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<\/p>\n Email Link<\/p>\n \n President Donald Trump and congressional Republicans are no longer promising to repeal Obamacare, but that doesn\u2019t mean they have given up efforts to take down the landmark health reform law.\n <\/p>\n \n Unlike in 2017, when the late GOP Sen. John McCain\u2019s dramatic thumbs-down<\/a> dashed his caucus\u2019s hope of overturning the Affordable Care Act, Republicans barely mentioned Obamacare as they swiftly pushed Trump\u2019s massive domestic agenda package<\/a> through Congress this year. Instead, they focused their talking points on eliminating fraud in Medicaid and protecting the program for the most vulnerable.\n <\/p>\n \n And this time, they were successful in dealing a major blow to the Affordable Care Act. The \u201cbig, beautiful bill,\u201d along with a new rule<\/a> from the Centers for Medicare and Medicaid Services, is expected to leave millions more people without health coverage, raise costs for those who remain in Obamacare policies, and reverse more than a decade of improvement in the nation\u2019s uninsured rate.\n <\/p>\n \n In addition, Trump\u2019s package<\/a> is projected to shrink another major provision of the Affordable Care Act \u2014 expanding Medicaid coverage to low-income adults \u2014 by requiring many of them to work<\/a>, volunteer or engage in other activities at least 80 hours a month.\n <\/p>\n \n \u201cThe net effect of the changes they are making is a partial repeal of the ACA,\u201d said Larry Levitt, executive vice president for health policy at KFF, a nonpartisan research group.\n <\/p>\n \n What\u2019s more, Republicans may further undermine Obamacare before the end of the year if they do not extend the enhanced federal premium subsidies<\/a> that former President Joe Biden and congressional Democrats approved in 2021. The beefed-up subsidies, which helped propel record sign-ups<\/a> for Obamacare coverage but lapse at the end of 2025, will be a subject of debate when Congress returns in September.\n <\/p>\n \n Democratic lawmakers are already calling attention to the subsidies\u2019 expiration, which would send people\u2019s premium payments skyrocketing and prompt millions to drop their policies, experts say. Some Republicans have voiced support in exploring the matter, especially since red-state residents would likely be among those losing coverage.\n <\/p>\n \n Even though the \u201cbig, beautiful bill\u201d contains the largest-ever cuts to federal support for health coverage, it remains to be seen whether the Republicans\u2019 toned-down rhetoric on Obamacare will help them avoid the retribution they suffered in the 2018 midterms, when the repeal effort was a major factor in the Democrats winning control of the House.\n <\/p>\n \n \u201cMany of the changes are so technical, it may be hard for the public to grasp what\u2019s happening,\u201d Levitt said. \u201cMany of the changes will take years to take effect.\u201d\n <\/p>\n \n Between them, the new law and rule will make it harder to enroll in and renew Affordable Care Act coverage by increasing verification requirements, hiking out-of-pocket costs for enrollees, and banning certain legal immigrants<\/a> from qualifying for federal subsidies.\n <\/p>\n \n The rule is expected to cause up to 1.8 million people to lose Obamacare coverage next year, and the losses will likely be concentrated in seven GOP-led states, including Florida, Georgia, South Carolina and Texas, as well as North Carolina, which has a Democratic governor, according to the Centers for Medicare and Medicaid Services.\n <\/p>\n \n Meanwhile, the Affordable Care Act provisions in the law are forecast to lead to 2.1 million more people being uninsured in 2034, according to the Congressional Budget Office.\n <\/p>\n \n \u201cIt\u2019s a radical weakening of what the marketplaces will be able to deliver in the next few years,\u201d said Jennifer Sullivan, director of health coverage access at the left-leaning Center on Budget and Policy Priorities.\n <\/p>\n
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