Trump and Republicans once more face a tough political fight over Obama-era health law

WASHINGTON (AP) — 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.

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.

“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.

Those concerns are expected to linger into 2026 when the elections could shift control of Congress.

Some Republican lawmakers are open to extending the subsidies, but Trump said he would only support a plan that sends money to individuals rather than insurance companies, which he complains are “making a fortune.”

“Congress, do not waste your time and energy on anything else,” he wrote on social media.

‘Call it Trumpcare. Call it whatever you want to call it’

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.

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.”

Other Republicans have pushed GOP leaders to support an extension, but with changes such as new income limits to qualify.

Vince Haley, who runs the White House Domestic Policy Council, and Heidi Overton, a deputy assistant on the council, have had conversations with industry leaders and members of Congress on the issue, according to a senior White House official who spoke on condition of anonymity to describe internal discussions.

Trump has his own ideas of what he would like to see in a proposal, according to the official, and recognizes the political need for Republicans to have a plan.

The president also said he is talking directly with some Democratic lawmakers, though he declined to name them.

One thing is clear: Trump wants to leave his stamp on the health law that he long has called “a disaster.”

“Call it Trumpcare. Call it whatever you want to call it,” Trump said of his proposed overhaul during an interview last week on Fox News Channel. “But anything but 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.

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.”

He contrasted the law with Medicare, the program providing health coverage for older adults. Medicare faced a tough fight when it was passed in 1965, but the controversy died down, and Republicans and Democrats in the 1980s worked together with Republican President Ronald Reagan to expand it.

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 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.”

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Associated Press writers Lisa Mascaro and Mary Clare Jalonick contributed to this report.