Former President Donald Trump’s renewed focus on repealing and replacing the Affordable Care Act, known colloquially as Obamacare, has alarmed some Republicans scarred by the GOP’s failure to deliver on promises to dismantle the law and who view the issue as a political loser with the American people.
Many on Trump’s team said they were surprised by the former president’s recent declaration on his social media website Truth Social that replacing Obamacare would be a priority of his administration, as Obamacare had not been a focal issue in ongoing policy conversations and the campaign has not yet drafted any kind of health care policy alternative. One Trump adviser told CNN the post came “completely came out of nowhere,” and said the team “has not been talking to him about health care.”
Some Trump advisers who spoke with CNN also conceded that calling for the termination of a health care law that provides millions of Americans coverage and is largely viewed favorably by the public is a political loser going into 2024. Republicans have tried and failed for years to implement substantial changes to Obamacare and the party has largely abandoned efforts to campaign on the issue.
The resurrection of the health care battle has given Democrats fresh political ammo, and the Biden campaign quickly seized on Trump’s threats. The campaign held a press call with former House Speaker Nancy Pelosi and North Carolina Democratic Gov. Roy Cooper, whose state will become the 40th to expand Medicaid on Friday, to respond to Trump’s comments. The campaign also on Thursday released an ad focused on health care and prescription drug costs, attempting to draw a sharp contrast with Trump. The ad – which features a pediatric nurse who calls Trump’s health care policies “troubling” – will run in media markets in seven states that will be key to Biden’s 2024 electoral map.
“There are very few issues where Republicans are at a greater disadvantage then health care. The Biden campaign desperately wants the election to be about health care and abortion. If the election is about those two issues in 2024, then Democrats will have a great night in November,” Ken Spain, a GOP consultant and former communications director for the National Republican Congressional Committee, told CNN.
“The concern that Republicans have always had about Trump is his lack of discipline. The question is, is this really an issue he intends to campaign and formulate a strategy around, or is this just another lapse in discipline?” Spain added.
Health care “was a loser in 2018 and it’s a loser now,” one Trump-aligned Republican operative told CNN, referencing the 2018 midterm elections that ushered in a Democratic majority in the House of Representatives.
Trump’s health care legacy while in office is viewed by many Republicans as lackluster at best. His failure to fulfill his core campaign promise of repealing and replacing Obamacare – even with a GOP monopoly on power in Washington – was an early blow to Trump, who had painted himself as the ultimate dealmaker.
“Talk about the border,” the operative said. “Talk about the economy. Talk about no more foreign wars. Don’t talk about health care.”
Advisers to Trump said the catalyst for the former president’s posts was a recent article written by the Wall Street Journal editorial board that raised concerns that patients are seeing higher costs because insurers are using work arounds to an Affordable Care Act rule. Trump included a portion of the op-ed in his initial post on the issue.
The topic had also recently been brought up to Trump during a Mar-a-Lago meeting with Jeff Colyer, the former governor of Kansas. The two discussed health care policy over lunch, a Trump adviser told CNN.
Trump’s online pronouncements about replacing the law with his own belied the fact that his campaign has not settled on health care plan.
The campaign’s in-house policy team, led by advisers Vince Haley and Ross Worthington, has been drafting aggressive proposals for a potential second Trump term, but the campaign has not been actively working on a health care proposal, the Trump adviser told CNN. The team first started floating ideas for an alternative to Obamacare in recent days — but only after Trump started posting about it online.
One person familiar with the campaign’s process said it was likely that Trump’s team would also review health care proposals put forward by outside advocacy groups, including Project 2025, a partnership of groups organized by the conservative think tank the Heritage Foundation. But this person stressed the proposals by the outside groups are merely suggestions and that the campaign would look at a range of ideas before putting forward its own unique proposal.
“The campaign is not going to adopt a position that’s suicidal,” this person said, acknowledging how politically fraught the issue can be. “But it is equally suicidal not to recognize the American people’s profound cry for health care reform.”
Like many of the policy proposals Trump’s current team is drafting for a potential second term, there are also serious concerns about how the former president could successfully enact them if reelected, acknowledging the necessary obstacles Congress and the courts could pose to a new health care agenda.
Trump bringing health care back to the forefront has also reignited talk of his failure to repeal and replace Obamacare in 2017.
Members of Trump’s orbit have long blamed that failure on the late Sen. John McCain of Arizona, who famously voted that year against repealing the ACA with a dramatic “thumbs down” on the Senate floor, tanking the Trump administration’s efforts.
And despite Trump’s promises to release a health care plan that could replace Obamacare, Trump left office in 2020 without having produced one. Just weeks before the 2020 presidential election, Trump issued an executive order pledging to protect Americans with preexisting conditions, but the plan fell far short of a comprehensive proposal.
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