During his first year in office, dismantling major parts of the Affordable Care Act was one of President Trump’s most passionate priorities. During his speech, health care occupied a comparatively minor place, with the president laying out no new initiatives.
Instead, he made a bold claim: “We repealed the core of the disastrous Obamacare — the individual mandate is now gone.” The statement glided over the fact that the Republican-led Congress has not produced legislation to “repeal and replace” the sprawling 2010 health-care law, as Trump exhorted lawmakers to do, with the Senate repeatedly failing to muster enough GOP votes for any of several permutations it considered.
The change to which the president referred was, in the end, tucked into the massive tax bill enacted late last year. It does not outright eliminate the ACA’s requirement that most Americans carry health insurance. That would have taken a separate piece of legislation. Instead, it ends in 2019 a penalty the ACA created for those who flout that requirement. This year, what Trump in his speech called “tremendous penalties” amount to $695 per adult or 2.5 percent of a household’s income, whichever is greater.”
The president said the law forces people to pay those tax penalties “because they could not afford government-ordered health plans.” In 2016, data from the Internal Revenue Service shows, about 6.5 million Americans paid penalties averaging $470 — about 20 percent fewer than the year before. The data does not indicate how many could not afford health insurance, as Trump said, and how many could have afforded coverage but chose not to buy any.
As for the president’s assertion the insurance requirement is the core of the law, the picture is not so clear. Health-policy experts disagree over the extent to which the mandate — the least popular aspect of the ACA, polling consistently has shown — motivates people to buy insurance, and how much difference ending the penalty will make.
Meanwhile, large swaths of the ACA remain intact, including the insurance marketplaces created for people who do not have access to affordable coverage through a job.