Has Donald Trump killed Obamacare? The future of the Affordable Care Act

The vote to repeal and replace the Affordable Care Act squeaked through the House of Representatives. 

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In Britain, progressives woke to the Conservative party trampling on the last of their electoral dreams, with historic wins in local elections. But this isn't the only thing to be miserable about. Across the Atlantic, controversial cheeto Donald Trump took one step towards trampling on his predecessor's flagship domestic policy, the Affordable Care Act aka Obamacare. Here's what you need to know.

Wait, what just happened?

The House of Representatives just approved legislation to repeal and replace major sections of the Affordable Care Act. At first glance, this is a major two fingers to the former President, Barack Obama. Not only is the ACA known as "Obamacare", but it really was, to quote his vice-President Joe Biden, "a big f*cking deal". Obama succeeded where the last Democratic President failed and brought the United States closer to a system of universal healthcare (although on a very different model from the NHS). Before Trump's election, the ACA had already survived several challenges in the courts. 

So the grannies are being left to die on the streets?

Not yet, and probably not at all. First, while Republicans have jabbed Obamacare for years, now they truly do have the power to take healthcare away from poor and sick voters, some are having doubts. The legislation only squeaked through, by 217 votes to 213. One Democrat opponent of the bill called it "political suicide". Obamacare included the expansion of Medicaid, a government subsidised health service for the poorest families. While some Republicans worry about being seen to leave vulnerable people to die, others see advantages in having a system of healthcare in place that can prevent outbreaks from spreading. Another controversial measure is the return to allowing insurers to charge people with pre-existing medical conditions more. 

Even for those Republicans who hate every inch of Obamacare, replacing it is a huge operation. The legislation now passes to the upper chamber, the Senate, where there will be more opposition from the Democrats, and Republican rebels. One Republican senator, Bob Corker, said the bill has "zero chance" of passing in its current form. 

What happens if Trump gets his way in the end?

As described above, moderate Republicans will probably try to avoid a piece of legislation that just seems outright murderous, especially since a Gallup poll found 55 per cent of Americans actually approve of the ACA.

But they may nevertheless seize on the opportunity to cut funding for what the rest of the world thinks is family planning and the evangelical American right considers an abortion free-for-all - Planned Parenthood. The new legislation would strip the organisation of funding for a year (a measure likely to be renewed each year), and financially penalise health plans that included abortion in the coverage.

So is Obamacare dead yet?

No. Obamacare might have rolled out healthcare to millions of uninsured Americans, but there were hardheaded reasons for reform too - not all of which have been solved.

The US spends a higher percentage of GDP on healthcare than other developed nations. Plus there's the fact that making healthcare free can help defend against a huge range of threats, from obesity to outbreaks of dangerous viruses. As Trump said in February: "Nobody knew healthcare could be so complicated."

Julia Rampen is the digital news editor of the New Statesman (previously editor of The Staggers, The New Statesman's online rolling politics blog). She has also been deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.