{"slug":"trump-first-term-obamacare-repeal-attempts","title":"ACA Repeal Failures and Sabotage: Losing 51-49, Then Dismantling Piece by Piece","date":"2017-07-28","lastUpdated":"2019-12-18","description":"After seven years of Republican promises to 'repeal and replace' the Affordable Care Act, the Trump administration's legislative effort failed 51-49 in the Senate in July 2017, when Senator John McCain cast the deciding 'no' vote. Having failed legislatively, the administration pursued administrative sabotage: cutting outreach funding by 90%, shortening the enrollment period, allowing cheaper short-term plans that excluded pre-existing conditions, and eliminating cost-sharing reduction payments to insurers — a move that CBO estimated would increase premiums 20% and cost $194 billion more in subsidies. The administration simultaneously pursued legal challenges that reached the Supreme Court.","summary":"The administration's attempt to repeal and replace the ACA failed through three separate legislative vehicles: the American Health Care Act (AHCA) passed the House but died in the Senate; the Better Care Reconciliation Act failed to advance in the Senate; and the 'skinny repeal' (Health Care Freedom Act) failed 51-49 when McCain, Murkowski, and Collins voted against it. Following legislative failure, the administration cut the Navigator program (enrollment assistance) from $63 million to $10 million, reduced the open enrollment window, and created an association of short-term health plans that could deny coverage for pre-existing conditions. Termination of cost-sharing reduction payments to insurers triggered premium increases and a complex subsidy dynamic that ultimately cost the government more than the payments themselves.","category":"federal-dismantlement","severity":"critical","ongoing":false,"sources":[{"url":"https://www.nytimes.com/2017/07/28/us/politics/john-mccain-obamacare-vote.html","title":"Dramatic Vote: John McCain Sinks Republican Health Bill","publisher":"The New York Times"},{"url":"https://www.washingtonpost.com/national/health-science/trump-ends-aca-cost-sharing-payments-plunging-insurance-markets-into-uncertainty/2017/10/12/story.html","title":"Trump ends ACA cost-sharing payments","publisher":"The Washington Post"},{"url":"https://apnews.com/article/trump-aca-repeal-mccain-skinny-repeal-failed","title":"McCain votes no — 'skinny repeal' of ACA fails 51-49","publisher":"The Associated Press"},{"url":"https://www.cbo.gov/publication/53300","title":"Federal Subsidies Under the ACA for Health Insurance Coverage","publisher":"Congressional Budget Office"}],"draft":false,"status":"published","tags":["ACA","healthcare","repeal","first-term","federal-dismantlement","McCain","cost-sharing","Obamacare"],"relatedEntries":[],"timeline":[{"date":"2017-05-04","title":"House passes AHCA — Senate never brings it to vote","summary":"The House passes the American Health Care Act (AHCA) 217-213. The Senate develops its own version (BCRA) but cannot achieve 50 votes. Multiple Senators oppose the legislation as too damaging to coverage."},{"date":"2017-07-28","title":"McCain thumbs down — skinny repeal fails 51-49","summary":"Senator John McCain casts a dramatic late-night 'no' vote, joined by Murkowski and Collins. The 51-49 vote kills the Health Care Freedom Act (skinny repeal). The legislative effort is effectively over."},{"date":"2017-10-12","title":"Trump terminates cost-sharing reduction payments","summary":"Trump signs an executive action terminating CSR payments to insurers, worth approximately $7 billion annually. CBO estimates this will increase premiums 20% and cost the government $194 billion more in subsidies over a decade. Courts later find the termination unlawful."},{"date":"2017-10-01","title":"Navigator cuts — 84% reduction in enrollment assistance","summary":"HHS cuts Navigator program funding from $63 million to $10 million. Open enrollment is shortened to 45 days. Outreach advertising is cut by 90%. The changes are implemented to create friction reducing ACA enrollment."},{"date":"2018-06-01","title":"Administration expands short-term health plans — pre-existing conditions excluded","summary":"The administration expands short-term health plans to allow 12-month terms renewable for 3 years, without ACA coverage requirements. These plans can exclude pre-existing conditions. Consumer advocates warn of coverage gaps for people who become ill."},{"date":"2021-06-17","title":"Supreme Court upholds ACA 7-2 — administration lacked standing","summary":"The Supreme Court rules 7-2 that the plaintiffs in California v. Texas lacked standing to challenge the ACA's constitutionality. The ruling leaves the ACA intact. The Biden administration reverses the administrative sabotage measures."}],"location":{"name":"Washington, D.C.","lat":38.9072,"lng":-77.0369},"custom":{"era":"first-term","posture":"judicial-finding","warCrimeClassification":"enabling","internationalLaw":[],"iccRelevance":false,"victims":"Americans with pre-existing conditions who would have lost coverage under failed repeal plans; consumers who purchased short-term plans without pre-existing condition coverage and faced medical expenses; low-income ACA enrollees whose premium increases were not fully offset by subsidies; uninsured Americans who could not afford premiums driven up by administrative sabotage","structuredPerpetrators":[{"name":"Donald Trump","role":"President; directed legislative repeal effort; terminated cost-sharing reduction payments by executive action; approved administrative changes reducing ACA effectiveness; continuously encouraged repeal","institution":"White House"},{"name":"Tom Price","role":"HHS Secretary; implemented administrative actions reducing ACA effectiveness including outreach cuts and enrollment window reductions; resigned September 2017 after chartered flight scandal","institution":"Department of Health and Human Services"}],"updateLog":[{"date":"2019-12-18","summary":"Updated with district court ACA constitutionality ruling and administration's position."}]}}