The future of Obamacare hangs on a few seats in Congress. Here's what could happen next

• Even as Republicans and former President Donald Trump largely move on from plans to try and repeal the Affordable Care Act, they still hold a very different vision for the program's future than Democrats do.
• At stake in the November elections are the health care law's enhanced subsidies and its progress to expand Medicaid coverage across the United States.

"Repeal and replace" has long been the Republican mantra when it comes to the Affordable Care Act.

These days, not so much.

"I'm not running to terminate the ACA," former President Donald Trump wrote in a Truth Social post in March. During the Sept. 10 presidential debate, Trump again said he did not plan to eliminate the program. That is, unless he could "come up with a plan that's going to cost our people, our population, less money and be better health care than Obamacare."

It's a remarkable about-face coming from a candidate who said in Oct. 2016 that real change, "begins with immediately repealing and replacing the disaster known as Obamacare."

It also shows how entrenched former President Barack Obama's signature health-care legislation has become in American life. Around 60% of Americans hold a favorable opinion of the 2010 health care law, a recent KFF poll found. A record number of people — over 20 million — signed up for coverage on the ACA marketplace in 2024.

But even as existential threats to the program appear to recede, Republicans and Democrats are still deeply divided over what the health care law's role should be in the future, said Cynthia Cox, vice president and director of the program on the ACA at KFF.

"When you're asking about ways to improve the ACA, there's a lot of different interpretations of what that might mean," Cox said. "One person's