Republican campaigns are silent on health care

• And it begs the bigger question of what the GOP's health care agenda will look like if the party flips control of one or both houses of Congress.

Axios contacted Republican campaigns in 10 of the closest House and Senate races. Only Nevada's U.S. Senate hopeful Adam Laxalt responded. And a review of candidates' websites and past statements found that even hard-liners endorsed by former President Trump have dialed back language on social media channels and eschewed positions like repealing the ACA.

• Laxalt campaigned against the ACA while running for Nevada Attorney General in 2018. He softened his stance two year later when running for governor, saying he supported protections for patients with preexisting conditions. Now, as he challenges incumbent Democrat Catherine Cortez Masto, the only health care issue on his website is investigating what he terms public health failures of the government's COVID-19 response.
• His press secretary, Brian Freimuth, wouldn't elaborate on Laxalt's position on the ACA, but said if elected, he would "prioritize reducing costs, expanding choices, and allowing patients to keep the doctor they prefer while protecting those with pre-existing conditions."
• Ohio Senate candidate J.D. Vance also hasn't laid out a health care agenda on his website, though he said at a February campaign event that "Obamacare was a disaster" and needed to be repealed and replaced by "something with substance."
• Georgia Senate hopeful Herschel Walker hasn't spoken much about health care, but his website said he wants to increase "competitive market options to ensure that every Georgian has access to quality, affordable healthcare."
• North Carolina Senate candidate Ted Budd also isn't showcasing policy points or saying much on health care since April, when he lamented on a podcast that an Obamacare repeal and replace bill he backed as a congressman in 2017 died in the Senate.
• Pennsylvania Senate hopeful Mehmet Oz, a retired cardiothoracic surgeon, has said he'd expand access to private short-term health plans former President Trump championed as an alternative to ACA coverage. CNN reported in March that Oz previously supported federal health insurance mandates and promoted the Affordable Care Act, though his campaign told CNN that stance had changed.
• Ohio's Madison Gesiotto Gilbert, who's running for the 13th congressional district, told an Ohio Trump rally in April that she backs eliminating Obamacare but has since confined her positions to opposing Medicare for All and backing "patient-centered health care that removes the role of the federal government."

Between the lines: This kind of distancing makes sense, said Republican strategist Brendan Buck.

• "Republicans have been talking about health care for the last decade almost exclusively around repeal and replace. We found out the hard way that it’s not a winning issue anymore and backed off of that entirely."
• The GOP wants to make these midterms about the economy, Buck said. "It's not bias against health care. But, if it's not inflation, gas prices, then it's not a front burner issue."

Flashback: Republicans failed to repeal the Affordable Care Act in Congress, and a case to invalidate the law brought by a group of GOP attorneys general was thrown out by the Supreme Court in June 2021.

• But Republicans had scored big electoral wins on health care in the past, like in 1994 over former President Clinton's universal health care plan and in 2010 in response to passage of the ACA.

The big picture: The difficulty has been coming up with a distinctly Republican take on health care, said Larry Levitt, executive vice president of the Kaiser Family Foundation.

• "When Republican candidates have talked about health care, it's generally in opposition to Democratic plans," Levitt said. "That leaves Republicans in a bit of a box in this campaign since the ACA is now as popular as ever."
• Recent KFF polling shows the Affordable Care Act has a 55% approval rating, one of the highest ratings on the law since it was implemented.

What's next: If the GOP does take control of the House or Senate, Buck expects that Republican focus for health care policy will be much smaller in ambition and focused on issues like expanding telehealth or the use of health savings accounts.

• There also will likely be investigations of the origins of COVID-19 and the Biden administration's response. Topics up for consideration include whether coronavirus was man-made, as well as scrutinizing U.S. funding to the Wuhan Institute of Virology, Axios has reported.
• "They have no intent on biting off full systemic reform," said Buck. "Repeal and replace is pretty dead. I'm confident that Republican leaders even if they control both the House and Senate wouldn't rerun that play — the ACA is here to stay."

But, but, but: The Inflation Reduction Act extends enhanced ACA health insurance subsidies for another three years. If a Republican is elected president in 2024 or the GOP controls Congress, it's certainly possible lawmakers could choose not to renew the subsidies again.

• Republicans could also try to repeal the new law's prescription drug price negotiations which are set to begin in 2026. Rep. Buddy Carter (R-Ga.) alluded to such a prospect during a recent Fox News interview.

The bottom line: Republicans' wariness about engaging on health care reinforces how the Affordable Care Act has become a permanent fixture of the health system — and gives Democrats a big opening to claim credit for its coverage expansions and policy reforms beyond the law.