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Donald Trump has been promising a health care plan to replace the Affordable Care Act for more than a decade. He promised it during his first term, promised it again on the campaign trail, and promised it once more last week.
Once again, it didn’t materialize.
Dustin Granger for Louisiana is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
The so-called “Great Health Care Plan” amounted to a short fact sheet with no real details. Some of its ideas—price transparency and plain-language insurance information—already exist under the Affordable Care Act. Nothing in it replaces coverage, strengthens protections, or explains how real medical care would be paid for.
At the center of the proposal is a promise to “send money directly to the American people” so they can buy the insurance of their “choice.” That sounds appealing until you ask basic questions. How much money? Enough to cover cancer treatment? A serious accident? A chronic illness?
Those questions go unanswered. As always.
This isn’t a mistake. It’s the strategy. The Art of the Delay.
The Affordable Care Act was never meant to be the final word on health care. It was a compromise—one that expanded coverage while preserving private insurance. Instead of building on it, Republicans spent years weakening its foundations, starting with the individual mandate. When the system began to strain, they blamed the law rather than their sabotage.
Now they are attacking another core support: the subsidies that make coverage affordable. For more than ten years, Republicans have promised a replacement “soon.” After all that time, what finally arrived was nothing.
Under the ACA, insurers cannot deny coverage for pre-existing conditions. Insurance markets are stabilized by spreading risk across healthy and sick people alike. Break that system apart, and premiums rise. Coverage shrinks. The people who need care most are priced out.
Republicans call this “choice.” In reality, it’s the system we already lived under—one that worked fine if you were healthy and failed you the moment you weren’t.
This isn’t complicated. Every other wealthy country uses some form of universal coverage, and ordinary people pay less for health care than Americans do. The reason we don’t follow that path isn’t technical. It’s financial. Fixing health care means higher taxes on the wealthy and lower or no premiums for everyone else.
So instead of fixing the system, Republicans delay. They weaken what exists, undermine its funding, and promise a replacement that never comes.
This isn’t a failure of creativity. Donald Trump has never understood health care policy, and his fixation has always been tearing down the Affordable Care Act because he hates the president who signed it. Congressional Republicans oppose the ACA for a simpler reason: it expands coverage to ordinary Americans. That’s why, fifteen years later, there is still no real alternative.
Louisiana will feel the consequences directly. Nearly all Louisianans who buy insurance on the ACA marketplace rely on subsidies to afford coverage. If those subsidies disappear, premiums will rise sharply—often doubling—and an estimated 80,000 to 90,000 people in our state could lose health insurance entirely.
The fact is that losing the Affordable Care Act—along with Medicaid now, and Medicare and Social Security down the road—would hurt, and in some cases kill, many of their own supporters. That has clearly not been a problem for them.
The voting record is clear. When Republicans came within one vote of repealing the Affordable Care Act in 2017, every Democrat voted to save it. Democrats have continued to vote to protect and expand health care. With very few exceptions, Republicans have voted the opposite way. That pattern hasn’t changed.
Louisiana’s leaders are part of that pattern. Speaker Mike Johnson, along with Bill Cassidy, John Kennedy, Julia Letlow, Steve Scalise, and Clay Higgins, have consistently voted to weaken or block health care protections their own constituents rely on.
Calling this a “plan” doesn’t make it one. Republicans have made clear they will not fix health care. Until Louisiana changes its voting patterns and gives Democrats a chance to govern, the result will remain the same: higher costs, more bankruptcies, and shorter lives.
What can you do to help change Louisiana?
Set up a $5 monthly contribution to the Louisiana Democratic Party here [ [link removed] ]
We have to get back to nuts and bolts of what built Democratic domination in the past. Sign up your interest to become a precinct organizer here [ [link removed] ].
Who’s running for Congress in 2026? Check out Jamie Davis [ [link removed] ], Jabarie Walker [ [link removed] ] & Tracie Burke [ [link removed] ] running for U.S. Senate against Bill Cassidy, Conrad Cable [ [link removed] ] & Matt Gromlich [ [link removed] ] against Speaker Mike Johnson (LA-4), Lauren Jewett [ [link removed] ] against Steve Scalise (LA-1), Tia Lebrun [ [link removed] ] against Clay Higgins (LA-3) and Larry Foy [ [link removed] ] against Julia Letlow’s successor (LA-5).
Dustin is a financial advisor and Certified Financial Planner with over 20 years of experience guiding Louisiana families as co-owner of Generation Wealth [ [link removed] ]. A lifelong resident of Louisiana and LSU alumnus, he is also a proud #girldad. Dustin ran for Louisiana State Treasurer in 2023, bringing in more votes than any other statewide Democratic candidate, though he was ultimately unsuccessful. He has since focused on strengthening the Louisiana Democratic Party, having been elected Treasurer in 2024 and serving on the State Central Committee. As a delegate to the 2024 Democratic National Convention and a frequent commentator on social media and local TV networks, Dustin holds leaders accountable and champions progressive solutions for a revitalized Louisiana.
Dustin Granger for Louisiana is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

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