Trumpcare v Obamacare: How they compare and how many people will lose insurance

Alexandra Wilts
Washington DC
Friday 05 May 2017 12:55 BST
Donald Trump celebrates with Congressional Republicans in the Rose Garden of the White House after the House of Representatives approved the American Healthcare Act
Donald Trump celebrates with Congressional Republicans in the Rose Garden of the White House after the House of Representatives approved the American Healthcare Act (Reuters)

The House of Representatives has passed a new healthcare bill, meaning that President Donald Trump is one step closer to repealing Obamacare, otherwise known as the Affordable Care Act. Here is a breakdown of how Mr Trump’s healthcare plan differs from former President Barack Obama’s.

Number of people left uninsured

Obamacare: The nonpartisan Congressional Budget Office (CBO) estimated that if the ACA continues to be the law of the land, the number of uninsured Americans – currently 28 million – would remain stable for the next decade.

Trumpcare: The CBO did not have time to predict the potential effects of the latest version of the American Health Care Act (AHCA). In an analysis of an earlier version of the bill, the office found that a total of 54 million could be uninsured by 2026 if the AHCA becomes law.

Individual mandate

Obamacare: All Americans must have health insurance or pay a tax penalty.

Trumpcare: The AHCA repeals the mandate, but those who go without health insurance for more than 63 days must pay a 30 per cent surcharge on their insurance premiums for a year.

Employer mandate

Obamacare: Companies with more than 50 employees are required to provide health insurance or pay a penalty.

Trumpcare: The AHCA repeals the employer mandate.


Obamacare: To pay for the new system, the ACA raised Medicare taxes on those with incomes above $250,000. It also imposed new taxes on makers of medical devices, health insurers, drug companies, investment income, tanning salons and high-end health insurance plans. The legislation gave some tax credits to middle-income earners to help them pay out-of-pocket health expenses.

Trumpcare: The AHCA repeals most Obamacare taxes.

Essential health benefits

Obamacare: Mandates that all insurance plans cover certain health conditions and services, such as annual physical exams, prescription drug costs, mental health counselling and women's health services.

Trumpcare: Enables states to waive requirements set forth in the ACA.


Obamacare: Expanded Medicaid health insurance for low-income individuals.

Trumpcare: Cuts federal funding for Medicaid expansion starting in 2020.

Pre-existing conditions

Obamacare: Prevents health insurers from denying coverage or charging more to individuals who have pre-existing medical conditions, such as asthma or heart disease.

Trumpcare: Allows states to waive rules that currently stop insurers from charging new customers more because of their medical history. States can opt out of the ACA requirements if they set up high-risk insurance plans, known as high-risk pools, for individuals who cannot afford traditional insurance. A new amendment provides an extra $8 billion to subsidise the cost of insuring those with pre-existing conditions.

What would not change

Both the ACA and the Republican bill allow children to be covered by their parents’ insurance policies until they are 26.

Insurers would still not be allowed to set annual and lifetime limits on how much they will reimburse individuals for “essential health benefits”, such as doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, and mental health services.

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