Former president Donald Trump made what would once have been a shocking acknowledgment during last week’s presidential debate: He has essentially accepted that the 2010 Affordable Care Act (ACA), also known as Obamacare, is here to stay. Meanwhile, Vice President Kamala Harris has repudiated her past advocacy of Medicare-for-all. Instead, the Democratic nominee promises to preserve private insurance markets and strengthen the ACA. The 2024 election still has big implications for health-care access and affordability. Yet both parties are moving away from their past extremes on the ACA. After a decade and a half of partisan wrangling, Obamacare won.
By the Editorial Board
Mr. Trump said last week that he will keep Obamacare unless he can come up with a replacement that offers better care at a lower cost. He also said that he has only “concepts of a plan” to replace it. Even he implicitly acknowledges the unlikelihood of repeal. “Until then, I’d run it as good as it can be run,” he said at the debate.
The 2016 Republican platform declared that “any honest agenda for improving healthcare must start with repeal.” The 2024 version promises to “expand access to new Affordable Healthcare.” Even Project 2025 stops short of calling for the repeal of the ACA. Instead, the Heritage Foundation initiative offers “policy suggestions to curb the abuses” of the law.
For its part, the 2024 Democratic platform dropped references to Medicare-for-all and a public option from the 2020 version. Now it says: “We’ll never quit fighting to protect and expand the Affordable Care Act.” During the debate, Ms. Harris quickly pivoted when asked about her past support of the single-payer health-care proposal from Sen. Bernie Sanders (I-Vt.). “I absolutely support … private health-care options,” she said. “What we need to do is maintain and grow the Affordable Care Act.”
While imperfect, the ACA has been extraordinarily successful. Government data released last week showed nearly 50 million Americans have been covered by health insurance plans through the ACA’s marketplaces. The share of Americans without coverage is down to 8 percent, about half what it was before Obamacare.
Republicans fought hard to stop President Barack Obama’s signature initiative 14 years ago because, historically, entitlement programs cannot be taken away once the public becomes accustomed to them. Conservatives raced to repeal the law before it gained widespread acceptance. They came close. Ultimately, the ACA was saved by a single vote in 2012 (from Chief Justice John G. Roberts Jr., in the biggest legal challenge to the law) and again in 2017, when Sen. John McCain (R-Ariz.) gave a thumbs-down to repeal on the Senate floor amid congressional Republicans’ attempt to kill the law legislatively. But the window probably closed when Republicans suffered heavy losses in the 2018 midterm elections after that repeal attempt.
Yes, Mr. Trump tried hard to destroy the ACA when he had the chance. He got rid of its “individual mandate” as part of the 2017 tax bill, stopped payments for cost-sharing subsidies (an act that increased premiums), cut funding for outreach and advertising plans, and proposed budgets that would have weakened protections for people with preexisting conditions. In 2020, the Trump Justice Department also asked the Supreme Court to overturn the law. In a second term, he could again try to undermine the system by neglect or sabotage. Mr. Trump’s running mate, Sen. JD Vance (Ohio), proposed Sunday to deregulate the Obamacare marketplaces in a way that could explode costs for older Americans or those with preexisting conditions — though, as ever, it was unclear whether he was really speaking for Mr. Trump.
After Mr. Trump left office, Democrats expanded eligibility for and increased subsidies for people to buy insurance on the ACA marketplaces. Enrollment in these plans has nearly doubled since 2020. But these credits will expire in 2025 unless Congress acts. Democrats rightly want to extend them. But Republicans remain unlikely to support doing so.
Moreover, 10 GOP-run states still refuse to expand Medicaid under the ACA — including Florida, Texas and Georgia. Ongoing litigation also threatens to weaken the law. In June, the U.S. Court of Appeals for the 5th Circuit opened the door to rolling back an ACA mandate that insurance companies cover preventive services.
All this shows why vigilance is warranted — and why Mr. Trump should be pressed on health-care specifics.
Even so, the substantial shift in rhetoric and, perhaps, in intent is good news for the tens of millions of Americans who benefit from Obamacare.
