Obamacare, Trump Care and Other
If you are confused regarding heath care options today you could join a large club so to speak along with huge numbers of other Americans including policy makers, insurers, brokers and even elder law and health care attorneys. Insurance can be complicated. When discussing the “open enrollment period,”for instance, you should know a difference between “open enrollment” for the Healthcare Marketplace (included in Obamacare) which in Pennsylvania is referred to as “Pennie,” a subject I have addressed in other columns, and “open enrollment” for Medicare plans and also what is happening now affecting the Healthcare Marketplace.
What You Need To Know. Open Enrollment for Medicare which is primarily a matter of deciding among many Medicare Advantage plans and relates largely although not exclusively to those over age 65 is different from Open Enrollment for the Marketplace/Pennie. In any event, both Medicare and Marketplace “open enrollments” are currently in effect and can require choices to be made by Americans during this period which will very likely affect their healthcare and substantially affect its cost for 2026. The dispute primarily relates to whether huge numbers of Americans who currently receive the benefit of reduced premiums under Obamacare will likely pay substantially more for health care coverage in 2026 and beyond and is at the heart of the debate between Democrats and Republicans at this time. In fact, the federal government shutdown that just ended largely, related largely, although not exclusively, to the question whether Americans would continue to receive these Marketplace reductions in premiums, referred to as Enhanced Premium Tax Credits, under Obamacare or would the credits would be removed.
The History. The House of Representatives which is majority Republican passed the bill (One Big Beautiful Bill) in the 2026 budget. This included the reductions in payments described. On arriving at the U.S. Senate, in order for a vote to pass, under what are known as filibuster rules, a simple majority was not enough. Eventually, as the government was shut down, as air traffic was affected and flights were cancelled, and many government employees were laid off, a small group of Democrats and the vast majority of Republicans in the Senate voted with a promise that there would be a later vote to the Congress at large. However, the prospects are not greeted optimistically at this time.
If the bill does include the Obamacare credits it is likely that Americans, including Americans living in states that did not accept Medicare Expansion under Obamacare, will be seriously affected. Also seriously affected by the budget as it currently is proposed are SNAP (Food Stamp) benefits both during this time and going forward.
One argument made against the health insurance credits has been that the federal government could not continue both to afford them under Obamacare and continue to allow the growth of massive exclusions from federal estate tax for the most wealthy Americans which had initially been provided under the Tax Cuts and Jobs Act passed during the first Trump Administration and set to expire on January 1, 2026. The “One Big Beautiful Bill” passed this year as described, but not yet signed into law, among other things, extended the extensive exclusions from Federal Estate Tax first provided under the TCAJA. According to some reports, unless changes are made, those receiving tax credits may see a premium increase of 81 percent on average, with some paying double or four times as much as they pay today… The trade off is reflected in health insurance and Medicaid adjustments in the bill as well as other reductions to several programs.
Is Trump Care An Option? One recent proposal suggested by the President and referred to as Trump Care suggested that there be direct subsidies which the federal government would pay directly to Americans. See “Is Trump’s Idea to Pay Americans Directly for Health Care Possible?” by Mary Kekatos, ABC News,November 12, 2025. It has been briefly discussed by some commentators and was apparently supported by Senator Lindsey Graham of South Carolina. Subsidies currently are sent directly to insurance companies. There are several problems with direct payment to individuals. As the Kekatos article notes, even if paid to insurers for the individuals the insurers would not know how to calculate premiums for persons based on their individual health care needs and history. If “$10,000 or $20,000…were paid directly to the individual “they might keep it instead to pay for other bills rather than paying for insurance.” A concern.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.