The following is a list of plans which were considered to replace the
Affordable Care Act
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act (PPACA) and informally as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by Presid ...
(commonly referred to as the ACA or Obamacare) during the
Donald Trump administration. The plans were considered after the
Republican Party gained a federal
government trifecta
A government trifecta is a political situation in which the same political party controls the Executive (government), executive branch and both chambers of the legislative branch in countries that have a Bicameralism, bicameral legislature and a ...
in
2016
2016 was designated as:
* International Year of Pulses by the sixty-eighth session of the United Nations General Assembly.
* International Year of Global Understanding (IYGU) by the International Council for Science (ICSU), the Internationa ...
. "Repeal and replace" has been a Republican slogan since March 2010 when the ACA was signed into law. The slogan was adopted by President
Donald Trump
Donald John Trump (born June 14, 1946) is an American politician, media personality, and businessman who is the 47th president of the United States. A member of the Republican Party (United States), Republican Party, he served as the 45 ...
.
Background
President
President most commonly refers to:
*President (corporate title)
* President (education), a leader of a college or university
*President (government title)
President may also refer to:
Arts and entertainment Film and television
*'' Præsident ...
Donald Trump
Donald John Trump (born June 14, 1946) is an American politician, media personality, and businessman who is the 47th president of the United States. A member of the Republican Party (United States), Republican Party, he served as the 45 ...
and many
Republicans have vowed to repeal and replace Obamacare; President Trump signed
an executive order on January 20, 2017, his first day in office, that according to
White House Press Secretary
The White House press secretary is a senior White House official whose primary responsibility is to act as spokesperson for the executive branch of the United States federal government, especially with regard to the president, senior aides and ...
Sean Spicer would "ease the burden of Obamacare as we transition from repeal and replace". Spicer would not elaborate further when asked for more details.
On January 12, 2017, the Senate voted 51 to 48 to pass an
FY2017 budget resolution
The United States budget process is the framework used by Congress and the President of the United States to formulate and create the United States federal budget. The process was established by the Budget and Accounting Act of 1921, the Congr ...
,
S.Con.Res. 3, that contained language allowing the repeal of the
Affordable Care Act
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act (PPACA) and informally as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by Presid ...
through the
budget reconciliation process, which disallows a
filibuster
A filibuster is a political procedure in which one or more members of a legislative body prolong debate on proposed legislation so as to delay or entirely prevent a decision. It is sometimes referred to as "talking a bill to death" or "talking ...
in the Senate.
In spite of efforts during the vote-a-rama (a proceeding in which each amendment was considered and voted upon for about 10 minutes each until all 160 were completed) that continued into the early hours of the morning, Democrats could not prevent "the GOP from following through on its repeal plans."
Plans
Several media outlets have reported widespread opposition in
Congress
A congress is a formal meeting of the representatives of different countries, constituent states, organizations, trade unions, political parties, or other groups. The term originated in Late Middle English to denote an encounter (meeting of ...
and the American public against repealing the Affordable Care Act without replacing it.
Barack Obama
Barack Hussein Obama II (born August 4, 1961) is an American politician who was the 44th president of the United States from 2009 to 2017. A member of the Democratic Party, he was the first African American president in American history. O ...
has stated that "The Republicans will own the problems with the health care system if they choose to repeal something that is providing health insurance to a lot of people".
Early proposals
The proposed CARE Act reverts many of the benefits of the Affordable Care Act.
Senator
Rand Paul
Randal Howard Paul (born January 7, 1963) is an American politician serving as the Seniority in the United States Senate, junior United States senator from Kentucky since 2011.
A member of the Republican Party (United States), Republican ...
had said he planned to introduce a replacement plan during the week of January 9, 2017. One key provision in his plan was to offer cheaper, less robust insurance plans for people.
Senators
Susan Collins
Susan Margaret Collins (born December 7, 1952) is an American politician serving as the senior United States senator from Maine. A member of the Republican Party, she has held her seat since 1997 and is Maine's longest-serving member of ...
