With the budget deal struck in the House of Representatives and Senate, President Donald Trump and congressional Republicans are moving to dismantle the Affordable Care Act.
While many of the tax breaks and subsidies to help the American public afford health care are already expiring, Trump has vowed to keep them in place.
However, if the House and Senate are able to pass their own versions of the spending bill, it could be that the federal government will lose billions of dollars in funding for these health care programs.
“The president has said he wants to end the Affordable Cuts and Replace Act.
That means we need to get rid of it, and that’s what we’re doing,” said Kevin Murphy, a senior fellow at the Brookings Institution and a longtime advocate for reducing federal spending.
The Affordable Care for All Act, or ACA, is a law signed by President Donald J. Trump and signed into law by President Barack Obama in February 2020.
It requires most Americans to buy health insurance, and it includes many provisions that the GOP and Trump have called the “heartbeat” of the Affordable Act.
The plan includes eliminating the individual mandate, and making subsidies to buy private insurance available to all Americans.
It also creates a $100 tax credit for those who buy their own health insurance and provides money for states to set up their own exchange websites.
While these are all big wins for Trump, they could also cause many Americans to lose their health insurance.
According to the Congressional Budget Office, under the ACA, the number of people without insurance increased from 1.2 million in 2016 to 1.7 million in 2019, with more than 1.3 million in 2020.
The CBO estimates that more than half of Americans will have insurance by 2026.
The ACA is also the reason why the number, and the cost, of health insurance is so high, according to the American Health Care Association.
“We know that there is a lot of uncertainty around the next few years about what the impact of these changes will be,” said Murphy.
While Republicans have been working to repeal the ACA since 2017, the budget plan includes $500 billion in tax breaks, which could go to offsetting the costs of the ACA.
That’s where the $2.5 billion for local governments comes in.
Under the bill, the federal portion of the Local Government Operating Grants Program, or LOGAP, is set to expire in 2021.
“I think the Trump budget will be really bad for the American people, and especially for the cities, the counties and the states,” said Michael Ryan, director of government affairs at the Association of State Budget Officers.
Ryan noted that the Trump plan will also end some tax breaks for state and local governments.
It could be more expensive to build a new hospital or school, he said, because the tax credit is gone.
“This is a big loss for the taxpayers and for local communities,” Ryan said.
Murphy said that while Trump is promising to keep the tax benefits, he could also eliminate them by changing the law to make them available to everyone.
Murphy and others have called for repealing the federal tax break for businesses that invest in local businesses, but Republicans have argued that’s a mistake.
“When the president talks about protecting the middle class, he’s not necessarily talking about the middle classes,” Murphy said.
Ryan said that even if Trump were to keep some of the federal health insurance tax breaks intact, there are also a number of other benefits that could be lost to local governments that are currently on the chopping block.
“If the budget is passed, they will probably have to change some other tax breaks that they don’t have to do because they can’t,” Ryan added.
One example of these could be a tax break that gives tax credits to those who invest in real estate.
Currently, the deduction for mortgage interest and state and municipal property taxes is tax-deductible.
Ryan called this benefit “a very important part of local governments and the real estate industry” and said that repealing it could cost local governments up to $600 million a year.
“What they could do is get rid all of these deductions that they have that are supposed to be offsetting these federal taxes and take that money and put it back into the real-estate industry,” Ryan continued.
Ryan and other experts said that many local governments have been hit hard by the Trump tax cuts and could be left worse off.
“There’s not a lot that you can do to make it better, especially with the federal part of the Medicaid program [Medicaid] coming up, and there’s a lot they’re going to have to be concerned about, particularly with the $700 billion of cuts in other taxes,” Ryan stated.
“So it’s not that the president’s been a great leader, it’s just that he’s really bad at the job of leading,” Ryan noted.
The health insurance industry is also a huge economic driver for the U.S. economy,