Trump again calls for Obamacare to be “replaced,” reopening a fight that Republicans have already tried to end

WASHINGTON – Donald Trump took aim at the Affordable Care Act in his presidential debate with Kamala Harris on Tuesday, reigniting a 15-year-old partisan dispute over a law that has gone from a burden to a political advantage for Democrats.

“Obamacare was a lousy health care reform. It always was. It's not very good now,” Trump said on stage. “And I said if we can think of something and work on it, we'll implement it and replace it.”

Trump indicated that he would only repeal the ACA, also known as “Obamacare,” if he could come up with a better and cheaper system. When asked by moderators if he had a plan, he replied, “I have concepts for a plan,” adding that he intends to release “concepts and options … in the not too distant future.”

The former president did not provide a more precise timetable.

“We could do a lot better than Obamacare,” Trump said.

Trump's comments were another turning point in the 15-year battle over the ACA, which Republicans have sought to abandon. Trump, who revisited the issue last fall, played down the prospect of repealing the law if he returned to the White House this year – until he was asked about it in the debate on Tuesday.

The Harris campaign is exploring ways to weaponize Trump's comments, including paid ads and events on the health care issue, according to two sources familiar with the campaign's thinking. One source called the revival of the issue a “flop” by Trump that gives Harris' campaign “a huge opportunity” with key voting blocs.

On the day of the debate, the Biden administration announced that the number of people covered by the ACA reached a historic high this year, at 20.8 million Americans. In total, the White House said, about 50 million Americans have been covered through the ACA's private marketplaces since 2014, in addition to those covered by the law's Medicaid expansion.

Harris' senior adviser David Plouffe promised Wednesday that voters would hear more about Trump's comments on health care reform.

“He promised us a health care plan in 2015. A long time ago. It never came. Last night he said he had the blueprints of the plan. But he still wants to essentially kick millions of people off health insurance,” Plouffe said on MSNBC. “People in the swing states are going to hear about it very soon.”

The 2010 law, signed by then-President Barack Obama, was initially unpopular and was politically exploited by Republicans, who promised to “repeal and replace” it if they came to power. But when Trump and a Republican-led Congress tried to undo the law in 2017, it sparked a public backlash and boosted the ACA's popularity. A Republican repeal bill backed by Trump sought to roll back subsidies for expanding health insurance and eliminate some of the ACA's protections for people with pre-existing conditions, one of its most popular features. The proposal failed by one vote when Sen. John McCain (R-Arizona) unexpectedly voted “no” during a late-night Senate session.

Harris, then a senator, recalled that vote on Tuesday.

“You don't have a plan,” she told Trump. “And what the Affordable Care Act has done is it has made insurance companies lose the ability to turn down people with pre-existing conditions. I don't have to tell the viewers tonight that. Do you remember what that was like? Do you remember when an insurance company could turn down a child with asthma, a breast cancer survivor, or a grandparent with diabetes? And thankfully, during my tenure as vice president over the last four years, we've strengthened the Affordable Care Act.”

In the 2018 election, Democrats turned the tables, accusing Republicans of excluding millions of Americans from health insurance and giving insurers back the ability to deny coverage to people with pre-existing conditions. The ads wrote themselves. Nevertheless, Trump persisted in his push to repeal the law for the rest of his presidency, and supported a lawsuit to repeal the law in 2020, the year he lost re-election to President Joe Biden.

In Congress, Republicans have expressed little desire to resume the painful fight to repeal the law, given its widespread benefits and the deep roots of the health care system. They include some of the most conservative lawmakers who favor changes to the health care system, but not from the perspective of repealing the ACA.

The Affordable Care Act “hasn't worked because costs have skyrocketed. … The deductibles have gone up tremendously. The copayments have gone up tremendously,” said Senator Rick Scott (R-Fla.), who is up for re-election this fall, in an interview. “You want to have a safety net so that people can get health insurance. … So the way I would look at it is, I wouldn't talk about what we should do with the ACA. I say, how are we going to fix the system?”

When asked whether he supported Trump's call to reopen the ACA fight, Republican Senator John Barrasso of Wyoming did not answer directly.

“We want to make sure that people get the care they want and insurance that is affordable and appropriate for them,” he said. “And that's a real challenge for many Americans under Obamacare because premiums have gone up – more expensive for the individual, and many of Obama's promises have been broken.”