Is the Affordable Care Act a central issue in the 2024 presidential election or not?
With fewer than 90 days until the election, the answer remains unclear as Democratic and Republican campaigns operate with ambiguity when it comes to healthcare plans, and particularly in the use of actions "repeal" and "replace."
The Republican Party's official platform, presented at its convention in Milwaukee in July, includes no mention of the ACA and limited references to other healthcare reforms. Former President Donald Trump campaign's policy plan, Agenda 47, contains sparse healthcare policy proposals that are included in a chapter aimed at addressing affordability.
The Democratic National Convention is set to begin Aug. 19. Leading up to it, Vice President Kamala Harris has criticized the Republican stance on the ACA, portraying the Republican candidate as a threat to the law. At her Aug. 6 rally in Philadelphia to announce her pick for vice president, Ms. Harris said Mr. Trump would "end the Affordable Care Act and take us back to a time when insurance companies had the power to deny people with pre-existing conditions" if given the chance.
"President Trump is not running to terminate the Affordable Care Act," a Trump campaign spokesperson said in a statement to The New York Times. "He is running to make healthcare actually affordable." Republican vice presidential nominee JD Vance suggested to NOTUS that healthcare system reforms would be a priority in a Trump administration.
The apparent lack of clarity regarding healthcare policy in a presidential election is unusual. The 2022 elections were the first in more than a decade in which the security of the ACA, enacted by President Barack Obama in 2010, was not a central issue, and the Republican Party had moved away from its longstanding campaign to repeal it.
Mr. Trump made the first move against the ACA this election cycle when in November he took to Truth Social to identify healthcare as one agenda item for his 2024 campaign with plans to replace the landmark law if he won a second term. This prompted concerns among some Senate Republicans.
President Joe Biden then recalled Mr. Trump's proposed actions to the ACA in his campaign messaging in March, but using "terminate" instead of "replace."
"Now Trump keeps telling us he's going to terminate the ACA," President Biden said in a March 23 campaign video. "Think about what that means." His remarks coincided with the 14th anniversary of the law and followed the announcement by CMS that 20 million people enrolled in individual insurance plans on the ACA exchange for 2024 — the highest enrollment in the exchange's history.
Days later, Mr. Trump took to Truth Social to state termination was not part of his plan. "I'm not running to terminate the ACA," he said, "AS CROOKED JOE BUDEN DISINFORMATES AND MISINFORMATES ALL THE TIME, I'm running to CLOSE THE BORDER, STOP INFLATION, MAKE OUR ECONOMY GREAT, STRENGTHEN OUR MILITARY, AND MAKE THE ACA, or OBAMACARE, AS IT IS KNOWN, MUCH BETTER, STRONGER, AND FAR LESS EXPENSIVE."
The ambiguity surrounding healthcare policy might be intentional, The New York Times noted in its Aug. 12 report: "The most significant blow to the law could come from inaction."
The Biden-Harris administration passed the American Rescue Plan Act in 2021. The law enhanced subsidies for individuals purchasing health coverage on ACA marketplaces, which are set to expire at the end of 2025. Mr. Trump and congressional Republicans are unlikely to support legislation extending these subsidies, which experts credit for the high enrollment numbers in recent years, which has buoyed many large commercial payers.
The ACA remains one of the most contested statutes in American history, facing seven Supreme Court challenges within a decade, according to professors at Washington, D.C.-based Georgetown University. As of April, 62% of Americans held a favorable opinion of the ACA, while 37% viewed it unfavorably, according to a survey by KFF.
Ambiguity surrounding healthcare is a bipartisan concern, particularly given that a May 2024 Pew poll found healthcare to be the third-highest priority for voters, with 57% of respondents identifying it as a critical issue. Only inflation (No. 1) and the ability of Democrats and Republicans to work together (No. 2) ranked higher.