Health care may turn out to be a major winning issue for Democrats.
Expanding access to health care has been a shared policy priority for Joe Biden and the former Democratic presidents who joined him onstage at a lucrative New York City fundraiser last night, Bill Clinton and Barack Obama. But the politics of health care look very different for Biden than they did for his two predecessors.
Clinton and Obama faced widespread public resistance to their health-care plans that forced them to play defense on the issue. Biden and his campaign team, by contrast, see health care as one of his best opportunities to take the offensive against Donald Trump and the GOP.
Health care is one of the few major issues that more voters say they trust Biden than Trump to handle, according to national media polls. And Trump has ensured that voters will see a clear choice on the issue by renewing his pledge to repeal the Affordable Care Act passed under Obama, which now provides health insurance to more than 45 million people.
House Republicans dramatically sharpened that partisan contrast last week when the Republican Study Committee—a conservative group whose membership includes more than four-fifths of the House Republican Conference’s members and all of its leadership—issued a budget proposal that would not only repeal the ACA but also fundamentally restructure Medicare, Medicaid, and the federal tax incentive for employers to provide insurance for their workers.
The sweep of the House GOP health plans, like similar proposals in the Project 2025 policy blueprint put together by a consortium of conservative groups, “sets up a clear contrast with the direction Democrats have gone,” Larry Levitt, the executive vice president for health policy at KFF, a nonpartisan think tank, told me. “At the root of a lot of these Republican Study Committee proposals is reducing what the federal government spends on health care, and putting the risk back on individuals, employers, and states.”
Expanding access to health care has been a priority for Democratic presidents since Harry Truman. Clinton and Obama were especially focused on the issue. But politically, it proved more burden than boon for each man.
Clinton sought to remake the health-care system through the highly complex “Clintoncare” plan to expand coverage and control costs that emerged from a policy process led by then–first lady Hillary Clinton. But the plan collapsed without ever reaching a floor vote in the House or Senate. That failure helped power the GOP wave in 1994 that carried the party to control of both congressional chambers, including its first House majority in 40 years.
Obama succeeded where Truman and Clinton (and, for that matter, Republican Richard Nixon) had failed, by passing the ACA in 2010. But the deeply polarizing legislative fight over the law fueled the Tea Party backlash that led Republicans to another congressional landslide that year. Four years later, Democrats suffered yet more House and Senate losses, partly because of public discontent over the website snafus that snarled the launch of the ACA in 2013. Polls through those years consistently showed that more Americans expressed unfavorable than favorable views of the new law.
The turning point for the ACA came when Trump and congressional Republicans tried to repeal it in 2017. House Republicans passed legislation revoking the law in May that year, and Trump, who had endorsed the effort, immediately marked the occasion by summoning them to the White House Rose Garden for a victory celebration. Trump’s repeal drive failed, though, when three GOP senators voted against it—including the late Senator John McCain, who sealed the effort’s fate with a dramatic thumbs-down gesture on the Senate floor.
During the legislative struggle, public opinion on the ACA flipped. For the first time since Obama had signed the law, more Americans that spring consistently said they supported than opposed the law, in KFF’s regular tracking poll. Since then, the share of Americans who view the law favorably has always exceeded the share who oppose it; KFF’s latest survey last month produced one of the most positive ratings ever for the ACA, with 59 percent supporting it and only 39 percent opposing.
Democrats had been dinged for supporting the ACA in earlier campaigns; suddenly, defending it was a key contributor to the party’s big House gains in the 2018 election. Particularly important was the Democrats’ shift from emphasizing the ACA’s expanded coverage for the uninsured to stressing its provisions barring insurance companies from denying coverage or raising premiums for the millions of Americans with preexisting health problems.
