Trump and Republicans Face Tough Political Fight on Health Care

Introduction to the Issue

President Donald Trump is once more targeting former President Barack Obama’s signature health care law, picking a political fight before next year’s elections that is reminiscent of one he lost in his first term. Back then, Trump and fellow Republicans tried but failed to dismantle the Affordable Care Act, a stinging defeat viewed as contributing to the party’s losses in 2018.

Scaling Back Ambition

This time, Trump seems to be scaling back his ambition to repeal and replace the law. But he is struggling to ease voters’ concerns over the high cost of living — combined with a looming deadline to extend expiring subsidies that help people pay for their “Obamacare” premiums — and it is not clear how he plans to prevent history from repeating itself.

Concerns Over Affordability

“You can’t address an affordability crisis by making health care less affordable,” said Jonathan Oberlander, a professor at the University of North Carolina at Chapel Hill whose work has focused on health care policy and the politics of the Obama-era health overhaul. Consumers insured through the law’s marketplaces have received notices of hefty premium increases for next year if the subsidies are not extended by Jan. 1 — a reprieve that Trump said Tuesday he would not support. Unless he changes his mind, that leaves it to Congress to find a solution or let the tax credits expire, raising the rates of 24 million people covered through ACA exchanges.

Concepts of a Plan

During his White House campaign last year, Trump was calling to repeal the law, but said he only had the “concepts of a plan” to do so. He has yet to elaborate. The president has since focused on overhauling the COVID-era subsidies that have helped keep down premiums. Democrats forced the recent government shutdown by demanding an extension and have linked that to broader concerns about affordability that were front and center during elections this month as Democrats had big victories.

Call it Trumpcare

“Congress, do not waste your time and energy on anything else,” he wrote on social media. Republicans in Congress are working behind the scenes with the White House to devise an answer. There is no guarantee they will succeed. Sens. Rick Scott, R-Fla., and Bill Cassidy, R-La., have floated separate proposals that would create savings accounts along the lines of what Trump says he would support.

The Debate and Its Challenges

House Republicans are working on a series of bills “that would actually lower costs for families,” said Majority Leader Steve Scalise, R-La. “We’re going to keep bringing those bills over the next few months.” House Democratic leader Hakeem Jeffries of New York panned Trump’s idea of giving money directly to those buying insurance. He said people can already access the tax break on a monthly basis to defray the costs of the policies. “Donald Trump has zero idea what he’s talking about,” Jeffries said. “It’s all fantasy.”

The Unwinding of Obamacare

The debate underscores how hard it is to unwind Obamacare. Democrats may have unintentionally put a spotlight on the problems in the law in their shutdown fight by drawing attention to the need for subsidies to make the coverage affordable, said Tevi Troy of the Ronald Reagan Institute. “Republicans have been scared about talking about the issue,” said Troy, who was a deputy health secretary in Republican President George W. Bush’s administration. “And this fight raised the issue again in a way that is favorable for Republicans because eight years later the prices have not gone down” since Trump’s first-term repeal effort.

Bipartisan Compromise

Troy said more Republicans are starting to realize they need to do something about the high costs of coverage, but will need to find some sort of bipartisan compromise to get it passed. Oberlander, the North Carolina professor, said the “never-ending war over Obamacare” since it was signed into law 15 years ago has been fueled partly by problems with it, but largely by the hyperpartisan era of modern politics. “This is one front in a broader partisan war in American politics,” Oberlander said of the ACA. “Partisan polarization makes it hard to come to bipartisan compromise.”

Conclusion

If Trump and Republicans attempt to repeal Obamacare again, they will have a much harder political fight than in 2017, when then-Sen. John McCain, R-Ariz., doomed the effort with a decisive thumbs-down, Oberlander said. There are now more than twice as many people getting insurance through the ACA as there were then, and some of the law’s provisions are popular, such as the ban on denying coverage or raising rates for people with preexisting health conditions. “You cannot go all the way back to 2009,” Oberlander said. “And whatever Republicans do, they have to work with that reality.”

FAQs

• Q: What is the current issue with the Affordable Care Act (ACA) that Trump and Republicans are facing?
  A: The current issue is the looming deadline to extend expiring subsidies that help people pay for their “Obamacare” premiums, with Trump indicating he would not support an extension unless it meets his conditions.
• Q: How many people could be affected if the subsidies are not extended?
  A: Approximately 24 million people covered through ACA exchanges could see their rates increase if the tax credits expire.
• Q: What is Trump’s proposal for addressing the health care issue?
  A: Trump has suggested giving money directly to individuals rather than insurance companies, but the details of his plan are not fully elaborated.
• Q: Why is it challenging for Republicans to repeal or significantly alter the ACA?
  A: The challenge stems from the increased number of people insured under the ACA since its inception, the popularity of certain provisions like protection for preexisting conditions, and the need for bipartisan compromise in a highly polarized political environment.