Healthcare is back at the forefront of the 2024 presidential campaign after former President Donald Trump pledged to overhaul the Affordable Care Act Tuesday and President Joe Biden vowed to expand it.
Trump fired off his statement on his Truth Social platform, essentially pre-butting remarks that Biden was set to deliver later in North Carolina by claiming the current president was making up claims about Trump wanting to end the ACA.
Related: Trump attack on ACA elevates healthcare in 2024 election
"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," Trump posted in his typo-ridden style.
"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," he wrote.
Trump's campaign did not reply to a request for information on how he would like to improve the Affordable Care Act, but the language does mark a shift from late last year when Trump was using words like "terminate" and "replace" in regard to the health law.
In late November Trump posted: "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!"
He clarified a few days later what he meant by "terminate," saying “I don’t want to terminate Obamacare, I want to REPLACE IT with MUCH BETTER HEALTHCARE. Obamacare Sucks!!!”
Trump's campaign website does not include a lot of healthcare-related proposals, but many of them focus on targeting "Big Pharma." One general entry on healthcare recounts some of Trump past policies, then makes promises for the future: "He will stop all COVID mandates and restore medical freedom, end surprise medical billing, increase fairness through price transparency, and further reduce the cost of prescription drugs and health insurance premiums. President Trump will always protect Medicare, Social Security, and patients with pre-existing conditions."
Biden, speaking at a campaign stop in North Carolina shortly after Trump's post, leaned into preserving and expanding the Affordable Care Act, saying he wanted to make permanent enhanced subsidies that Democrats passed in the American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022. Those enhanced subsidies expire in 2025.
"I enacted tax credits to save an average of $800 per person per year, reducing healthcare premiums for millions of working families under the ACA. Those tax credits expire next year,” Biden said. "I’m calling on Congress to make that $800 expanded affordable health care tax credit permanent."
Biden proposed making the improved subsidies permanent in his State of the Union Address earlier this month, and they are at least part of the reason enrollment in the ACA health plans surged in 2023 to more than 21 million.
At the same time, the law has become more popular, with a KFF tracking poll in February finding that about six in 10 Americans approve the health program.
At his campaign event Tuesday, Biden did accuse Trump and Republicans of planning to end Obamacare.
“Trump and his MAGA friends in Congress want to get rid of the ACA and kick these Americans off their health insurance. It’s sick. Now they want to, quote — his word — ‘terminate’ the ACA,," Biden said. "But we’re not going to let that happen."
While Trump has not offered any plan details, the Republican Study Committee, which includes about four-fifths of the GOP in the House, released a plan last week that would shift the Affordable Care Act, Medicaid and the Children's Health Insurance Program to block grant funding, among other changes.
Edwin Park, a professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families, estimated in an analysis last week that such an approach would cut spending in the programs by about 54%, or $4.5 trillion, over 10 years.