(Maine) and
Bill Cassidy
William Morgan Cassidy (born September 28, 1957) is an American physician and politician serving as the Seniority in the United States Senate, senior United States senator from Louisiana, a seat he has held since 2015. A member of the Republic ...
(La.) introduced their plan, the
Patient Freedom Act of 2017, on January 23, 2017, which would offer states the option to retain the Affordable Care Act, if they chose, or receive a block grant to be used on an alternative plan they prefer.
House legislation
American Health Care Act

A comprehensive plan to replace the Affordable Care Act was announced by the House Republican leadership on March 6, 2017. It retains many features of the Affordable Care Act, but replaces ACT's system of subsidies with tax credits and federally-funded
Medicaid
Medicaid is a government program in the United States that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by U.S. state, state governments, which also h ...
coverage with a system of block grants to states based on the nature and number of recipients served. Conservative critics such as
Rand Paul
Randal Howard Paul (born January 7, 1963) is an American politician serving as the Seniority in the United States Senate, junior United States senator from Kentucky since 2011.
A member of the Republican Party (United States), Republican ...
characterized the plan as "Obamacare Light" and continued to advocate total repeal, while other Republicans such as
Cory Gardner
Cory Scott Gardner (born August 22, 1974) is an American attorney and politician who served as a United States senator from Colorado from 2015 to 2021. A Republican, he was the U.S. representative for Colorado's 4th congressional district from ...
from states which had accepted Medicaid expansion expressed worry about whether the new plan would adequately fund services for Medicaid patients.
The
United States House Committee on Ways and Means
The Committee on Ways and Means is the chief tax-writing committee of the United States House of Representatives. The committee has jurisdiction over all taxation, tariffs, and other revenue-raising measures, as well as a number of other progr ...
approved one portion of the bill on March 9, 2017, after an all-night session.
The second portion of the bill was also approved March 9 by the
United States House Committee on Energy and Commerce
The Committee on Energy and Commerce is one of the oldest standing committee (United States Congress), standing committees of the United States House of Representatives. Established in 1795, it has operated continuously—with various name chang ...
on a party-line vote.
On March 13 the
Congressional Budget Office
The Congressional Budget Office (CBO) is a List of United States federal agencies, federal agency within the United States Congress, legislative branch of the United States government that provides budget and economic information to Congress.
I ...
released its evaluation of the proposal. It projected a rise in uninsured by 24 million by 2028, but savings of $337 billion over ten years. In 2018, most of the reduction would be caused by the elimination of the penalties for the individual mandate, both directly and indirectly. Later reductions would be due to reductions in Medicaid enrollment, elimination of the individual mandate penalty, subsidy reduction, and higher costs for some persons.
By 2016 the CBO estimates that the average amount paid for medical insurance would decrease by about 10%. That results from increased prices for older patients and reduced credits which is predicted to increase the proportion of younger people in the pool and reduce the proportion of older people.
The bill was approved by the
House Budget Committee 19 to 17 on March 16, 2017. Three members of the
Freedom Caucus
The Freedom Caucus, also known as the House Freedom Caucus, is a congressional caucus consisting of Republican Party (United States), Republican members of the United States House of Representatives. It is generally considered to be the most Cons ...
,
Dave Brat (Va.),
Mark Sanford
Marshall Clement "Mark" Sanford Jr. (born May 28, 1960) is an American politician and author who served as the U.S. representative for South Carolina's 1st congressional district from 1995 to 2001 and from 2013 to 2019, and as the 115th govern ...
(S.C.) and
Gary Palmer (Ala.) voted against it.
It went next to the
House Rules Committee,
then to the full House.
The bill, once it passed the House, would go to the Senate under
budget reconciliation rules. Thus, only material which affects the budget can be included and only a simple majority vote will be required in the Senate. Despite his vow not to get involved into day-to-day politics former President Obama became a part of the discussion on March 23, 2017 (the seventh anniversary of ACA and one day prior to the vote on the American Health Care Act) by hailing among other things 20 million more people insured, preexisting conditions covered, young people staying on their parents' plans until 26, lowered costs for women's health care and free preventive care as progress due to the Affordable Care Act. On March 24, 2017, the bill was withdrawn by Speaker
Paul Ryan
Paul Davis Ryan (born January 29, 1970) is an American politician who served as the List of Speakers of the United States House of Representatives, 54th speaker of the United States House of Representatives from 2015 to 2019. A member of the ...
