Everything You Need to Know About the American Health Care Act (TrumpCare) in One Place

We present a simple summary of the American HealthCare Act (AHCA), sometimes known as TrumpCare, the plan to repeal and replace aspects of the Affordable Care Act (ACA) via the 2017 budget reconciliation process.

See Summary of the American Health Care Act by the Kaiser Family Foundation for a more robust overview. This version is short and readable while remaining complete.

UPDATE 2019: This plan never passed, and thus some specifics here are of historical interest only.

An Overview of the Key Provisions of the AHCA and How it is Different From the ACA

Below are key provisions of H.R. 1628, the American Health Care Act, as passed by the House of Representatives on May 4, 2017. This act changes the Affordable Care Act. Please note that these provisions are not scheduled to go into effect until after the 2020 election.

This bill:

  • Repeals the mandates (2016). This means there is no fee for not getting coverage although the plan adds a new fee, a 30% fee if you want to reenter the market after not having coverage for more than 63 days. The new fee means employers won’t have to provide coverage to full-time employees anymore.
  • Repeal standards for actuarial values (2020). This opens the door for junk plans that are inexpensive but have very limited coverage.
  • Repeals out-of-pocket cost assistance (2020). This means a reduction in assistance.
  • Changes premium cost assistance based on income (2018). Those making between 100% – 600% of the poverty level get assistance, but assistance is based on age, not income. This will mean a reduction in assistance for many.
  • Retains guarantee issue on pre-existing conditions. However, some essential health benefits can be waived at the state level. This subject is complex. We can sum it up by saying the bill’s provisions considered together “weaken” pre-existing conditions protections.
  • Retains the requirement to cover young adults under 26.
  • Modifies age rating limit to a 5:1 ratio in 2018 unless states adopt different ratios. Seniors can pay up to five times more than young adults. ObamaCare, the ACA, allowed seniors to be charged only a 3:1 ration. That means seniors not yet on Medicaid, but needing assistance, could see much higher premiums.
  • Retains rating limits on sex and health status in general. However, it allows states to charge more for certain conditions via a waiver.
  • Open enrollment remains, as does special enrollment. However, HHS rules narrow open enrollment and made special enrollment harder.
  • It establishes a high-risk pool called the State Patient and State Stability Fund. There is some concern that it is going to be funded well enough to be effective.
  • Changes funding for very specific health centers. In essence, it prevents Planned Parenthood from taking Medicaid and shifts funding to Community health centers which may or may not currently exist.
  • Adds state options for work requirements for Medicaid.
  • Freezes Medicaid expansion funding at a per-capita rate and creates new rules (2018-2020). This will decrease state funding for Medicaid by over $880 billion.
  • Eliminates most of the Affordable Care Act’s taxes, this includes the Medicare tax on high earners, all taxes on industry, and all taxes large employers face.

The last CBO projection, which was scored before a few final changes were made, said the following.

The plan (before the Amendments) had a price tag that came in under the ACA,  saving $337 billion over the decade. However, it did this by leaving 52 million without coverage by 2026. It increases the number of uninsured Americans by 24 million by 2026 for a total of 52 million. The costs and uninsured rates are subject to change based on changes to the bill.

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Deb on

I think it’s BS! In their full out attack on everything President Obama did, the GOP is acting reckless and cruel. You punish the most vulnerable in society and give the most affluent the breaks. Disgusting and I hope with all my heart the republicans pay dearly in the coming elections.

Lynn on

It is terrible, when you look at who is being effected by these new changes to Obama Care, the senior people, who are barely struggling along as it is. The disabled children and all those with pre-existing conditions, which is a huge chunk of the people in America, as studies show, if you live without income, or low income, you are prone to more health problems. Whereas, those who are rich, live the best way they can, including eating well, less stress, seeing the best doctors. This is unreal! I’ve met a man who is a car salesman, and he had an injury to his nose so he can’t breathe through his nose, so he breathes through his mouth. He is not able to get his nose fixed because he does not have health insurance. I feel bad for him. This is just so not right! The people of the United States deserve better Congressional Law makers then they currently have right now, because they are not looking out for whats best for the people or this country.

Repeal Obamacare on

Your whole argument is shot in the foot by your own words. If ObamaCare is SO AWESOME why doesn’t this car salesman have insurance?

