Repealing the Affordable Care Act

Sign against ACA repeal
Editor's note:

In Unpacked, Brookings experts provide analysis of Trump administration policies and news.

THE ISSUE: If Congress rejects the new House Republican-backed replacement for the Affordable Care Act (ACA), the full repeal long advocated for by many Republicans could be their next option.

A straight ACA repeal would leave an estimated 20+ million people without health coverage.


  • Republicans have long advocated for repealing the ACA and if their new replacement isn’t approved, that plan could soon be put into motion.
  • The ACA provides coverage, and subsidies towards coverage, to people who previously couldn’t get health insurance through the individual market.
  • A straight ACA repeal would leave an estimated 20+ million people without health coverage.
  • If the ACA is repealed, many lower-income Americans (earning a maximum family income of about $33,000) participating in Medicaid, which was expanded under the ACA, would lose health coverage.
  • Many individuals with pre-existing medical conditions, previously unable to get health insurance, would also lose coverage.
  • The ACA also benefits health insurance industry by stabilizing coverage, and provides assurance to state hospitals that patients have coverage of some kind.
  • It is incumbent upon Republicans to provide a clear plan and implement it quickly in order to stabilize the markets and assure Americans that whatever replaces the ACA will be at least as good and at least as affordable as their current plans.
  • Polling on repeal shows that people are unhappy with the ACA, but not with their coverage. They most frequently criticizes the cost and the availability of coverage.
  • Republicans are faced with a challenge: Americans don’t just want repeal, they want a replacement that is comprehensive and affordable.