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Health care is still haunting the Republican Party, seven years after its disastrous attempt to repeal Obamacare. Whether Democrats can take advantage — that’s another story.
Republicans are building their campaigns to retake the White House and Senate on immigration, inflation and the culture wars, not whether to keep the Affordable Care Act intact. Instead, both Donald Trump and JD Vance sometimes freelance their own ideas on how to change the law.
First there was Trump’s “concepts of a plan” for replacing Obamacare, as the former president put it during last month’s debate. Then Vance riffed about the idea behind “high-risk pools,” a previous failed Republican proposal that would have potentially raised premiums on people with expensive conditions by allowing insurers to cover them separately.
Perhaps most alarming to Democrats was Vance’s claim that Trump “saved” the Affordable Care Act by working across party lines. In reality, the former president mostly tried to tear down the law.
“It’s a huge political loser,” said Maryland Sen. Chris Van Hollen, who ran Democrats’ campaign arm in 2018 during the GOP’s multiple Obamacare repeal attempts. “Which is why JD Vance tried to pretend Trump wanted to strengthen the Affordable Care Act.”
Despite that assessment, the high point for health care’s salience was six years ago, when the GOP lost the House in a blue backlash against Trump. For all the fodder that Trump and Vance offer them on health care, Democrats aren’t fully saturating their messaging with reminders of the Republican vulnerability. Instead, they’re looking to capitalize on it however they can.
Vice President Kamala Harris’ campaign has spent seven figures on an ad mocking “concepts of a plan” and attacking Trump for his anti-Obamacare view. The Harris camp also released a 43-page “Trump Vance” health care policy plan, describing it as one that would “rip away coverage from people with preexisting conditions.”
Meanwhile, Vance’s indirect suggestion of a return to insurance pools prompted one Republican to check in personally with Trump to make sure he wasn’t backing a return to the 2018 days. Trump responded that he did not support high-risk pools, this Republican told Semafor.
The Trump campaign, however, says there’s little daylight between the running mates and indicated it’s open to reviving the Obamacare debate. Trump campaign spokesman Brian Hughes said in a statement that the ticket believes “the health care market is still a place where competition and efficiency are in the best interest of the consumer.”
“Given the Harris-Biden economy that has made inflation impact every sector’s affordability, health care among them, we look forward to restoring a vibrant economy that makes everything, including health care, more affordable,” Hughes added.
Republicans aren’t convinced the potential revisiting of the health care law matters to voters as it once did. Alex Conant, a GOP strategist and former aide to Florida Sen. Marco Rubio, affirmed that “it was an issue that Democrats routinely won on, so I’m not surprised that Harris wants to make this an issue again.
“I’m just skeptical that it is something that voters are going to be really engaged on,” he said.
Democrats portray health care as one element of their broader effort to tag Trump and Vance as dishonest.
“It’s just pointing to one more example of: These guys aren’t on the level. Have a health care plan that you can talk about that’s better than what we’ve got now,” said former Rep. Tim Ryan, D-Ohio, who ran against Vance in a 2022 Senate race. “But no, they’ve got to lie about it.”
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Trump’s “concepts of a plan” aside, Republicans aren’t campaigning on Obamacare repeal anymore — with good reason. The health care law is more popular than ever these days, and more people than ever are enrolled on its exchanges.
The GOP’s initial push to gut the law stemmed in part from the Affordable Care Act’s unpopularity during its early years. Republicans see an advantage on different issues now, particularly the border and inflation.
Steven Law, the president of the Senate Leadership Fund super PAC, described health care’s status for voters as a potential gauge of partisanship.
“If you’re going to the voting booth believing that health care is your most important issue, more often than not, you’re inclined to be a Democratic voter to begin with,” Law, whose PAC is aligned with Minority Leader Mitch McConnell, told Semafor.
“Immigration, and the cost of living, and some other cultural issues have just a whole lot more edge to them right now in the electorate,” he added.
Still, health care is about to have inescapable prominence on Capitol Hill; Affordable Care Act subsidies expire next year, and insurance premiums may start going up soon if Congress doesn’t act to extend them.
Burgess and Shelby’s View
Congressional Republicans actually don’t mind Trump’s “concepts of a plan” — it’s vague, but it doesn’t give Democrats a ton of ammunition. The GOP has more angst about Vance’s detailed comments about health care. Even if Republicans wanted to take another whack at Obamacare should they win big this fall, they wouldn’t want to get into the specifics now.
But while Democrats are at ease talking about health care, it’s not clear that Team Harris plans to significantly step up its emphasis on the issue in the final weeks of the campaign. Harris ad spending that mentioned health care decreased in September compared to August, where it ranked in the middle of issues they focused on, according to AdImpact.
There’s some new evidence that extra attention to health care might help Democrats: a recent Associated Press poll found health care ranked second after the economy on voters’ minds. And there’s evidence the Harris camp is listening: It held an organizing call with health professionals on Sunday night.
Even so, the energy behind the current health debate is a far cry from the Affordable Care Act’s first decade of life.
The View From Trump World
One person close to the Trump campaign said that the former president’s best health care talking point is his endorsement by Robert F. Kennedy Jr., a vaccine critic who has suggested a “break” in infectious disease research. Kennedy, this person said, allowed Trump to weigh in on health care by talking about “chronic disease.”
“What is Donald Trump’s policy? Robert Kennedy. And that’s what bothers Harris the most,” this person added. “Trump has moved on from focusing on repealing and replacing, understanding that the base of the problem is our declining health.”
Of course, Trump also said within the past year that Republicans shouldn’t “give up” on replacing Obamacare.
Notable
- Sen. Tom Cotton is hoping to combine an extension to Trump’s tax cuts with health care reform into one bill come the new year, NBC News reported.
- Congressional Democrats are already making a push to make the expiring ACA subsidies permanent, according to the Washington Post.