Trump’s Healthcare Promise: “No One Will Lose Coverage” — 20 Million Were at Risk 🏥🚫 #Chaos

In January 2017, newly inaugurated President Donald J. Trump made a sweeping promise: “We’re going to have insurance for everybody… no one will lose coverage” (Shear & Pear, 2017). At the time, many Americans, especially those insured through the Affordable Care Act (ACA), clung to these words with a mix of hope and apprehension. Yet the reality of Trump’s healthcare policy between 2017 and 2021 told a different story — one of risk, confusion, and deepening inequality.

From the beginning, Trump prioritized dismantling the ACA, often called “Obamacare.” Republicans in Congress introduced multiple bills aiming to repeal and replace the law. In July 2017, the Senate came just one vote shy of fully repealing the ACA, an effort narrowly defeated by Senator John McCain’s dramatic “thumbs-down” vote (Kaplan, 2017).

Even without a full repeal, administrative actions taken by the Trump White House severely weakened the ACA’s protections. The administration slashed funding for ACA outreach and advertising by 90%, cut the open enrollment period in half, and expanded the availability of short-term health plans that could deny coverage for preexisting conditions (Park, 2018). Critics called these “junk plans,” pointing out they offered cheaper premiums at the cost of crucial protections.

By 2018, the nonpartisan Congressional Budget Office (CBO) estimated that approximately 20 million Americans were at risk of losing or seeing substantial disruptions to their health insurance coverage due to Trump-era policies (Congressional Budget Office, 2018). This included individuals who relied on Medicaid expansion, marketplace subsidies, and those with preexisting conditions — protections that had been vital under the ACA.

One of the Trump administration’s most controversial moves was its support for a 2018 lawsuit, Texas v. United States, which argued the ACA’s individual mandate was unconstitutional and that the entire law should be invalidated. The Department of Justice, under Trump, took the unprecedented step of refusing to defend an existing federal law in court (Goodnough & Pear, 2018). Had the lawsuit succeeded — it ultimately failed in the Supreme Court in 2021 — millions would have immediately lost coverage, protections for preexisting conditions would have evaporated, and Medicaid expansion would have been gutted.

Despite these risks, Trump continued to insist publicly that his administration would produce a “beautiful” healthcare plan. In March 2020, he claimed, “We’re working on a plan that will be better, less expensive, and everybody will be covered” (Karni, 2020). However, no comprehensive healthcare proposal ever emerged from the White House. Congressional Republicans, too, failed to unite behind a replacement, cycling through unpopular alternatives like the American Health Care Act (AHCA), which independent analyses said would have left 23 million more Americans uninsured by 2026 (Congressional Budget Office, 2017).

Behind the chaos, everyday Americans faced real-world consequences. Premiums in some states rose sharply after the Trump administration canceled payments to insurers meant to stabilize ACA markets (Abelson, 2017). Meanwhile, Medicaid work requirements — first approved in Arkansas and several other states under Trump — led to thousands being kicked off Medicaid rolls without proof of alternative coverage (Rudowitz et al., 2019).

The COVID-19 pandemic further exposed the frailty of the healthcare system under Trump. Millions of Americans lost employer-based coverage as job losses skyrocketed. Yet rather than expand ACA protections or reopen federal enrollment broadly, the Trump administration chose limited special enrollment periods and offered minimal outreach (Keith, 2020). The administration also continued its legal assault on the ACA even as the country faced its worst public health crisis in a century.

While the ACA ultimately survived Trump’s term, experts argue the administration’s constant sabotage efforts undermined public trust in the law and left America more vulnerable to healthcare inequality. As Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute, put it: “There was a drumbeat of uncertainty… which makes insurers skittish and consumers confused” (Park, 2018).

By the end of Trump’s first presidency in January 2021, no universal healthcare plan had materialized, despite four years of promises. Millions remained uninsured or underinsured, and healthcare costs continued to rise faster than inflation.

The 2017–2021 period stands as a case study in how healthcare policymaking — or the lack of it — can carry life-or-death stakes for millions. Trump’s repeated assurances that “no one will lose coverage” ultimately rang hollow for the many Americans who faced uncertainty, higher costs, and potential loss of insurance during his term.

🏥🚫 #Chaos

Footnotes

  1. Shear, M. D., & Pear, R. (2017, January 15). Trump vows insurance for all in Obamacare replacement plan. The New York Times. https://www.nytimes.com/2017/01/15/us/politics/trump-health-care-obamacare.html
  2. Kaplan, T. (2017, July 28). McCain’s “no” vote: A Senate drama that unfolded in three acts. The New York Times. https://www.nytimes.com/2017/07/28/us/politics/john-mccain-health-care.html
  3. Park, H. (2018, October 11). How Trump is quietly sabotaging Obamacare. The New York Times. https://www.nytimes.com/interactive/2018/10/11/us/politics/trump-obamacare-affordable-care-act.html
  4. Congressional Budget Office. (2018, May 23). Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2018 to 2028. https://www.cbo.gov/publication/53826
  5. Goodnough, A., & Pear, R. (2018, June 7). Trump’s Justice Department attacks protections for pre-existing conditions. The New York Times. https://www.nytimes.com/2018/06/07/health/obamacare-justicedept-preexisting-conditions.html
  6. Karni, A. (2020, March 3). Trump promises new healthcare plan but offers no details. The New York Times. https://www.nytimes.com/2020/03/03/us/politics/trump-healthcare.html
  7. Congressional Budget Office. (2017, May 24). Cost Estimate: H.R. 1628, American Health Care Act of 2017. https://www.cbo.gov/publication/52752
  8. Abelson, R. (2017, October 12). Trump’s cut to health subsidies expected to drive up costs. The New York Times. https://www.nytimes.com/2017/10/12/health/trump-obamacare-insurance-subsidies.html
  9. Rudowitz, R., Musumeci, M., & Hall, C. (2019, March 7). Medicaid Work Requirements: Results from the First Year in Arkansas. Kaiser Family Foundation. https://www.kff.org/report-section/medicaid-work-requirements-results-from-the-first-year-in-arkansas-issue-brief/
  10. Keith, K. (2020, May 1). COVID-19 and the Individual Market: Limited Options without a National Enrollment Period. Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/forefront.20200501.434244/full/