Repealing the Affordable Care Act: Bad for the Poor, Good for the Rich

Repealing the Affordable Care Act: Bad for the Poor, Good for the Rich
Don Campbell/ The Herald-Palladium via AP
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President Trump and Republican leaders in Congress have made their intention to repeal the Affordable Care Act (ACA) clear. Repealing the ACA without an immediate replacement would take health coverage away from tens of millions of Americans, remove popular protections for consumers against insurance companies, and unravel states’ individual insurance markets. And beyond these devastating impacts, the Republicans’ likely plan would also give a windfall tax cut to the highest-income Americans.  At the same time, it would raise taxes significantly on millions of low- and moderate-income families due to the loss of their premium tax credits.

The top 400 highest-income taxpayers — whose annual incomes average more than $300 million apiece — each would receive an average annual tax cut of about $7 million through the elimination of two Medicare taxes on high-income households that were enacted as part of the ACA. In total, the group would receive tax cuts of about $2.8 billion annually. Meanwhile, the roughly 160 million American households with incomes below $200,000 would get nothing from the repeal of these two taxes.

In addition, ACA repeal as a whole would significantly raise taxes on about 7 million low- and moderate-income families due to the loss of their premium tax credits — worth an average of $4,800 in 2017 — that help them buy health coverage through the health insurance marketplaces and afford to go to the doctor when needed. 

The $2.8 billion total tax cut that the top 400 would receive each year is roughly the value of premium tax credits that 813,000 people in the 20 smallest states and Washington, D.C. would lose combined if the ACA is repealed without a replacement (see chart).


The huge cut for wealthy filers flies in the face of the standard set in place by President Trump’s nominee for Treasury Secretary, Steven Mnuchin, that there would be “no absolute tax cut for the upper class” under the new administration’s policies. And these tax cuts are just a precursor of what’s to come on the Republican agenda: they also plan to move a broader tax package this year, and the tax proposals from both the House GOP and President Trump last year include massive additional tax cuts for those at the very top.

Researchers have documented how ACA repeal would strip health coverage from tens of millions of Americans, making it harder for them to access needed care.  At the same time, it would lavish the nation’s very highest-income households with multi-million dollar tax cuts. This approach reveals the skewed priorities that are guiding the Republican-led assault on health reform.


Brandon Debot is a Tax Policy Fellow at the Center on Budget and Policy Priorities

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