The impact of the American Health Care Act (AHCA), also called “TrumpCare,” often focuses on the 23 million Americans projected to lose coverage. Many of the 130 million Americans with pre-existing conditions are also aware they could face higher premiums and reduced benefits should they buy insurance on their own under the AHCA. But 36 percent of Americans believe the cost of their health care would stay about the same under the legislation. Unfortunately, they’re wrong.

If enacted, TrumpCare will affect all Americans no matter what type of health insurance they have: Medicare, Medicaid, employer coverage, or a plan on the individual market. Here, we describe how TrumpCare would change coverage, and we provide maps that show how many people in each county and state could see their costs go up or coverage go down under the bill.

Map 1. How Trumpcare Affects All, by County

  • People with individual market coverage: Americans who buy insurance on their own disproportionately benefit from the Affordable Care Act (ACA). They receive tax credits if eligible, enhanced consumer protections, and a transparent Marketplace to buy coverage. Subsequently, these people would disproportionately lose under TrumpCare. The legislation would reduce financial assistance for low- and middle-income enrollees and significantly raise premiums for older enrollees. TrumpCare’s state waivers would undermine protections for people with pre-existing conditions. And, it would increase deductibles and cost sharing by eliminating cost sharing subsidies and standards for plans. As such, people who buy coverage on their own and through the Marketplace would pay more out of pocket under TrumpCare.
  • People with Medicaid: The AHCA would roll back the ACA’s expansion of Medicaid, which improved coverage, access to care, and financial security for millions of Americans. Moreover, TrumpCare would cap federal Medicaid funding for every state. This cap would apply to spending for all enrollees, including children needing special education, seniors needing long-term services, people with severe disabilities, and low-income families. By cutting federal spending by one-fourth by 2024, the AHCA would make it virtually impossible for states to manage costs without reducing benefits or coverage altogether for tens of millions of Medicaid enrollees. And by ending retroactive coverage and presumptive eligibility, the AHCA would limit coverage for every person newly enrolling in Medicaid. In short, Medicaid enrollees would lose coverage and benefits under AHCA.
  • People with employer coverage: The AHCA would eliminate the employer shared-responsibility provision, which currently requires large employers to offer affordable health coverage to their workers, causing some employers to drop coverage altogether. It also would delay implementation of the excise tax on high-cost plans (known as the “Cadillac tax”) designed to lower premiums for workers and their families. By allowing states to waive essential health benefits, employers could reduce protections against high annual out-of-pocket costs and lifetime limits on coverage for up to 27 million Americans. And because of the magnitude of coverage losses under the AHCA, every hospital would likely experience spikes in uncompensated care. These costs—which start when an uninsured person walks into the emergency room—could be partially passed along to employer health plans in the form of higher premiums, sometimes called a “hidden tax.” As such, TrumpCare would raise costs for people with employer-based health insurance.
  • People with Medicare: Despite the president’s promise not to touch Medicare, TrumpCare does so in several ways. First, the AHCA would repeal an important tax on high-income Americans that supports Medicare. Second, by increasing the number of uninsured Americans, it would increase Medicare’s payments for uncompensated care. Third, by capping Medicaid payments for seniors who are also enrolled in Medicare, the legislation could result in cutbacks for services such as home care, driving up Medicare-financed services like hospitalizations. And, fourth, by repealing the drug industry fee whose revenue is dedicated to Medicare Part B, the bill would raise the program’s premiums by $8.7 billion over ten years. The AHCA would take two years off of the life of the Medicare Hospital Insurance Trust Fund, according to its actuaries. As such, TrumpCare would harm all seniors by raising Medicare premiums and making the Medicare Trust Fund bankrupt in less than a decade.
Map 2. How Trumpcare Affects All, by State

Click Here to Download Map Data.

The legislation’s impact does not end there. It would also affect people who get health care through the Veterans Health Administration: 7 million people would no longer would be able to access premium tax credits through the Marketplace. People insured through private plans in TriCare may also pay higher premiums to offset rising levels of uninsurance. And the AHCA’s Medicaid cuts could limit support for the Indian Health Services.

Notably, the one group of Americans that TrumpCare would explicitly exempt is members of Congress. They would maintain pre-existing condition protections.

Notably, the one group of Americans that TrumpCare would explicitly exempt is members of Congress. They would maintain pre-existing condition protections.1

There is no “us versus them” in this debate over health care. If the AHCA is signed into law, health coverage could be worse for us all.

Sources and Notes

State Coverage Estimates: Estimates for state Medicare, Medicaid, and employer-sponsored insurance were taken from 2015 data from the Kaiser Family Foundation State Health Facts. Estimates for the number of Marketplace enrollees were obtained from the 2015 Marketplace Enrollment Report from HHS. Note that those enrolled in both Medicaid and Medicare are categorized in the Medicaid enrollment and not in Medicare enrollment.

State Coverage Loss Estimates: Estimates for 2026 coverage loss (increase in the uninsured) were obtained from the Center for American Progress and based on the Congressional Budget Office’s estimate of 23 million in that year.

County Coverage Estimates: Data by county from the 2015 American Community Survey from the U.S. Census were obtained to estimate Medicare, Medicaid, and employer-sponsored insurance coverage estimates. For data consistency, the county coverage data were used to calculate relative state-based weights for each county and were scaled to state totals used in the state map. Estimates for Marketplace enrollment by county for 2017 were obtained from the Kaiser Family Foundation and similarly used to calculate county-based weights for application to total state 2015 Marketplace enrollment.

County Coverage Loss Estimates: Our county estimates follow the analytic and data approach taken by the Center for American Progress, with data from the American Community Survey from the U.S. Census at the county rather than congressional district level. Note that the American Community Survey uses a different number of years to estimate county rather than congressional district coverage.

Coverage Loss Risk Estimates: States and counties were divided up into three categories—low, medium, and high—based on the percentage of the total population under age 65 represented by the estimated AHCA’s coverage losses by geographic area.

Note, all numbers rounded and may not sum to totals.

Notes

  1. The House separately passed bills to remove the exemption for Members of Congress from the state waivers of community rating and essential health benefits and restore Veterans’ access to tax credits.

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