board, published an analysis of the Trump health-care plan. The analysis concluded that the Trump repeal-and-replace plan would cost $550 billion in a static scoring model, or $330 billion under a dynamic scoring model (which includes predicted effects of economic growth due to the changes).


The chart to the left shows the CRFB’s breakdown of the costs.

Perhaps more concerning is the fact that Trump’s plan doesn’t actually include a comprehensive “replacement” for the ACA. According to the CRFB’s analysis, repealing Obamacare would result in 22 million Americans losing their health insurance. The Trump plan would only provide coverage to 5 percent of those people. In other words, according to the CRFB, “the plan would increase the number of uninsured individuals by about 21 million.” Now, there are some notable caveats to the numbers above: The CRFB assumes the requirement that insurers cover pre-existing conditions would be eliminated (Trump has said elsewhere that he would keep it, although it doesn’t appear on the website), and it doesn’t incorporate potential savings from block-granting Medicaid (which vary according to policy specifics).

The Affordable Care Act has dramatically reduced the number of people in this country who don’t have health insurance. But the law also has some flaws, especially the portion pertaining to individuals who don’t receive insurance coverage through their employers. Those flaws should be addressed, regardless of who wins next week’s election. But as it’s currently written, the Trump health-care plan falls well short of producing “much better health care at a much less expensive cost.”