(with the endorsement of
President Donald Trump
Donald John Trump (born June 14, 1946) is an American politician, media personality, and businessman who is the 47th president of the United States. A member of the Republican Party (United States), Republican Party, he served as the 45 ...
) after failing to gain enough support in the
House of Representatives.
On May 4, 2017, the United States House of Representatives narrowly voted to repeal the Patient Protection and Affordable Care Act and passing the American Health Care Act with a narrow vote of 217 to 213, sending the bill to the Senate for deliberation. The Senate indicated they would write their own version of the bill, instead of voting on the House version.
Other legislation
On March 7, 2017
Pete Sessions sponsored an alternate proposal to
repeal and replace the Patient Protection and Affordable Care Act entitled the "
World's Greatest Healthcare Plan of 2017". The bill's current format removes the ACA's
individual mandate, which taxed individuals without health insurance. Moreover, it maintains some aspects of the ACA including ensuring insurance coverage for pre-existing conditions, allowing children to stay on their parents' health care until they are 26 years old, and banning the use of lifetime spending limits by insurance companies.
Senate legislation
In response to the passage of the
AHCA in the House, Republican leadership in the Senate stated that they would draft their own version of the legislation instead of bringing the House's version to a vote. Thirteen senators began meeting behind closed doors to draft the legislation. The group was criticized for not including women senators.
In a meeting of the
Senate Finance committee
The United States Senate Committee on Finance (or, less formally, Senate Finance Committee) is a standing committee of the United States Senate. The committee concerns itself with matters relating to taxation and other revenue measures generall ...
, Senator
Claire McCaskill
Claire Conner McCaskill (; born July 24, 1953) is an American former politician who served as a United States Senate, United States senator from Missouri from 2007 to 2019 and as State Auditor of Missouri, state auditor of Missouri from 1999 to ...
asked chairman Senator
Orrin Hatch
Orrin Grant Hatch (March 22, 1934 – April 23, 2022) was an American attorney and politician who served as a United States senator from Utah from 1977 to 2019. Hatch's 42-year Senate tenure made him the longest-serving Republican U.S. senat ...
why no
congressional hearings had been held on the proposed legislation. Video of the exchange went
viral. In addition to forgoing normal hearings and
legislative markup, Senate Republicans instituted new rules to limit the ability of reporters to ask senators about the legislation. When asked if Senate Republicans planned to release the text of the bill to the public, a Senate aide told
Axios
Axios commonly refers to:
* Axios (river), a river that runs through Greece and North Macedonia
* ''Axios'' (website), an American news and information website
Axios may also refer to:
Brands and enterprises
* Axios, a brand of suspension produ ...
, "We aren't stupid." According to
Don Ritchie
Donald Taylor Ritchie (9 June 1926 – 13 May 2012) was an Australian who intervened in many suicide attempts. He officially suicide prevention, rescued at least 180 people who had intended to attempt suicide at The Gap (Sydney), The Gap ...
,
Historian Emeritus of the Senate, such a secretive process has not been seen in the Senate in over a hundred years.
On June 16, 2017, a
bipartisan
Bipartisanship, sometimes referred to as nonpartisanship, is a political situation, usually in the context of a two-party system (especially those of the United States and some other western countries), in which opposing Political party, politica ...
group of seven current
governors
A governor is an politician, administrative leader and head of a polity or Region#Political regions, political region, in some cases, such as governor-general, governors-general, as the head of a state's official representative. Depending on the ...
sent a letter to
Senate Majority and Minority Leaders Mitch McConnell
Addison Mitchell McConnell III (; born February 20, 1942) is an American politician and attorney serving as the senior United States senator from Kentucky, a seat he has held since 1985. McConnell is in his seventh Senate term and is the long ...
and
Chuck Schumer
Charles Ellis Schumer ( ; born November 23, 1950) is an American politician serving as the Seniority in the United States Senate, senior United States Senate, United States senator from New York (state), New York, a seat he has held since 1999. ...
criticizing the House's legislation and requesting a bi-partisan effort in the Senate to reform healthcare. The signatories include Governors
John Kasich
John Richard Kasich Jr. ( ; born May 13, 1952) is an American politician and author who was the 69th governor of Ohio from 2011 to 2019, a member of the U.S. House of Representatives from 1983 to 2001, and a Republican candidate for the pre ...
