Nov 27, 2023 - Politics & Policy

Trump's Obamacare gift

Illustration of a gift box wrapped in wrapping paper with a health plus pattern on it.

Illustration: Aïda Amer/Axios

Christmas has come early for Democratic campaign staffers, courtesy of former President Trump's vow over the holiday weekend to "never give up" on repealing and replacing the Affordable Care Act (ACA).

Why it matters: Democrats are eager to revive their health care playbook from 2018, when the party rode a "blue wave" to the House majority by aggressively campaigning on Republican attempts to gut Obamacare.

  • In fact, the Biden campaign has already altered its plans for this week in the wake of Trump's comments and will air TV ads contrasting the president's health care agenda with Trump's proposal to repeal the ACA.
  • "My predecessor, once again — God love him — called for cuts that could rip away health insurance from tens of millions of Americans," Biden said in remarks from the White House Monday. "They just don't give up."

The big picture: Despite having full control of the White House and Congress, Republicans were unable to repeal and replace the ACA in 2017 — a failure Trump called "a low point for the Republican Party" on Saturday.

  • In 2021, just months into President Biden's term, the Supreme Court rejected Republican efforts to strike down the entire ACA and saved the law for the third time.
  • Since then, Republicans have largely accepted that the ACA is here to stay and stopped campaigning on "repeal and replace," recognizing the issue as a political loser.

Polls appear to back that consensus: Nearly 60% of Americans had a favorable view of the ACA as of May 2023, with support steadily rising from 50% at the start of the pandemic, according to KFF tracking surveys.

  • The ACA's protections for people with pre-existing conditions have proved especially popular, with 79% of Americans — including 66% of Republicans — saying in 2020 that they did not want the Supreme Court to overturn those protections.
  • Voters overwhelmingly trust Republicans to do a better job on border security (50%-20%), crime (46%-20%) and the economy (49%-28%), but Democrats still maintain a distinct advantage on health care (45%-22%), according to a September NBC News poll.

Driving the news: Trump's claim in a Truth Social post that he's "seriously looking at alternatives" to the ACA has set off a frenzy among Democrats hungry for political momentum.

  • "[Trump] was one vote away from getting it done when he was president — and we should take him at his word that he'll try to do it again," Biden campaign spokesperson Ammar Moussa said in a statement.
  • The Democratic Congressional Campaign Committee issued a press release highlighting cuts to the ACA proposed by the Republican Study Committee, a conservative bloc of 156 House Republicans.
  • House Majority PAC — Democrats' main outside spending group — blasted out a series of emails Monday calling on vulnerable New York Republicans to condemn Trump's comments.

Between the lines: Trump has often been ridiculed by Democrats for his recurring pledge to unveil a new health care plan in a matter of "weeks," which he made at least five times in 2020.

  • While his Obamacare alternative has not materialized, conservative policy groups staffed by Trump alumni have been openly sketching out health care plans for the next Republican administration all year.
  • With Trump and the Biden campaign officially throwing down the gauntlet, a robust debate on addressing soaring health care costs may actually be on the table in 2024.
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