Affordable Care Act Replacement – What to Expect


President-elect Donald Trump has said that dismantling the Affordable Care Act (ACA) is one of his highest priorities and congressional Republicans are working on a plan to repeal it with a delayed effective date — perhaps as long as two to four years — to give them time to agree on an alternative. Repeal legislation most likely will be done early in 2017 through the budget reconciliation process, which would require only 51 votes in the Senate, instead of 60.

Republicans have not reached a consensus on a detailed replacement law since ACA was enacted in 2010 and the difficulties are many. Some Republicans, including Trump and House Speaker Paul Ryan (R-Wis.), say that they would retain popular portions of ACA, such as a ban on preexisting condition exclusions, while eliminating the mandate for individuals to maintain health coverage. However, the individual mandate was intended to encourage healthier people to be insured in order to counterbalance the increase in the number of sicker people getting insurance once they were no longer excluded due to a preexisting condition.

Our Affordable Care Act Replacement table is based on plans offered by Republican leaders that may provide clues to future legislation.

H.R. 3762 was passed by the House and the Senate, and vetoed by President Obama in early 2016. H.R. 3762 is the only "ACA repeal" bill to pass Congress. Its sponsor, Tom Price (R-Ga.), is president-elect Trump's choice for Secretary of the Department of Health and Human Services.

H.R. 2300, also sponsored by Price, contains the most detailed blueprint for ACA replacement. Proposed in 2015, it contains a system of age-based tax credits to use for purchasing coverage.

The Trump plan analysis contained in the table is based on a document posted on the Trump website. Ryan and Sen. Orrin Hatch (R-Utah) have made proposals that have not been introduced in bill form but may have significant influence on the way forward.