Harris, Trump clash over future of ObamaCare

Vice President Harris wants to put ObamaCare front and center in the campaign’s final weeks. 

Abortion has been the primary health issue for much of the campaign, but Harris is reopening Democrats’ successful 2018 playbook by elevating the Affordable Care Act.  

While Harris embraced single payer “Medicare for All” during the 2020 presidential campaign, she has now fully pivoted to embracing improvements to the status quo.  

“I absolutely support — and over the last four years as vice president — private health-care options,” she said during September’s presidential debate, adding “what we need to do is maintain and grow the Affordable Care Act.” 

Harris’s campaign unveiled policy positions in early September, including a plan to “make affordable health care a right, not a privilege by expanding and strengthening the Affordable Care Act.” 

Harris wants to make the law’s temporary enhanced subsidies permanent. Millions of enrollees have come to rely on the enhanced subsidies, and they’ve helped boost health insurance enrollment to record levels. 

The subsidies expire in 2025 and congressional Democrats have already introduced bicameral bills to extend them permanently, but it’s likely something they won’t be able to achieve unless they control all three branches of government.  

The Harris campaign hasn’t released much detail about how else she would specifically strengthen the law, but instead has focused on what they say is the danger and damage former President Trump could inflict.

They published a 43-page report slamming the Trump camp’s “plans” for the law, and released an ad featuring a Wisconsin farmer with a brain tumor who credits the ACA for saving her life.

Trump’s shifting tone

Early in the campaign, Trump revived his previous calls for repealing the law and replacing it with something better. Senate Republicans were quick to shut down any talk of bringing up repeal again, even if they were to control the government.  

Lately, Trump has slightly shifted his tone. When pressed by ABC moderators during September’s presidential debate, Trump acknowledged that he doesn’t currently have a plan to replace ObamaCare if it were repealed, only “concepts of a plan.”  

Trump lately has been criticizing the law, while also claiming that he “saved” it from failing.  

Trump has never been specific about how he’d replace health coverage for tens of millions of Americans.  

But in the absence of an official plan from the top of the ticket, Trump’s running mate Sen. JD Vance (R-Ohio) has tried to fill in some of the details.  

Vance has said Trump’s health plan would focus on deregulating the insurance markets to promote choice and “not have a one-size-fits-all approach” of putting everyone into the same insurance risk pool. 

That seemed to harken back to “high-risk pools” championed by conservatives in the House when they were crafting an ObamaCare replacement bill in 2017.   

Critics contend allowing states to put sick people into separate pools could undermine the insurance marketplace and effectively end the law’s protections for people with pre-existing conditions.  

The Affordable Care Act forces insurance companies to cover everybody the same, regardless of their medical condition or risk.  

“We want to keep those regulations in place, but we also want to make the health insurance marketplace function a little bit better,” Vance said during the CBS vice-presidential debate. 

According to insurance experts, the general idea of a high-risk pool is to pull out of the market the sicker people who cost more in order to reduce premiums for the healthy people who are in the regular market.  

But the pools rarely succeeded in covering people who needed insurance the most. Nearly all state high-risk pools excluded coverage of preexisting conditions anywhere from three months to a year and then charged exorbitant premiums — if they covered the person’s condition at all.