Does Trump want to repeal the ACA, as Biden says? Tracking his changing stance over the years

President Joe Biden has repeatedly warned voters on the campaign trail that his opponent, former President Donald Trump, would take away their health care if he regains the White House.

"MAGA Republicans have tried to get rid of the Affordable Care Act more than 50 times, and Trump is still determined to do it," Biden said May 19 in Detroit. "In his words, he wants to ‘terminate’ the Affordable Care Act, which would deny 3 million Black Americans health insurance, deny protections for preexisting conditions for millions more Americans. But we’re going to deny Trump."

Biden has made similar statements in speeches, interviews and ads and has featured clips of Trump calling the ACA, also known as Obamacare, a "disaster" and saying that Trump "wants to terminate it." Former President Barack Obama signed the ACA into law in 2010.

Trump campaigned on a promise to repeal Obamacare in 2016; a promise we rated Broken. He kept that anti-ACA position throughout his term, even after Republican senators, notably the late-Sen. John McCain, R-Ariz., voted against repealing the health care law in 2017. In July 2021, the U.S. Supreme Court dismissed a case from Republican-led states and the former Trump administration that had asked justices to block the law. In late 2023, Trump renewed his vow to replace Obamacare multiple times.

In March, Trump publicly announced a change in position. He wrote on Truth Social that he doesn’t want to terminate the ACA, but instead wants to make it "better."

"I’m not running to terminate the ACA," Trump wrote in his March 26 post. Instead, he said he would make the law "MUCH BETTER, STRONGER, AND FAR LESS EXPENSIVE."

The Biden campaign responded by telling PolitiFact that Trump’s single post on improving Obamacare needs to be compared with his repeated threats to dismantle it.

"Here is a fact Truth Social posts and transparently false spin from his campaign can’t fix: Donald Trump tried to repeal the Affordable Care Act and rip away health care from millions when he was president — and has promised to do it again. Repeatedly," Ammar Moussa, Biden-Harris campaign director of rapid response, wrote in an email.

Trump’s campaign did not respond to a request for comment.

Trump said multiple times on Truth Social in November and December that he would try to replace Obamacare, before backtracking in March. 

"The cost of Obamacare is out of control, plus, it’s not good Healthcare. I’m seriously looking at alternatives," Trump wrote Nov, 25 on Truth Social. "We had a couple of Republican Senators who campaigned for 6 years against it, and then raised their hands not to terminate it. It was a low point for the Republican Party, but we should never give up!"

On Nov. 29 he wrote, "I don’t want to terminate Obamacare, I want to REPLACE IT with MUCH BETTER HEALTHCARE. Obamacare Sucks!!!"

On Dec. 25: "Obamacare is too expensive, and otherwise, not good healthcare. I will come up with a much better, and less expensive, alternative! People will be happy, not sad!" 

But after Biden started to release ads resurfacing Trump’s promises to get rid of Obamacare, Trump in March accused Biden of misinforming on his position, and shared his new stance that vowed to improve on the health care program. 

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PolitiFact asked Trump’s campaign whether the former president stands by his March statement. We also asked for more details about his policy on the ACA. The campaign did not reply. Trump released a policy platform called "Agenda 47" for a second White House term, but it doesn’t address Obamacare.

Health policy experts told PolitiFact that, without a detailed plan, Trump could theoretically approach the ACA in several ways. Other conservatives have written proposals that involve overhauling the health care system, including dismantling many of Obamacare’s provisions — but it’s not known if Trump will adopt any of those tactics.

Ultimately, experts said, it comes down to whether he prioritizes it; if he gets the support of key health care industry players; how many Republicans are on board, and the level of control they have in Congress.

Thomas Miller, a senior fellow at the conservative American Enterprise Institute who researches health care policy and the Affordable Care Act, said a second Trump administration would be more likely to reinstitute some of the things it did before, and make more regulatory or administrative changes, rather than go the legislative route.

"There aren't that many great legislative opportunities because people haven't done the work, they haven't built the roster of ready-to-go bills and popularized them," Miller said. "So, that’s why they go back to codify regulations so they can be more permanent, or stretch things a little more on the margins; but that's not the same as something transformational."

The Affordable Care Act is highly popular among Americans in 2024, a February KFF poll found.  A record 21.3 million people sought individual health insurance plans through the ACA during the most recent open enrollment period.

"Trump’s plan would be in favor of what works for him politically," Miller said. Trump, he said, doesn't appear to hold a deep set of "beliefs in the health care or health policy space. He has that for other issues, but not as much for the health care area, so other people fill in the blanks for him."

Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University, said she wouldn’t expect the same sweeping repeal attempt that Trump tried before because the political support isn’t there. Still, she said, he could dismantle it a little at a time.

Corlette also pointed out that the law is massive — it covers insurance reforms, preexisting condition protections, marketplace plans, Medicare and Medicaid regulations, tax law provisions, and more — further complicating making determinations on what Trump would or could do. 

"It’s hard to know what you can take away from Trump’s statement with respect to the ACA," Corlette said. "But I think people can make the assessment that a number, maybe not all, but a number of the ACA’s insurance reforms — like the insurance minimum benefits and pre-existing condition protections —  if not fully repealed, those could be rolled back so that insurers will have a lot more flexibility to charge more or deny certain types of care."

Biden said Trump wants to terminate the Affordable Care Act.

In 2016, Trump campaigned on a promise to repeal and replace the ACA. In the White House, Trump supported a failed effort to do just that. In the years since, he has repeatedly stated his intent to dismantle the health care law, including in campaign stops and social media posts throughout 2023.

In March, however, Trump signaled a change in stance, publishing one Truth Social post in which he said that he wasn’t running to terminate the ACA but to make it "better" and "less expensive."

Trump hasn’t released other details or said how he would do this. His campaign platform includes nothing on the ACA. And his campaign didn’t answer our questions about his plan. Health care policy experts identified an array of possible changes — some big, some small — that could be executed under another Trump administration but said a sweeping repeal likely isn’t in the cards due to a lack of support.

After years of Trump’s anti-ACA rhetoric and action, the former president’s stated change of position represents an important detail that Biden’s statement fails to acknowledge. We rate it Half True.