(
Ohio
Ohio ( ) is a U.S. state, state in the Midwestern United States, Midwestern region of the United States. It borders Lake Erie to the north, Pennsylvania to the east, West Virginia to the southeast, Kentucky to the southwest, Indiana to the ...
),
Steve Bullock (
Montana
Montana ( ) is a landlocked U.S. state, state in the Mountain states, Mountain West subregion of the Western United States. It is bordered by Idaho to the west, North Dakota to the east, South Dakota to the southeast, Wyoming to the south, an ...
),
Brian Sandoval
Brian Edward Sandoval ( ; born August 5, 1963) is an American politician, academic administrator, and former federal judge who served as the 29th Governor of Nevada from 2011 to 2019.
A graduate of the University of Nevada, Reno, Sandoval began ...
(
Nevada
Nevada ( ; ) is a landlocked state in the Western United States. It borders Oregon to the northwest, Idaho to the northeast, California to the west, Arizona to the southeast, and Utah to the east. Nevada is the seventh-most extensive, th ...
),
John Bel Edwards (
Louisiana
Louisiana ( ; ; ) is a state in the Deep South and South Central regions of the United States. It borders Texas to the west, Arkansas to the north, and Mississippi to the east. Of the 50 U.S. states, it ranks 31st in area and 25 ...
),
John Hickenlooper
John Wright Hickenlooper Jr. ( ; born February 7, 1952) is an American politician, geologist, and businessman serving as the Seniority in the United States Senate, junior United States Senate, United States senator from Colorado since 2021. A mem ...
(
Colorado
Colorado is a U.S. state, state in the Western United States. It is one of the Mountain states, sharing the Four Corners region with Arizona, New Mexico, and Utah. It is also bordered by Wyoming to the north, Nebraska to the northeast, Kansas ...
),
Charlie Baker
Charles Duane Baker Jr. (born November 13, 1956) is an American politician serving as the sixth president of the National Collegiate Athletic Association, since 2023. A member of the Republican Party, he served as the 72nd governor of Massa ...
(
Massachusetts
Massachusetts ( ; ), officially the Commonwealth of Massachusetts, is a U.S. state, state in the New England region of the Northeastern United States. It borders the Atlantic Ocean and the Gulf of Maine to its east, Connecticut and Rhode ...
), and
Tom Wolf
Thomas Westerman Wolf (born November 17, 1948) is an American politician and businessman who served as the 47th governor of Pennsylvania from 2015 to 2023. He previously served as chairman and CEO of his business, The Wolf Organization, and l ...
(
Pennsylvania
Pennsylvania, officially the Commonwealth of Pennsylvania, is a U.S. state, state spanning the Mid-Atlantic (United States), Mid-Atlantic, Northeastern United States, Northeastern, Appalachian, and Great Lakes region, Great Lakes regions o ...
).
On July 18, 2017, the healthcare bill in the Senate collapsed following the defections of Senators Mike Lee of Utah and
Jerry Moran
Gerald Wesley Moran ( ; born May 29, 1954) is an American lawyer and politician who is the senior United States senator from Kansas, a seat he has held since 2011. A member of the Republican Party, he was chair of the National Republican Senato ...
of Kansas, making them the third and fourth Republicans to defect. President Donald Trump expressed his disappointment and indicated he would "let Obamacare fail".
