A new Donald Trump Administration has the potential to significantly impact health care in the United States, and the Affordable Care Act (also known as ACA or “Obamacare”) is frequently mentioned as a potential target.

“Obamacare was lousy health care. Always was," Trump said during his debate with U.S. Vice President Kamala Harris in September. "It's not very good today and, what I said, that if we come up with something, we are working on things, we're going to do it and we're going to replace it." Asked by moderator Linsey Davis to clarify if he had a plan, Trump responded by saying he had “concepts of a plan” to replace Obamacare.

Now, the president-elect’s concepts need to be turned into actual plans if he’s going to take action against ACA. BenefitsPRO rounded up three possible scenarios that experts envision:
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‘Massive changes’?

“If Republicans maintain control of the House, changes to the ACA could be ‘massive,’ according to House Speaker Mike Johnson,” notes KFF. “While ACA repeal was not a winning issue in 2017, Republicans could attempt to offset tax cuts by significantly reducing ACA subsidies and making massive funding cuts and changes to how Medicaid is financed, with far-reaching implications, beyond the ACA Medicaid expansion. This would be similar to the 2017 ‘repeal and replace’ push that would have left most protections for people with preexisting conditions in place but nonetheless would have left tens of millions without affordable health coverage due to budget cuts. As was the case in 2017, changes to ACA and Medicaid funding could be done through budget reconciliation, without concern of the filibuster.”
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Technical fixes only?

“Efforts to repeal and replace the Affordable Care Act (ACA) no longer retain the level of political or public support they did in 2016. Instead, recent comments from President-elect Trump have suggested he takes credit for ‘saving’ the ACA; this may indicate more focus on technical fixes across the sector rather than sweeping reforms,” according to PwC.

Related: How will a Trump win impact 401(k) plans? Retirement experts weigh in
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Slash and burn?

The Trump Administration “will face an immediate decision next year on whether to back an extension of enhanced premium subsidies for Obamacare insurance plans. Without the enhanced subsidies, steep premium increases causing lower enrollment are projected. The current uninsured rate, about 8%, could rise,” National Public Radio reports. “Trump supporters and others who have worked in his administration say the former president wants to improve the law in ways that will lower costs. … Efforts to weaken the ACA could include slashing funds for enrollment outreach, enabling consumers to purchase more health plans that don’t comply with ACA consumer protections, and allowing insurers to charge sicker people higher premiums.”

As recently as May, about 6 in 10 adults (62%) had favorable opinions of the ACA, according to KFF’s health tracking poll — including protections for preexisting conditions and the ability to keep young adults on their family health plans until age 26.

The Affordable Care Act will turn 15 years old in March 2025.