Despite the GOP 2024 front-runner's call, congressional Republicans are divided on whether to pick that battle again after they tried and failed to eliminate the law in 2017.
WASHINGTON — Even as his party has backed away from the issue, Donald Trump is doubling down on his calls to replace the Affordable Care Act, also known as “Obamacare,” if he’s elected president again.
“I don’t want to terminate Obamacare, I want to REPLACE IT with MUCH BETTER HEALTHCARE. Obamacare Sucks. ” Trump said in a pair of late-night posts on social media.
Trump promised “much better Healthcare than Obamacare for the American people,” although he hasn’t offered a replacement plan.
The former president made a similar promise in 2016. The following year, he endorsed a Republican-led bill to undo a substantial portion of the law, repealing the ACA’s subsidy extensions and regulations in an attempt to lower costs on the open market. The nonpartisan Congressional Budget Office projected that it would have rescinded insurance coverage for about 23 million people. It also threatened protections for pre-existing conditions. It fell short in Congress; as did his effort to get the Supreme Court to invalidate the law.
Republicans have abandoned plans to repeal Obamacare in the years since. But they’ve repeatedly struggled to craft alternatives that achieve the coverage extensions and consumer protections under the 2010 law, which was unpopular when Democrats first passed it and became popular as the GOP tried to nix it in 2017.
Still, some Senate Republicans said they’re open to revisiting the effort to unwind and replace the ACA.
“I would love to see us revisit it,” said Sen. Ted Cruz, R-Texas, who is running for re-election in 2024. “Lowering premiums is critically important to Texans.”
"I authored legislative language in 2017 that would expand choices and dramatically lower premiums, and my language was adopted in the bill the Senate was considering," Cruz said. "Unfortunately . John McCain famously thrust his thumb downward and killed the effort."
Sen. JD Vance, R-Ohio, said the key question is “how we reform and replace” the ACA, arguing that “there’s a lot that we can improve upon” and Republicans can’t “run away from the issue.”
“There is broad recognition that a lot of the plans of the ACA are really expensive and really low-quality,” Vance said when asked about Trump’s calls. “I think it’s always been the position of Republicans that we should have better health care.”
Republicans would need to win control of the White House and both chambers of Congress to have any hope of unwinding the ACA, a law that Democrats strongly support.
And Sen. Mike Rounds, R-S.D., said reopening the ACA fight in 2025 would require Republicans to craft a replacement plan ahead of time, which they haven’t done.
“We most certainly can do a better job, but it would require us to start proposing what the change would be now so that we wouldn’t be in a position of repealing without having a better replacement,” Rounds said.
Other Republicans are skeptical that they can disentangle and remove the ACA after 13 years of it being entrenched in the U.S. health care system.
Sen. Mike Crapo, R-Idaho, who’s in line to chair the Finance Committee if Republicans win control of the chamber, said he wants to overhaul health care but rejected the messaging of repealing or eliminating the ACA.
“I don’t think it should be characterized as repealing any particular law,” Crapo said. “It’s basically part of all of the existing health care structure. And I would not say we should eliminate our entire health care structure. But I just think to talk about it in terms of a decade-old debate is not the right characterization.”
Notably, even some hard-right Republicans say they must have an alternative in order to avoid the pitfalls of 2017.
“The devil's in the details. It depends on — replace it with what?” said Rep. Ralph Norman, R-S.C., a member of the Freedom Caucus. “What got Republicans in trouble before is they wanted to take it away but didn’t have a means to replace it that the American people would buy. It’s got to be a well-defined plan.”
“It’s a tough topic,” Norman said.
Rep. Chip Roy, R-Texas, said he favors “massive reforms to our health care system, frankly, irrespective of Obamacare.” He said the law’s coverage expansions don’t guarantee access to quality care.
“So the president is right about that,” he said, referring to Trump. “But my message to the president would be, well, maybe you shouldn’t have cut a crappy deal with [then-Speaker] Paul Ryan when you were president.”
President Joe Biden responded Monday to Trump’s comments signaling he’d seek to “terminate” and find “alternatives” to the ACA.
“My predecessor has once again — God love him — called for cuts that could rip away health insurance for tens of millions of Americans in Medicaid,” Biden said. “They just don’t give up.”
Sahil Kapur is a senior national political reporter for NBC News.