On July 25, a procedural vote was passed by the Senate to begin debate on the healthcare bill, 51–50 with Vice President Mike Pence breaking the tie. The same day, the bill was soundly defeated 43–57, with nine Republicans defecting and no Democrats or Independents voting for the bill. As the effort to repeal and replace the Affordable Care Act was stalled, Senate Majority Leader
Mitch McConnell
Addison Mitchell McConnell III (; born February 20, 1942) is an American politician and attorney serving as the senior United States senator from Kentucky, a seat he has held since 1985. McConnell is in his seventh Senate term and is the long ...
scheduled a vote on a partial-repeal amendment. This too was defeated, 45–55, with 7 Republicans defecting. Subsequently, a "skinny repeal" of the healthcare bill was voted on in the early hours of July 28. The decisive vote against their own party's bill was cast by Senators
John McCain
John Sidney McCain III (August 29, 1936 – August 25, 2018) was an American statesman and United States Navy, naval officer who represented the Arizona, state of Arizona in United States Congress, Congress for over 35 years, first as ...
,
Susan Collins
Susan Margaret Collins (born December 7, 1952) is an American politician serving as the senior United States senator from Maine. A member of the Republican Party, she has held her seat since 1997 and is Maine's longest-serving member of ...
and
Lisa Murkowski
Lisa Ann Murkowski ( ; born May 22, 1957) is an American attorney and politician serving as the Seniority in the United States Senate, senior United States senator from the state of Alaska, having held the seat since 2002. She is the first woman ...
; their vote along with the Democrats defeated the bill 49–51.
On September 13, 2017, an amendment to the American Health Care Act, commonly known as
Graham-Cassidy, was submitted. The bill is sponsored by
Lindsey Graham
Lindsey Olin Graham (; born July 9, 1955) is an American politician and attorney serving as the Seniority in the United States Senate, senior United States Senate, United States senator from South Carolina, a seat he has held since 2003. A membe ...
of South Carolina, with
Bill Cassidy
William Morgan Cassidy (born September 28, 1957) is an American physician and politician serving as the Seniority in the United States Senate, senior United States senator from Louisiana, a seat he has held since 2015. A member of the Republic ...
of Louisiana as a co-sponsor. A spokesman for the Senate Majority Leader
Mitch McConnell
Addison Mitchell McConnell III (; born February 20, 1942) is an American politician and attorney serving as the senior United States senator from Kentucky, a seat he has held since 1985. McConnell is in his seventh Senate term and is the long ...
said that a vote is planned for, before September 30 which is the deadline to pass bills under budget reconciliation.
Rand Paul
Randal Howard Paul (born January 7, 1963) is an American politician serving as the Seniority in the United States Senate, junior United States senator from Kentucky since 2011.
A member of the Republican Party (United States), Republican ...
and John McCain indicated that they would vote against the bill.
On September 26, 2017, Senate Majority Leader Mitch McConnell announced that the Senate would not vote on the Graham-Cassidy bill.
Administration
The Trump administration ended subsidy payments to health insurance companies, in a move expected to raise premiums in 2018 for middle-class families by an average of about twenty percent nationwide and cost the federal government nearly $200billion more than it saved over a ten-year period. The administration made it easier for businesses to use health insurance plans not covered by several of the ACA's protections, including for preexisting conditions,
and allowed organizations not to cover birth control. In justifying the action, the administration made false claims about the health harms of contraceptives.
The administration proposed substantial spending cuts to
Medicare,
Medicaid
Medicaid is a government program in the United States that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by U.S. state, state governments, which also h ...
and
Social Security Disability Insurance
Social Security Disability Insurance (SSD or SSDI) is a payroll tax-funded federal insurance program of the United States government. It is managed by the Social Security Administration and designed to provide monthly benefits to people who ha ...
. Trump had previously vowed to protect Medicare and Medicaid. The administration reduced enforcement of penalties against nursing homes that harm residents. As a candidate and throughout his presidency, Trump said he would cut the costs of pharmaceuticals. During his first seven months in office, there were 96 price hikes for every drug price cut. Abandoning a promise he made as candidate, Trump announced he would not allow Medicare to use its bargaining power to negotiate lower drug prices.
References
{{reflist, 30em
Proposed legislation of the 115th United States Congress
Patient Protection and Affordable Care Act replacement proposals
Patient Protection and Affordable Care Act replacement proposals
Legislation attempting to reform or repeal the Affordable Care Act
First Trump administration controversies