Fact check: Does Donald Trump want to do away with the Affordable Care Act?

US Vice President Kamala Harris stated on September 27, 2024, in a campaign advertisement: “Former President Donald Trump wants to take away the Affordable Care Act.”

In the September 27 online ad, a man identified as Dr Cesar Quintana, says: “I’ve dedicated my life to keeping people healthy, here in my office and throughout the community where I help others access the healthcare they need. That’s what the Affordable Care Act does. It helps our families access lifesaving healthcare. Donald Trump would take that away.”

The ad then shows a short clip of Trump saying “repealing and replacing Obamacare”. Quintana then says that would leave millions “without access to health insurance”.

The ad, which is also in Spanish, is partially correct. Trump opposes the Affordable Care Act, also known as Obamacare, enacted in 2010 during former President Barack Obama’s administration. As president, Trump cut enrolment assistance and supported repeal and replace efforts in Congress. But his stance on terminating the law has shifted.

Here are the facts.

Trump’s stance on the ACA in his 2016 campaign and as president

In his 2016 presidential campaign, Trump promised to repeal the law. The Harris ad clip of Trump saying “repealing and replacing Obamacare” is from January 26, 2017, when Trump discussed his administration’s plans at a congressional Republican retreat in Philadelphia.

Trump said that they would have an “ambitious legislative agenda” and that the first step would be eliminating the Affordable Care Act. He called it “a disaster,” and said he wanted to save families from what he described as a “catastrophic rise in premiums and debilitating loss of choice and just about everything else”.

Trump supported congressional Republican repeal and replace efforts, but they ultimately failed. One example is the American Health Care Act, a bill to repeal the Affordable Care Act subsidies and regulations that the House passed in May 2017, but failed to pass in the Senate. In June 2020, Trump’s administration asked the US Supreme Court to block the law, but the court dismissed the case.

Trump also cut funding for the law’s marketing, outreach and enrolment assistance. He expanded access to short-term, limited-coverage plans that Democrats call “junk insurance,” arguing they limit care and can lead to surprise medical bills.

During Trump’s presidency, Affordable Care Act enrolment declined by more than 2 million and the number of uninsured Americans rose by 2.3 million, according to government data.

Trump’s ACA position during his 2024 presidential campaign

During his 2024 campaign, Trump has gone back and forth on his position on the Affordable Care Act. At times, he has said that he wants to replace the law with an “alternative“. But he’s also said he wouldn’t terminate it.

In March, he wrote on Truth Social that he is “not running to terminate” the healthcare law, but wants to make it “better” and “less expensive”. On September 10, during the presidential debate with Harris, Trump said that he has “concepts of a plan” to replace the law. He said he would “run it as good as it can be run” before instituting his own plan. Trump still hasn’t specified his plan.

Karoline Leavitt, Trump’s campaign national press secretary, told PolitiFact that Trump “will implement real solutions to make America healthy again without relying on Big Insurance and Big Pharma,” but she did not specify how.

PolitiFact contacted the Harris campaign for evidence that Trump wants to end the Affordable Care Act. It referred us to a Harris campaign document, that the campaign claims shows how Trump is aligned with Project 2025.

Project 2025 is a 900-page handbook of policy proposals for the next Republican administration created by the conservative Heritage Foundation. Trump has distanced himself from Project 2025.

Project 2025 calls for changing the Affordable Care Act. For example, it recommends that the Food and Drug Administration reverse its 2000 approval of mifepristone, the first pill taken in a two-drug regimen for a medication abortion. The document also says some forms of emergency contraception – particularly Ella, a pill that women can take within five days of unprotected sex to prevent pregnancy – should be excluded from no-cost coverage. It also calls for separating the subsidised law exchange market from the nonsubsidised insurance market. But it does not call for ending the law.

Trump’s campaign platform doesn’t mention the Affordable Care Act.

Our ruling

A Harris campaign ad said that Trump wants to take away the Affordable Care Act.

Trump has given mixed and incomplete information about his plan for the law. He’s said that he wants to end it, that he wants to improve it and that he has “concepts of a plan” to replace the law. But he hasn’t given more details.

As president, Trump supported multiple efforts to get rid of the Affordable Care Act.

We rate the claim Half True.

KFF Health News Senior Correspondent Julie Appleby contributed to this report.