JD Vance is rewriting Trump’s healthcare story

In the presidential debate three weeks ago, Republican nominee Donald Trump made a stunning claim about his record on health care: He said he tried to “save” the Affordable Care Act when he was president.

During Tuesday night’s vice presidential debate, JD Vance repeated that claim and then went one step further: that Trump not only tried to save the health care law, but did so with the help of Democrats.

“Donald Trump could have destroyed the program,” Vance said. “Instead, he worked across party lines to ensure Americans had access to affordable health care.”

This is pure fantasy, literally the opposite of the truth.

And that’s important because the health care of tens of millions of Americans could depend on the outcome of the election. Voters have a right to know what Trump would do if he returned to the White House, which means understanding what he actually did the last time he was there.

The real story goes like this:

Trump promised during his 2016 presidential campaign to repeal the Affordable Care Act, also known as Obamacare. And it wasn’t a random, throwaway line.

He mentioned it constantly, often at the beginning of his rallies. His campaign website said: “On day one of the Trump administration, we will call on Congress to immediately and completely repeal Obamacare.”

And Trump kept that promise. He spent most of his first year in office working with Republican leaders to pass repeal legislation.

But while Trump had repeatedly said he would provide “great health care for a lot less money” and vowed that “we’re going to have insurance for everyone,” the GOP legislation he supported would have drastically reduced government spending on health care and the Protection weakened for people with previous illnesses.

Several independent forecasts showed that many millions of people would lose their insurance coverage.

Republicans knew these bills had little chance of winning Democratic support. Unlike former President Barack Obama and Democrats in 2009 and 2010, who spent months trying (unsuccessfully) to negotiate with a handful of Republicans over what became the Affordable Care Act, GOP leaders like the then-Speaker of the House represent Paul Ryan (R-Wis.) focused almost exclusively on consolidating support within their own party and getting legislation through Congress as quickly as possible.

Republicans managed to get their bills through the House, but they failed in the Senate because a handful of Republican lawmakers voted no.

In this sense, the only bipartisan action during the debate over repeal of the Affordable Care Act was when Republican senators like Lisa Murkowski of Alaska and John McCain of Arizona – in one of the last public acts of his life – sided with the Democrats and voted to stop Republican legislation from passing.

That defeat didn’t stop Trump from spending the rest of his presidency looking for other ways to undermine or destroy the law. He cut funding for outreach and enrollment counselors and led the federal government to join a lawsuit asking the Supreme Court to declare the entire program unconstitutional.

Not all of these efforts had much impact, and one actually backfired, triggering a response from the insurance industry that made Obamacare’s financial support more generous. But Trump’s intent was clear: “to repeal and replace the disastrous Obamacare law,” as an official White House statement said at the time.

And Trump is still talking about it. Last November he posted on truth social that he was still “seriously looking for alternatives.” And after acknowledging that “a few Republican senators” had prevented his failures in 2017, he said Republicans should “never give up!”

Last month, in the debate with Democratic presidential candidate Kamala Harris, Trump said he still wanted to replace the law and that he had “concepts for a plan” to do so – although, as usual, he did not specify what those concepts were.

Conservatives have many serious, intellectually consistent reasons to oppose the Affordable Care Act.

The law dramatically expanded Medicaid, an already extensive government program to provide health care for the poor. New subsidies have also been introduced to make it easier for people to get health insurance.

These two steps required a lot of new government spending, estimated at about a trillion dollars in the first ten years alone. The law financed this spending primarily by cutting Medicare payments to hospitals and other health care providers and imposing new taxes on the wealthiest Americans.

The Affordable Care Act also imposed new rules on private insurance, requiring carriers to sell more comprehensive policies and prohibiting them from denying coverage to people with pre-existing conditions.

New government spending, new regulations, new taxes—Republicans oppose all of these things, arguing that they make Americans’ lives worse rather than better.

And when Trump first ran for office, his calls to repeal the ACA likely won votes. Many people were still struggling with health care costs, including some whose insurance premiums had increased because of the law changes.

But public opinion turned firmly against repealing the ACA as people realized it would mean giving up some of the law’s protections for people with pre-existing conditions, not to mention the prospect of so many people losing their insurance altogether would lose. Despite their disappointments and frustrations, voters did not want to go back to the way things were.

And anger over repeal did not subside when the law died. The backlash was a key reason Republicans lost control of the House in 2018 and then gave up the Senate and the White House in 2020.

Today’s Republicans know this, which is why most of them have tried to avoid the issue of health care altogether – and, when it comes up, now insist that they don’t want to take away what Obamacare provided.

But there are all sorts of signs that Republicans remain interested in repealing the Affordable Care Act, or at least rolling back parts of it. Those signs include references in conservative agenda documents such as Project 2025, as well as statements Vance made during an interview on NBC’s “Meet the Press.”

Vance’s comments were particularly revealing because he said Republicans were interested in a “deregulation agenda” to avoid a “one-size-fits-all approach that puts lots of people in the same insurance pools.”

That’s how Republicans described their plans to loosen the rules of the Affordable Care Act during the repeal debate – an episode that Vance did his best to forget about on Tuesday night.