The Trump administration wants to kill ObamaCare. What happens if it does?

The Trump administration made its intentions clear this week about the future of the Affordable Care Act: It wants to nix it, in its entirety.

On Monday, in a letter to the 5th Circuit Court of Appeals, the Department of Justice said it agreed with a December ruling by a federal judge in Texas that struck down one of the biggest legislative accomplishments of the Obama administration as unconstitutional.

“The Department of Justice has determined that the district court’s judgment should be affirmed,” the Monday night letter said.

In that case, District Judge Reed O’Connor in Fort Worth ruled the ACA was unconstitutional because the individual mandate, which required Americans to either get health insurance or face a financial penalty, had already been stripped from the law.

While a coalition of states almost immediately appealed the decision -- the 5th Circuit Court of Appeals is currently reviewing the lower court’s ruling, but it’s ultimately expected to make its way to the Supreme Court -- if the ruling is upheld, it could have serious repercussions for the roughly 20 million Americans who would be left without health insurance.

It’s unclear what a plan to repeal and replace ObamaCare might look like (Republicans have repeatedly tried and failed to pass a replacement), but President Trump pledged on Wednesday to have a plan “far better than ObamaCare” if it was dismantled. He did not provide additional details about what the plan would include.

“ObamaCare is a disaster. It’s too expensive by far,” Trump told reporters in the Oval Office. “We’re coming up with plans. ... And if the Supreme Court rules that ObamaCare is out, we will have a plan that’s far better than ObamaCare.”

If the nine-year law is repealed, it could leave an 32 million people uninsured by 2026, according to a Congressional Budget Office report from 2017.

Premiums for policies purchased through marketplaces or directly from insurers, meanwhile, would likely increase by 20 percent to 25 percent in the first new plan year, following the enactment, according to the CBO. By 2026, the increase is expected to climb to 50 percent following the elimination of the Medicaid expansion. Average premiums would also likely spike as a result.

And if the law is struck down, more than 12 million low-income adults could lose the Medicaid coverage they’ve gained as a result of the ACA, as first reported by The New York Times.

But perhaps most notable are the Americans living with pre-existing conditions who would lose their coverage. In the 2018 midterm elections, House Democrats campaigned heavily on protecting health insurance coverage for people with pre-existing conditions, a signature issue that propelled many to victory.


According to a government analysis from 2017, an estimated 51 percent of Americans live with pre-existing conditions -- or about 113 million people. Prior to the implementation of the ACA, any of these people could have been denied coverage.