Trump Is Coming for Your Health Care—Again

The possibility that we might, as The New Republic’s editor Michael Tomasky put it, “sleepwalk” into a second Trump presidency is very real, which is all the more shocking given the mounting evidence that Trump Redux could well end America as we know it. The New Republic’s Matt Ford capably laid out how few guardrails remain in place, including, as Brian Beutler noted in his Off Message newsletter, “the likelihood that Trump will have carte blanche if not active participation from Congress.” The Atlantic, our doughty journal of ruling-class opinion, has even dedicated an entire upcoming issue to the topic.

That Trump poses a unique threat to our civic fabric and our democratic institutions is an important argument to make—and as Democrats proved in the recent midterms, it’s a winning argument as well. Still, it’s important to remember that in addition to being a wannabe despot, Trump is also an extremely conventional Republican politician with very stupid and harmful policy ideas. And lately, he’s been reminding us about one in particular: his plan to throw people off of their health insurance and make coverage worse and more expensive.

Over the Thanksgiving weekend, Trump announced his plan to revive one of the Republican Party’s less-liked vaudeville routines, the two-step known as “repeal and replace Obamacare.” “I’m seriously looking at alternatives,” he wrote on Truth Social. Despite the fact that reports immediately pointed out what a political loser the issue has been for the GOP, which essentially gave up on the idea of scuttling the Obama-era law in the most recent midterms, Trump has done nothing but push it even harder. “I don’t want to terminate Obamacare,” he wrote, “I want to REPLACE IT with MUCH BETTER HEALTHCARE. Obamacare Sucks!!!”

Okay, we get the point. For a long while, repealing and replacing the Affordable Care Act was among the Republican Party’s biggest priorities and also one of its most prolonged failures. Its failure was largely due to Obamacare’s ever-growing popularity but also to Republicans’ inability to propose a better replacement. Republicans view health care as a privilege won by those who rise to the top of the free market. Economic dislocation of any kind, in their view, is the result of individual moral failings. The Affordable Care Act, by contrast, literally redistributes taxpayer money to subsidize health care for those who can’t afford it. This is the bill’s cardinal virtue and the thing that enables all of its most popular components. That makes it complete anathema to Republicans.

This is probably why Trump’s own push to replace Obamacare ended up producing the American Health Care Act, which I once described as not so much a health care plan as “the opening salvo in a multi-part revenue baseline manipulation scheme that was supposed to pave the way for a massive tax cut for the wealthy.” While the bill was touted as the Republican alternative to Obamacare, its main feature was to guarantee worse coverage at higher costs—and throw millions of people off of their insurance to boot. In other words, it was a Republican health care plan. In fact, it was so effective at accomplishing standard Republican health care goals that when the White House tried to counter the Congressional Budget Office’s dire estimations of the damage the bill would do, the administration’s own analysis found that the CBO left off an additional two million people who were going to lose their insurance.

Republicans have mostly greeted Trump’s calls for repealing and replacing Obamacare with exasperation. The Hill reported that his renewed interest in gutting the law caused “new political headaches for Republicans locked in a highly competitive battle to win back the Senate majority.” Most Republicans admitted that the legislative margins were too tight to contemplate taking the matter up again and that there was a lack of consensus among members as to what a replacement might look like. Still, Ron DeSantis has also made Obamacare repeal a central plank in his campaign. And at least one Republican vying to flip a Senate seat from blue to red, Tim Sheehy, followed Trump’s call by coming out in favor of the “full privatization” of health care.

Trump may have only opened this political Pandora’s box a crack, but Democrats should pry it open with a crowbar. They have made this a winning issue before and could easily do so again. Obamacare is very popular; as Politico noted last week, roughly three in five Americans like the law. Many undecided voters may be unsure that a second Trump term spells doom for American democracy, but it may be enough to remind them that he and the GOP could spell doom for their health care.

This article first appeared in Power Mad, a weekly TNR newsletter authored by deputy editor Jason Linkins. Sign up here.