5 74 Chapter 16Chapter 16 || Social PolicySocial PolicyAmericans did not approve of Obamacare. This disagreement led to a shutdown of all
nonessential federal government services from October 1 to 16, 2013. The White House
estimated that the shutdown cost the economy about 120,000 jobs and between $2
and $6 billion.^2 While Obamacare remained unpopular, most Americans rejected the
confrontational tactics and blamed House Republicans for the shutdown.^3
When Donald Trump was elected and Republicans had unified control of the
government, they had the opportunity to repeal and replace Obamacare. However, with
no agreed-upon plan to replace the law, repeal failed by a single vote in the Senate in- While Republicans were unable to repeal the law, they enacted several measures
weakening the law, hoping to slowly kill it off. They eliminated the unpopular individual
mandate tax penalty for individuals who do not have health insurance, cut the ACA’s
advertising budget by 90 percent, shortened the open-enrollment period from three
months to six weeks a year, and reduced funds for personal enrollment assistance by
41 percent.^4
Despite these efforts, and contrary to President Trump’s claim that his
administration had “essentially repealed” Obamacare, by mid-2018 more than
26 million Americans had gained health insurance coverage because of the law, many
for the first time.^5 Perhaps most surprising was the strong enrollment in the health
care exchanges, with 11.8 million people signing up during the enrollment period for - This was only a 3.5 percent drop from the previous year despite the 50 percent
shorter enrollment period and the lack of advertising promoting the enrollment.^6 The
percentage of uninsured had fallen to a record 8.6 percent in early 2016, but by 2018 it
had crept back to 15 percent according to one survey.^7 While the ACA is proving to be
resilient, its long-term status remains uncertain. President Trump issued an executive
order in 2018 allowing small businesses to provide insurance that did not include the
10 basic components required by the ACA and continued a legal challenge to the law
in federal courts concerning the insurance subsidies.^8 Is this how social policy works?
A contentious battle and a frustrating outcome for most, if not all, involved? Although
the level of conflict around Obamacare is unusual in American politics, trade-offs
between social policy and other government priorities often produce political
The disagreements over social policy
run deep. Conflicts over “Trumpcare,”
the proposed replacement to
Obamacare, led to the legislative
failure of any repeal or replacement of
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