“Obamacare will never work,” Trump said during his second debate last month with Hillary Clinton. “It’s very bad, very bad health insurance. Far too expensive. And not only expensive for the person that has it, unbelievably expensive for our country.”
With Republicans set to take over both the Senate and House of Representatives, in addition to the presidency, a dismantling of Obamacare is a very real possibility. However, the Republicans do not hold a filibuster-proof 60 seats in the Senate, so a full repeal is unlikely, but Trump and Congress would have the power to make targeted changes to the law, including defunding “the consumer exchange subsidies in a budgetary maneuver known as reconciliation,” according to PricewaterhouseCoopers.
“It’s a challenge for a Trump presidency,” says Jack Hoadley, a research professor at Georgetown University’s Health Policy Institute. “To get a true repeal and replace through, he needs 60 votes in the Senate. That’s the minimum number of votes needed to overcome a filibuster in the Senate.”
In January, the GOP passed a bill that eliminated subsidies that help many Obamacare recipients afford their healthcare coverage, as well as Medicaid expansion that gave coverage to millions of low-to-middle income Americans. The bill also eliminated the employer mandate, which requires all employees to have health insurance or pay a tax penalty, and cut funding to organizations like Planned Parenthood.
Trump has proposed a number of measures that he said will allow people to buy affordable health insurance policies outside of the Obamacare exchanges. These include establishing tax-free health savings accounts designed to help individuals save money to pay for health care costs, and allowing policyholders to deduct the cost of their premiums on their personal income tax returns. Trump has also said he wants to allow insurance companies to sell their policies across state lines to increase competition.
However, even with these measures, Trump’s plan would increase costs for consumers who buy insurance individually. A recent study by the Commonwealth Fund and Rand Corp found that without repeal, an individual Affordable Care Act policy would cost an average of $3,200 per year in 2018, but repeal would increase the cost of a replacement policy to $4,700. The Commonwealth study also found that repealing Obamacare would increase deficit spending over the long-run.