The Affordable Care Act, also known as Obamacare, has existed largely on the edge of a cliff since President Donald Trump entered the White House.
While Trump has thus far failed to fulfill his campaign promise of repealing and replacing former President Barack Obama's signature health care plan, he appeared to get a second wind last week. The Justice Department sided with a federal judge in Texas, who ruled in December that the law's individual mandate was unconstitutional and that the rest of the law was therefore invalid—despite the Supreme Court previously upholding the law in 2012.
Mulvaney told ABC News White House Correspondent Jonathan Karl that he could guarantee that those with pre-existing conditions would not lose their coverage, claiming that "every single plan that this White House has ever put forward since Donald Trump was elected, covered pre-existing conditions." But Mulvaney failed to provide additional details and did not address how the millions of others who get their coverage through healthcare.gov and state exchanges would continue to do so.
So what does happen if the Affordable Care Act is struck down?
The short answer is we don't really know yet, because we haven't seen an alternative plan. Trump said last week that if the law is struck down "we will have a plan that is far better than Obamacare," but didn't elaborate on such a plan.
The Urban Institute's Health Policy Center estimated in a study released last month that 19.9 million Americans could lose their coverage, increasing the number of uninsured by 65%. And it's not just those who get their insurance from the exchanges or through ACA's Medicaid expansion who could be affected.
The Affordable Care Act also includes provisions that decrease costs of Medicare coverage and prescription drugs for senior citizens, another that allows children to stay on their parents' health insurance plans until they turn 26 years old, and lets many Americans get birth control, mammograms, and cholesterol tests for free. Even the Trump administration's policy priority to lower prescription drug prices relies on ACA.
The lukewarm response from members of the Republican Party—and the sharp criticism from Democrats—appears to have delayed Trump's plans, for now. Late Monday, Trump indicated that Republicans in Congress would wait until after the 2020 election to vote on an ACA replacement.