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Donald Trump promised that Republicans would “repeal and replace” the Affordable Care Act (ACA) with something “much better.” Fifteen years later, there is still no comprehensive replacement. 

 

The Affordable Care Act is on the Brink

More than 24 million people are currently enrolled in ACA Marketplace plans nationwide, benefitting from enhanced subsidies that make health care accessible for lower-income families. 

 

In Massachusetts alone, over 2 million residents rely on MassHealth or coverage from the Massachusetts Health Connector.

 

The ACA:

  • Provides premium tax credits and subsidies for people who are not eligible for Medicare.
  • Makes individuals with household incomes between $15,560 and $71,960 eligible for financial assistance.
  • Protects coverage for pre-existing conditions.

For a more detailed discussion of the Affordable Care Act benefits, please read KFF’s October Analysis.

 

What Happens if Republicans Fail to Act?

If Republicans have not generated an alternative health care plan and refuse to join Democrats in extending the ACA before January 1, 2026: 

  • ACA enhanced premium tax credits will expire at the end of this year.
  • 11.8 million people nationwide will lose health coverage, including over 300,000 in Massachusetts.
  • People with incomes below the federal poverty level will lose Advance Premium Tax Credits and ConnectorCare.
  • Massachusetts recipients of ACA premium tax credits could see their monthly costs rise by about $1,000, according to CBS News.

Without assistance, out-of-pocket costs rise, and hospitals face higher demand, and care becomes more expensive for everyone. 

 

Trump Complicates Talks

While Democrats sought to extend ACA benefits during the shutdown, Republicans refused to negotiate. As reported by The Hill, “Trump told Congress not to 'waste' time on extending the ACA’s enhanced subsidies, taking a hard line just as some lawmakers were exploring a bipartisan compromise.”

 

On Truth Social, he declared: 

 

“THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE.”

 

At the bill signing to end the shutdown, he said: 


“We’re gonna pay a lot of money to the people. They’re gonna go out and buy their own health care, and we’re gonna forget this Obamacare madness.” NBC News. 

 

The Bottom Line

Donald Trump continues to block ACA subsidies, slash Medicaid, and offer no viable replacement plan, leaving millions of Americans at risk. Democrats are fighting to:

  • Protect the Affordable Care Act.
  • Prevent premium spikes.
  • Preserve Medicaid.
  • Ensure families can afford the care they need. 

Republicans have promised a replacement for 15 years. There’s still nothing to show for it.

 
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Paid for by the Massachusetts Democratic State Committee

 

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