Health policy finally gets its election moment

Democrats have been eager for a health care fight. Trump and Vance are helping deliver it.

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In the closing moments of the recent presidential debate, Donald Trump uttered six words that could become the epitaph of the GOP’s quixotic quest to repeal Obamacare.

“I have concepts of a plan” to replace the Affordable Care Act, Trump announced on prime-time TV.

The line became a meme the instant it left his mouth.

For 14 years, Republicans have talked about getting rid of the Affordable Care Act. They got strikingly close! But the ACA’s brush with death in 2017 helped revive support for the law, and Republicans suffered enough Obamacare-related defeats in subsequent elections that party leaders mostly stopped talked about it.

Now, in the closing weeks of the presidential campaign, the GOP’s attempts to tear down the Affordable Care Act — and the party’s inability to field a politically viable replacement — are back in the spotlight.

Democrats are eager for this moment. The Harris campaign has wanted to fight on health care — and Trump and JD Vance are helping them do it.

A week of GOP policy pronouncements

First came Trump’s debate comments on the Affordable Care Act, where he reiterated his longtime opposition to the “lousy” law.

“We could do much better than Obamacare,” Trump said on Sept. 10, while grudgingly acknowledging that it’s the law of the land. He also pledged to “run it as good it as it can be run” if elected again — a promise undercut by his record of rolling back enrollment efforts for the Affordable Care Act and taking other steps as president to weaken the law.

Trump’s ACA pronouncements were a gift to Democrats. The Harris campaign lined up a week of events in battleground states seeking to capitalize on the “concepts of a plan” line, pointing to Trump’s years of trying to overturn the Affordable Care Act.

Then Vance went on NBC’s “Meet the Press” last Sunday and floated a specific idea: Republicans want to roll back protections in the Affordable Care Act’s insurance markets.

VANCE: A 65-year-old American in good health has much different health care needs than a 65-year-old American with a chronic condition. And we want to make sure everybody is covered. But the best way to do that is to actually promote some more choice in our health care system and not have a one-size-fits-all approach that puts a lot of people into the same insurance pools, into the same risk pools, that actually makes it harder for people to make the right choices for their families.

The Trump-Vance campaign initially played down the VP nominee’s comments, saying he was just talking about past achievements and not laying out a future plan.

But then Vance went deeper on his idea in a speech at a North Carolina rally last Wednesday.

“We’re going to actually implement some regulatory reform in the health-care system that allows people to choose a health-care plan that works for them,” Vance vowed. He specified that people would be grouped by their respective levels of illness when shopping for health coverage, suggesting that the riskiest patients would be steered toward different plans than healthier patients.

If that sounds surprising, it’s because the Affordable Care Act largely ended that practice.

Before the ACA, chronically ill patients often faced high premiums and other barriers to accessing coverage and care. Many struggled to find affordable health coverage.

But the 2010 health law restricted health insurance companies from evaluating patients on their individual risks and created new protections for people with pre-existing conditions.

We wrote about Vance’s comments last week at The Washington Post, and the story just ran in our Sunday A-section.

As you’ll see in our article, health policy experts said they were confused and concerned by the idea to resurrect pre-Affordable Care Act ideas around shunting chronically ill patients into what are known as high-risk pools.

“I feel like I’ve been transported back to 2009,” Harvard health policy professor Adrianna McIntyre told me.

But while Trump and Vance are baffling policy experts — and even some conservative political strategists — they’re galvanizing the Harris campaign.

Why Democrats want this fight

The polling has been clear: health care is one of Democrats’ electoral advantages.

KFF, a nonprofit health care research and polling organization, recently found that Harris has a nine-point edge on Trump when it comes to who voters trust to handle health-care costs. See for yourself — it’s one of her strongest issues.

The Affordable Care Act also has become quite popular. A decade ago, roughly one-third of Americans had a favorable impression of Democrats’ health law, per KFF. Today? It’s up to nearly two-thirds.

But while there’s been ample election-year focus on issues like abortion and the economy, it’s been harder for “health care costs” to find a lane in the news cycle. At least until the past two weeks.

Harris has her own heath policy weaknesses. She supported Medicare for All ahead of her presidential campaign five years ago, and many voters have said they’re uneasy with the idea of upending the U.S. health system and shifting more people to government health insurance.

While Harris has said she doesn’t support Medicare for All any longer, her campaign has worried about her past stance becoming a 2024 election-year issue. As expected, moderators did ask about it during the debate, and Trump tried to zing Harris on it too.

But Trump struggled to solidly land that attack — perhaps distracted by Harris praising his one-time rival John McCain.¹

With about six weeks left before Election Day, there are a lot of stories and policy ideas jockeying for voters’ attention. (And surely many more to come.) And after the past few weeks of renewed interest in the Affordable Care Act, will voters stay curious about health policy? Or will attention on the ACA fade as the debate recedes and other flashpoints emerge? That’s TBD to me.

But if Trump and Vance keep bringing up the Affordable Care Act, and specifically their plans to overhaul it, you can bet Democrats will make sure that voters hear about it.

1. Rather than stay focused on the question of Medicare for All, Trump initially tried to litigate Harris’s praise of McCain and the former Arizona senator’s feelings on the Affordable Care Act. It was just one of many moments where Trump appeared to take the bait that Harris laid for him during the debate.