Trumpcare vs Obamacare: What's the difference?

What will change now the Republicans have passed the American Health Care Act through the House of Representatives?

American Health Care Act protest
Protesters hold signs and shout at lawmakers as they leave the US Capitol in Washington DC
(Image credit: NICHOLAS KAMM / AFP/Getty Images)

Obamacare is "dead", said US President Donald Trump after the House of Representatives passed the Republicans' replacement healthcare bill by just four votes.

The passing of the American Health Care Act marks Trump's first legislative victory since taking office, the BBC reports, although the bill will now need to get through the Senate.

Democrats and other opposing voices say it will leave millions uninsured, with some predicting the bill will founder or have to be rewritten in the Senate for that reason.

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Republicans were chafing to get rid of former president Barack Obama's Affordable Care Act (ACA) before it even came into place in 2010. But what are the differences between that bill and the Republicans' replacement?

Number of uninsured people

Obama: There were 47 million uninsured Americans in 2010 before the introduction of Obamacare, according to Bloomberg. That number is now 28 million, The Independent says – and that number would likely remain stable if the Affordable Care Act was kept in place over the next ten years.

Trump: The nonpartisan Congressional Budget Office (CBO) has not yet calculated the effects of the latest version, but a March report of an earlier draft found 52 million people would likely be left without insurance by 2026 – almost double the number of those under Obamacare.

Penalties for the uninsured

Obama: All uninsured people pay a tax penalty.

Trump: Those who are uninsured for more than 63 days must pay 30 per cent more on their insurance premiums for one year.

Employee insurance

Obama: Companies with more than 50 employees have to provide health insurance or pay a fine.

Trump: Companies don't have to provide insurance.

Pre-existing conditions

Obama: Insurers cannot deny coverage or charge more to those with pre-existing medical conditions

Trump: States can dodge granting pre-existing coverage provided they set up high-risk insurance plans for people whose conditions see them priced out by normal insurers.

Essential benefits

Obama: All plans need to provide for certain health conditions or services, such as women's health, cancer treatment, prescription drugs, counselling.

Trump: States can choose which benefits are mandated and which can be left out entirely.

Medicaid (provides coverage to very low income people)

Obama: Expanded insurance for poorer individuals.

Trump: Starting in 2020, federal funding for Medicaid expansion will be cut.


Obama: Raised Medicare taxes for those earning over $250,000 and introduced a range of new taxes to pay for the ACA from medical device manufacturers, drug companies, tanning salons, high-end insurers, and investment income. The ACA also provided tax credits for low-income individuals who buy coverage on government-run marketplaces.

Trump: The new bill repeals most of the Obamacare-related taxes. Tax credits are based on age and there will be no more tax credits for health-related costs not covered by insurance.

What stays the same

Children are still allowed to remain on their parents' policies until the age of 26. Insurers are also not allowed to set annual or lifetime limits on the amount they reimburse people for pregnancy and childbirth, doctors' services, prescription drug coverage and other essential health benefits.

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