Background

Overhauling the health-care system could affect up to one-sixth of the American economy — and yet the White House and congressional leaders have repeatedly rushed ahead to try to pass legislation to repeal and replace Obamacare, often without waiting to determine the cost or impact of their proposals.

From the start of the Trump administration’s health-care reform push in March 2017, the process was marked by secrecy, backroom dealmaking, and conflicting statements from the White House and Congress about what bills would actually do.

At the same time, Trump threatened to allow the Affordable Care Act to fail. The administration has already canceled advertising that would have helped encourage people to sign up for insurance coverage and the White House raised the possibility of withholding mandatory payments to health insurers, temporarily doing so in July 2018.