Theresa Maddox on

This is no better for the American People than Obamacare it just changed some of the rules that doesn’t help the people over 60 that can’t retire due to low Medicare wages.
Everything goes up and up while Medicare stays the same so you have to buy a supplement to off set the cost for the elderly. You want me to tell you what
really pisses me off all these young people bleeding out system. Having kids with several different parents refuses to tell who daddy of the child is, getting food stamps but the elderly doesn’t qualify, getting disability at 24 yrs old they can be trained to do another job. I work everyday with disabilities because I have to in order to pay for food, lights, water, gas, health insurance, car insurance, doctor bills and medicine. No you have not done your job of helping the elderly or the American Vets. It is what it is……

Patrick on

I applaud you.!!!!

Kristine Pelow on

This scares me. And what is more frightening is a republican who supports this outlandish proposal. It will affect EVERYONE!! What a horrible selfish person Trump is.

Melinda Ortego on

I think Trump and his family including his and/or his wife’s parents should go under this plan now as his income only being the $1 he is taking as a president and see if he likes it. He can be the guinea pig.

Stan Heath on

why cant we just buy into medicare instead you tax me and give it to insurance companies for sorry coverage

Rhonda on

I think everybody should be pushing for more regulations on medical and pharmaceutical companies that have spiraled out of control instead of health insurance. With or without health insurance we can’t afford it. That is what the problem is and it is not fair to force Americans to buy health insurance they can’t afford everybody needs to push our government to put healthcare and pharmaceutical companies in check

Philip Maynard on

Find a way to legitimately, temporarily allow insurance companies to compete in all 50 states without ACA regulations or taxes until the law can be changed.
Then create a budget to pay the lower rates for the indigent instead of ACA higher rates.
Employ a massive, full time team, managed by six sigma professionals to work with the insurance industry produce talent, professionals, equipment and medical professionals willing to process the patients of these insurance agencies at fair and reasonable prices and rates in return for all of the business flow they can generate for them in return.
Do the same with hospital conglomerates who will dedicate select hospitals to do the same for the same benefit to themselves. (Predictability of high volume of business and predictable, collectable cash flow is more important than unpredictable instability created by outrageous prices and costs.
Then assess the real situation that remains and make a healthcare act based on that.
Use six sigma to streamline VA systems and processes, then use VA facilities when possible to pick up some of those uninsurable.
Enlist and hire insurance industry CEOs and executives to create a government owned, for profit, industry competitive insurance company whose profit can afford the indigent.

Geni McMullen on

I a old (82) and female. This plan is obviously against the survival of both/either. Scary!!!

Wynotta Crawford on

I don’t understand why the ratio is changed to higher for seniors. Some of this reads like throwing seniors under the bus and making it difficult for seniors to qualify for help with copy’s.

patrick on

I retired 2012. My health ins was 140.00 month.
Obama care in effect my ins was then 440.00 month
Go on line chek out OBama care,low monthly rate with 7000.00 deductable
Seriously ?
Cut family planning,why not? Plan your family ! Go to a free clinic if you’re in need.

James Tucker on

And the rich get richer. I’d except any insurance deal the Congress comes up with if they except it for themselves. It will never happen. Time to put the Dems back in power.

Erich Bastel on

The dems are the one that got us in this mess. We need to repeal and not replace Obamacare. Then it can go back to the way it was where if you’re a full-time employee the government makes your employer provid you insurance. That’s as far as the government should get involved in healthcare. Because now people who are full-time employed can’t afford it, but people without jobs are walking around with insurance. Please tell me how this is fair?

Larry on

The ACA is garbage, but this is way worse it’s s pure attack on the elderly and the poor. A leave the rich sitting pretty.

Larry on

Where is the AARP on this

Laura Murphy on

Why are insurance lobbyists writing this bill?
1. No, to charging older 5x as much.
2. Comfortable clause for pre-existing conditions. Insurers cannot “dump” you if they think you are too sick. They shouldn’t be in business if they don’t want to help sick people get well. Insurance cos. sound greedy.

Erich Bastel on

I think we need to repeal Obamacare and go back to the way it was where employers provide insurance for full-time employees. That way the workingman not only has insurance, it was affordable. Now us working people can’t afford insurance and if we can it’s less insurance then we had before. Meanwhile people who don’t work walk around with all the insurance in the world. I don’t see how this is fair?

Fran Jones on

I want the insurance plan the politicians have. Free, CADILLAC coverage, and have no payments and get the best of health care..
maybe if we can start sending all the politicians to the Veteran hospitals and let our HEROS (veterans), go where they go!!! and it would all be FREEEEE/

answer health on demand on

Great, google took me stright here. thanks btw for info. Cheers!