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A decade and a half ago, the Affordable Care Act set the stage for Donald Trump’s White House victory. The conservative backlash to Democrats’ massive and agenda-setting health care proposal was so strong that it gave rise to a newly empowered far-right faction in Congress, inspired a whole generation of angry political neophytes, and almost made Barack Obama a one-term President. Now, a solid 14 years later, those same rabble rousers seem to have convinced Trump, who spent years raging against the law informally known as Obamacare, that it might be good politics, if not also good policy.
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It may be hard to remember now but Trump built his 2016 campaign on the twin cornerstones of the false and racist claims that Obama was not born in the United States and an unflinching scorn for Obamacare. He rarely passed up an opportunity to decry the law as a “disaster” or proclaim that it “sucks,” and repeatedly said a new effort was just “two weeks” away. As recently as a few months ago, he was vowing to destroy it if granted a second term. “We should never give up!” he declared in a Truth Social post in November.
A funny thing has happened in the last few years, though. Obamacare’s popularity has grown as more and more Americans interact with a health care system fundamentally rebooted in bite-sized pieces, and the potency of the hatred toward the Obamas has faded. (Some ugly comments, however, continue to crop up.) The result is the jabs against the 44th President’s legacy-worthy legislation no longer land with the same thwack, crackling barely as a thud.
Now, in 2024, it seems Obamacare will not be detonating, but maybe even stand to be firmed up if Trump wins a return to the White House. In a new series of messages, the former President is telling voters… Well, here is one of his social media musings in all of its glory:
I’m not running to terminate the ACA, 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. IN OTHER WORDS, MAKE THE ACA MUCH, MUCH, MUCH BETTER FOR FAR LESS MONEY (OR COST) TO OUR GREST AMERICAN CITIZENS, WHO HAVE BEEN DECIMATED BY BIDEN, HIS RECORD INFLATION, BAD ECONOMY, AFGHANISTAN CATASTROPHE, AND JUST ABOUT EVERYTHING ELSE. CROOKED JOE BIDEN IS, BY FAR, THE WORST PRESIDENT IN THE HISTORY OF THE UNITED STATES! MAGA2024
This typo-laden turnaround—if that’s what it in fact is—was not always guaranteed. When the law was still taking shape, opponents convinced true believers that it would yield a rationing of health care services and perhaps even “death panels” that would do a cost-benefit analysis of treatments. Ultimately, after months of legislative hoop-jumping, the bill cleared Congress without a single Republican vote in support in March of 2010, and 34 House Democrats were against its final passage.
Polling immediately found the overall package to be an electoral clunker. A plurality 44% of voters held an unfavorable opinion of it in May of 2010, and those numbers didn’t really move all the way through Election Day that November, when Democrats suffered a seven-seat net loss in the Senate and dropped 63 seats in the House—the biggest wave since 1948. The unfavorable view of Obamacare was shared by 85% of Republicans that May, according to Kaiser Family Foundation polling. Months of Democratic explaining only shaved that number to 79% as voters headed toward the ballot box.
Put plainly: Obamacare might have been good policy, but it was lousy politics. The 14-month slog to pass the law left even its defenders with a bit of a chip on their shoulders. It wasn’t until fall of 2013 that people were able to sign up for private health insurance through the federal portal that was mired in glitches and bad P.R. For a long stretch there, Obamacare only brought ailments and not ointment. That’s where Trump picked up his initial instincts to seize on an often overlooked portion of the GOP’s base and feed the distrust.
And that tactic worked, at least until the upsides of the law kicked in. Over time, the polling got better. Parents of young adults realized their children could stay on their health plans as they got their careers going. The price tag for health care hasn’t exactly shrunk; the numbers tell the opposite story, actually. But the patient experience has gotten better even as medical bankruptcies and debts remain high. Still, there has not been a harsh rationing of care, and killing a regime that touches 45 million people—or roughly two-thirds of the size of all Social Security programs—is not a political winner.
That wasn’t necessarily the understanding when Trump and his nominal allies took over Washington in early 2017. Then, nixing Obamacare was atop their agenda. Trump unfurled executive actions—that later were rejected by the Supreme Court—and cajoled allies at the Capitol to move on his demands. But a revolt among moderates and GOP lawmakers in at-risk seats put that sect of the party on a collision course with the conservative ideologues. Party leaders pulled down the whole effort. Trump vowed revenge on those in the party whom he viewed as traitors.
“Obamacare unfortunately will explode,” Trump said in March 2017, trying his best to put shine on a loss. “It’s going to have a very bad year.”
Trump’s predictions of collapse proved faulty and now he’s hoping a national amnesia that has excused so many of his reversals carries into this realm. By this point, most Americans are numb to his flip flops; no one was truly surprised when Trump voiced support for TikTok not long after trying to ban it as President. But a TikTok ban was not integral to Trump’s political brand. For years, opposition to Obamacare was, almost as much as his support for a border wall.
It seems Trump has finally wised up to the fact that the health care law—while far from perfect—is doing good work for millions of Americans, perhaps becoming as sacrosanct as Social Security. The Supreme Court has repeatedly rejected efforts to scrap the law. Kaiser’s polling has 59% of Americans holding a favorable view of the Affordable Care Act, including 33% of Republicans. One report, released March 22, shows 45 million Americans benefiting from some aspect of the law. The days of “repeal and replace” seem to have faded as Trump finally realizes that even the law’s loudest critics lack a backfill program.
Republicans have quietly been positioning their most vulnerable members in this way, telling them that ending a program that has so quickly become enmeshed with day-to-day lives is a losing promise. Forty states, including some Republican-led ones, and the District of Columbia are participating in the Obamacare Medicaid expansion programs. Even weeks ago, as Trump was again thumping his ideas for canceling his loathed predecessor’s legacy law, Republican lawmakers were telling Trump he was on his own with no pals to “walk the plank” with him.
Biden seems eager to goad Trump to either defend his longstanding position or cop to a monumental flip-flop. In his State of the Union speech, the current President poked the former with plenty of pluck: “My predecessor, and many in this chamber, want to take those prescription drugs away by repealing the Affordable Care Act. I’m not going to let that happen. We stopped you 50 times before, and we’ll stop you again.”
For his part, Trump seems to finally realize the 51st time could be the most consequential to him yet: his own campaign this fall. So strong is his desire to reclaim power (and perhaps shut down some federal prosecutions against him), he will set aside more than a decade of anti-Obamacare language with barely a blink.
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