In 2016, contenders for the Republican nomination for president ran on the promise to repeal the Affordable Care Act – commonly referred to as “Obamacare.” In 2017, then-President Trump worked with Congress to attempt to repeal and replace it. This attempt ultimately failed in the Senate when Senator John McCain famously broke with the Republican Conference and gave a dramatic thumbs-down on the Senate floor. During the 2022 mid-term election cycle, Republican candidates for Congress largely remained silent on the push to repeal the ACA with some acknowledging the popularity of the program and how embedded it is in the U.S. health care system. Now, as we are nearing the 2024 primaries, hopefuls for the GOP nomination are once again taking aim at the ACA. However, with six in ten Americans approving of the ACA, this may prove to be an uphill battle.

Florida’s GOP Field is Leading the Charge

On his social media platform, “Truth Social,” former President Donald Trump announced that he is looking at alternatives to the ACA and that the 2017 failure to repeal and replace the ACA was a “low point for the Republican Party.” Trump’s campaign has yet to release any details on what a “Trumpcare 2.0” would entail.

Last week, on Meet the Press, Florida Governor, Ron DeSantis, called out President Trump’s failure to repeal and replace the ACA in 2017: “[Trump is] running on a lot of the things he campaigned on in 2016 and didn’t deliver it on: Whether it’s repeal and replace Obamacare, whether it’s building the border wall, whether it’s draining the swamp.” DeSantis stated that focusing on repealing the ACA is untenable but that his team is working on a plan that will “replace and supersede” the ACA. DeSantis also indicated that his campaign will roll out a proposal in the spring.

Candidates Promising Overhaul of U.S. Health Care System

During the fourth GOP presidential primary debate, Vivek Ramaswamy, responding to question directed at DeSantis, gave some details on how he would address rising health care costs under the ACA: “We need to start heaving diverse insurance options in a competitive marketplace that cover actual health, preventative medicine, diet, exercise, lifestyle and otherwise. And here’s how we deliver that, end the antitrust exemptions for health insurance companies.”

During a radio interview on Primary Politics with Jack Heath, presidential candidate Nikki Haley indicated that she would take a comprehensive, diagnostic approach to health care by “[opening] up all of health care, from the insurance companies to the hospitals to the doctors’ offices to the pharmaceutical companies to the PBMs and make sure we look at all of their warts… It’s not about one small policy of the Affordable Care Act, it’s about fixing the entire health care system.”

Republicans Face Uphill Battle on Health Care Issues

Addressing rising health care costs, whilst a top priority for most Americans, may prove to be a difficult task for the 2024 Republican presidential hopefuls. Recent polling from the Kaiser Family Foundation finds that roughly six in ten Americans trust Democrats more when it comes to: prescription drug costs, abortion, Medicare and Medicaid, the future of the ACA, affordability of health care, and access to mental health care.

In response to the attention on health care from Republican presidential hopefuls, the Biden Administration released a plan to tackle prescription drug costs, anticompetitive mergers and acquisitions, anticompetitive practices, and Medicare Advantage transparency. The statement also highlights various steps the Administration has taken to tackle health care costs and promote health care access.