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On the presidential campaign trail, former President Donald Trump is, once again, promising to repeal and replace the Affordable Care Act — a nebulous goal that became one of his administration's splashiest policy failures.

"We're going to fight for much better health care than Obamacare. Obamacare is a catastrophe," Trump 

The perplexing revival of one of Trump's 

 crusades comes at a time when the Obama-era health law is even 

 than it was in 2017, when Trump and congressional Republicans proved unable to pass their own plan to replace it. That failed effort was a big part of why Republicans lost control of the House of Representatives in the 2018 midterms.

Despite repeated promises, Trump never presented his own Obamacare replacement. And much of what Trump's administration actually accomplished in health care has 

Still, Trump secured some significant policy changes that remain in place today, including efforts to bring 

 charged by hospitals and paid by health insurers.

Trying to predict Trump's priorities in a second term is even more difficult given that he frequently changes his positions on issues, sometimes multiple times.

The Trump campaign did not respond to a request for comment.

Perhaps Trump's biggest achievement is something he rarely talks about on the campaign trail. His administration's "

" managed to create, test, and bring to market a COVID-19 vaccine in less than a year, far faster than even the most optimistic predictions.

Many of Trump's supporters, though, don't support — and some even vehemently oppose — COVID vaccines.

Here is a recap of Trump's health care record:

Trump's pandemic response dominates his overall record on health care.

More than 400,000 Americans died from COVID over Trump's last year in office. His travel bans and other efforts to prevent the global spread of the virus were ineffective, his administration was slower than other countries' governments to develop a diagnostic test, and he publicly clashed with his own government's health officials over the response.

Ahead of the 2020 election, Trump resumed large rallies and other public campaign events that many public health experts regarded as reckless in the face of a highly contagious, deadly virus. He 

personally flouted public health guidance

 after contracting COVID himself and ending up hospitalized.

At the same time, despite what many saw as 

 by the White House, Trump signed a massive COVID

 (after first threatening to veto it). He also presided over some of the 

 for the National Institutes of Health's budget since the turn of the century. 

And the mRNA-based vaccines Operation Warp Speed helped develop were an astounding scientific breakthrough credited with 

 while laying the groundwork for future shots to fight other diseases 

Trump's biggest contribution to abortion policy was indirect: He appointed three Supreme Court justices, who were instrumental in overturning the constitutional right to an abortion.

During his 2024 campaign, Trump has been 

 on the red-hot issue. Since the Supreme Court overturned 

 in 2022, Trump has bemoaned the issue as politically bad for Republicans; criticized one of his rivals, Florida Gov. Ron DeSantis, for signing a six-week abortion ban; and 

 with "both sides" on abortion, promising that "for the first time in 52 years, you'll have an issue that we can put behind us."

He has so far avoided spelling out how he'd do that, or whether he'd support a national abortion ban after any number of weeks.

More recently, however, Trump appears to have 

 over his criticism of Florida's six-week ban and more with key abortion opponents, whose support helped him get elected in 2016 — and whom he repaid with a long list of policy changes during his presidency.

Among the anti-abortion actions taken by the Trump administration were a reinstatement of the "

" that bars giving federal funds to international organizations that support abortion rights; a regulation to 

 and other organizations that provide abortions from the federal family planning program, Title X; regulatory changes designed to make it easier for 

 and employers to decline to participate in activities that violate their religious and moral beliefs; and other changes that made it harder for NIH scientists to conduct 

All of those policies have since been overturned by the Biden administration.

Unlike Trump's policies on reproductive health, many of his administration's moves related to health insurance still stand.

For example, in 2020, Trump signed into law 

 a bipartisan measure aimed at protecting patients from unexpected medical bills stemming from payment disputes between health care providers and insurers. The bill was included in the $900 billion COVID relief package he opposed before signing, though Trump had expressed support for ending surprise medical bills.

His administration also pushed — over the vehement objections of health industry officials — 

 that require hospitals to post prices and insurers to provide estimated costs for procedures. 

 also remain in place, although hospitals in particular have been slow to comply.

 popular entitlement programs like Medicare, Medicaid, and Social Security, his administration did not stick to that promise. The Affordable Care Act repeal legislation Trump supported in 2017 would have 

, and his Department of Health and Human Services later encouraged states to require Medicaid recipients 

One of the issues the Trump administration was most active on was reducing the price of prescription drugs for consumers — a top priority for both Democratic and Republican voters. But many of those proposals 

One Trump-era plan that never took effect would have pegged the price of some expensive drugs covered by Medicare to prices in other countries. Another would have required drug companies to 

A regulation allowing states to import cheaper drugs from Canada 

, in November 2020. However, it took until January 2024 for the FDA, under Trump's successor, to approve the 

, from Florida. Canada has said it won't allow exports that risk causing drug shortages in that country, leaving unclear whether the policy is workable.

 to disclose to patients when the cash price of a drug is lower than the cost using their insurance. Previously pharmacists could be barred from doing so under their contracts with insurers and pharmacy benefit managers.

Trump is credited by some advocates for overhauling Department of Veterans Affairs health care. However, while he did sign a major bill allowing veterans to obtain care outside VA facilities, White House officials also 

 of the spending needed to pay for the initiative.

Trump scored a big win for the libertarian wing of the Republican Party when he signed into law the 

 intended to make it easier for patients with terminal diseases to access drugs or treatments not yet approved by the FDA.

 how many patients have managed to obtain treatment using the law because it is aimed at the FDA, which has traditionally granted requests for "compassionate use" of not-yet-approved drugs anyway. The stumbling block, which the law does not address, is getting drug companies to release doses of medicines that are still being tested and may be in short supply.

Trump said in a Jan. 10 Fox News town hall that the law had "saved thousands and thousands" of lives. There's no evidence for the claim.

 is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about 

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Election 2024

Julie Rovner

Author

The former president is reviving campaign promises to undo Obamacare, an idea that fizzled during his first time in office. Based on his record, here's what else he might do in health policy.

What would a second Trump presidency look like for health care?

Go Deeper.

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