Just when they thought they were out, he pulled them back in: GOP's war on the ACA is on again whether they want it or not

Since Donald Trump was defeated in the 2020 Presidential election, most people seemed to be under the impression that the Republican Party's decade-long obsession with tearing down President Obama's signature legislative accomplishment, the Patient Protection & Affordable Care Act, was finally over.

Healthcare journalist extraordinaire Jonathan Cohn even pulled the trigger on publishing his definitive history of the ACA, The Ten Year War...although honestly, there was still one remaining major legal loose end to tie up which wouldn't happen until about eight months later.

Since then, while there has still been some squabbling over various aspects of the ACA and a few lingering federal lawsuits over one provision of it or another, for the most part the conventional wisdom among the public, the pundits and the politicians (both Democratic and Republican alike) seems to have been that the ACA is now fully baked in as much as Medicare or Medicaid. Republican members of Congress may still grumble over it, but they seem to have mostly accepted this reality.

Until a week or so ago, that is, when Donald Trump, the presumptive Republican nominee for President for a third time in a row decided to dredge his obsession with tearing down "Obamacare" into the public square again:

"The cost of Obamacare is out of control, plus, it's not good Healthcare. I'm seriously looking at alternatives. We had a couple of republican Senators who campaigned for 6 years against it, and then raised their hands not to terminate it. It was a low point for the Republican Party, but we should never give up!"

The initial response from Republican Senators ranged from denial to befuddlement:

Republican Senators are reacting cautiously after Donald Trump said over the weekend that he might try to repeal the Affordable Care Act if he returns to the White House, with some suggesting another push to fully scrap the health law was unlikely.

...“I don’t think that’s going to happen,” Sen. Susan Collins of Maine, one of three Republicans who voted in 2017 against eliminating Obamacare, told reporters on Monday when asked about full repeal.

...GOP Sen. Bill Cassidy of Louisiana, who led a last-ditch effort to replace the law, told Semafor he was only learning about Trump’s remarks for the first time and declined to comment.

...“I think the ACA has been a fraud committed on the American people,” Sen. John Cornyn of Texas told Semafor, adding he’d be “interested to see” how Trump proposes replacing it.

...But it’s unclear how much appetite exists among Republicans to try and fulfill a campaign promise that animated their party a decade ago. Sen. J.D. Vance of Ohio, a Trump ally in the Senate, said key planks of Obamacare are “broadly popular” with the American public including Republicans, such as rules barring insurers from denying coverage to individuals with pre-existing conditions or charging sick people more for healthcare.

“I don’t think there’s any effort to try to change them."

Since then, however, Trump has doubled down on his rhetoric to "never give up" trying to "terminate Obamacare," stating that...

"Getting much better Healthcare than Obamacare for the American people will be a priority of the Trump Administration. It is not a matter of cost, it is a matter of HEALTH. America will have one of the best Healthcare Plans in the world. Right now it has one of the WORST!"

...and then following up by "clarifying" that...

"I don’t want to terminate Obamacare, I want to REPLACE IT with MUCH BETTER HEALTHCARE. Obamacare Sucks!!!"

Welp. Setting aside the obvious contradiction (yes, replacing one piece of legislation with other legislation does, in fact, mean terminating the original legislation by definition), it appears that his original post wasn't just one of his usual one-off rants; he's fixated on killing the ACA again. And since Trump is the modern Republican Party and the modern Republican Party is Trump, if that's what he wants...that's exactly what they're gonna have to try and give him.

But wait, there's more! It's not just current Republican federal elected officials who are gonna have to dance to Trump's tune; other candidates running for federal office are already starting to follow his lead as well, including Ron DeSantis...

Gov. Ron DeSantis of Florida said on Sunday that, if elected president, he would pursue legislation that would “supersede” the Affordable Care Act, echoing former President Donald J. Trump’s comments, which Democrats seized upon last week.

...“We’re going to look at the big institutions that are causing prices to be high — big pharma, big insurance and big government — but it’s going to need to be where you have a reform package that’s going to be put in place,” he said. “Obamacare promised lower premiums. It didn’t deliver that,” he added. “We know we need to go in a different direction, but it’s going to be done by having a plan that’s going to be able to supersede it.”

 

...Beyond that and a list of principles — “more transparency, more consumer choice, more affordable options, less red tape” — he did not go deep on his plan. Of the more than 40 million Americans covered by A.C.A. plans, he said, “We’ll have a plan that will offer them coverage, so the coverage will be different and better, but they’re still going to be able to be covered.”

He said he would release a full proposal “probably in the spring,” which would be after a majority of states have held their primaries or caucuses.

"Probably in the spring" brings to mind Trump's own infamous "Two Weeks!" promise for his own "full and complete" healthcare plan (which of course was never revealed).

And today you can add the leading Republican hopeful for Senate in Montana:

SCOOP: Tim Sheehy, the frontrunner for Montana’s GOP Senate nomination, recently told a group of voters that the U.S. needs “to return healthcare to pure privatization,” @kadiagoba reports.

As I noted last week, the odds are that over 18.5 million Americans will be enrolled in either an ACA Qualified Health Plan (QHP) or ACA Basic Health Plan (BHP) by the time the dust settles in January, along with up to 24 million more in ACA Medicaid expansion coverage...with over 300,000 being newly enrolled in North Carolina alone just three days ago.

Combined, that's up to 43 million Americans, or nearly 13% of the entire U.S. population, who are either currently enrolled in (or about to become enrolled in) healthcare coverage directly provided by the Patient Protection & Affordable Care Act, otherwise known as Obamacare.

This only partly overlaps with the 50 - 129 million non-elderly Americans with at least one type of pre-existing condition which would put them at risk of being denied healthcare coverage without the ACA's patient protections being in place.

In other words, it looks like it's a good thing that I just ordered a new Mac Mini M2 replacement for my long-lived Intel-based MacBook Air, because apparently I'm going to need it over the next year. Here we go again...