Democrats Can Win if They Make the 2024 Election About Healthcare

Of all the issues before voters, healthcare remains the holy grail for Democrats.

In the last three election cycles, it delivered Democratic victories based on deeply held beliefs about which party could be trusted to reform a system that had left millions without health care and millions more bankrupt with medical debt.

The Affordable Care Act, signed into law in 2010 (and more commonly known as Obamacare), is far from perfect, but it allowed people with pre-existing conditions to get health insurance, it removed unrealistic caps on medical care, and it allowed young people to remain on their parents’ insurance policy until the age of 26.

It was revolutionary, and more than a decade of Republican calls to “repeal and replace” proved futile. The GOP might have learned its lesson, but Donald Trump, who never tires of his old fixations, says on social media he would like to “terminate” Obamacare and “replace it with something much better.”

When The Wall Street Journal ridiculed him with an editorial saying Democrats know he has no such plan, Trump went ballistic in a pair of late-night posts. “I don’t want to terminate Obamacare, I want to REPLACE IT with MUCH BETTER HEALTHCARE. Obamacare Sucks!!!”

Three exclamation points evidently got the attention of Trump challenger Gov. Ron DeSantis (R-FL), who’s running out of time to catch up with Trump among Republican primary voters. Under questioning by NBC News’ Kristen Welker, DeSantis said he wants to “replace and supersede” Obamacare, and he’ll be rolling out a “big proposal” in the spring (assuming he’s still in the race).

The DeSantis slogan doesn’t have the ring of “repeal and replace,” the GOP’s longtime battle cry, but it is music to Democrats whenever Republicans start mucking around in health care. Forty million Americans now have health insurance thanks to Obamacare, an ace card that Democrats hold going into the 2024 election where health care could once again play a decisive role in the outcome.

“It’s the most powerful kitchen table issue there is,” says Leslie Dach, executive chair of Protect Our Care, a health advocacy group, and senior advisor to the Congressional Integrity Project, a pro-Biden rapid response group. “Politically, it’s a loser for them (GOP) because it’s a totally non-partisan issue. The only place it’s partisan is in Washington, D.C. Everybody in America worries about getting sick, and how they’re going to pay for it, and they’re trying to make it an ideological issue.”

He cites a Washington Post headline after the 2018 midterm elections that credited healthcare for delivering the speakership to Pelosi. After losing the House majority in 2010, the Democrats regained power on the strength of Pelosi’s commitment to Obamacare. The first woman speaker returned to power to contend with then-President Donald Trump and fend off his efforts to kill Obamacare.

The orderly dissemination of the COVID vaccine, which became widely available after the election, helped the Democrats with a surprisingly strong showing in the 2022 midterms.

It will be 14 years in March since President Obama signed the Affordable Care Act into law. Most Republicans are ready to put the issue in the rearview mirror, recognizing the futility of repeal and replace, as well as the complexity of the healthcare market in a bitterly partisan political climate. But Trump and his distant competitor, DeSantis, feel differently.

“Why burst out with this now?” asks Dach, who has his theory about why Trump resurrected an issue that was a major point of contention between him and his predecessor. “It’s all about grievances and settling scores. He knows nothing about policy and doesn’t care to know.”

This is personal for a lot of Democrats, and they were ready to pounce when Trump launched his trial balloon to “terminate” Obamacare.

Gov. Roy Cooper (D-NC) just signed legislation that expanded Medicaid coverage under the ACA in his state, extending health care to 640,000 North Carolineans. In a call with news media, he welcomed the contrast between “the best of Biden and the worst of Trump,” noting that Obamacare is “the signature achievement of our first Black president,” and that one of Trump’s earliest pledges was to eliminate Obamacare.

Former House Speaker Nancy Pelosi—variously described as the godmother of Obamacare, or its midwife—in the same media call said Trump’s social media blast is “an attack on people, an attack on governing.” Ticking off the many benefits of Obamacare, she concluded, “there are so many reasons why this was a bad political move on the part of Trump…. We don’t want to be fearmongers, but we have to make the contrast and we have to be clear about it.”

Democrats are just getting started on healthcare. “Every last one of them blocked Medicaid expansion,” Pelosi notes. Nikki Haley’s home state of South Carolina and DeSantis’ Florida are two of 10 remaining states that have blocked Medicaid expansion, withholding health care coverage from hundreds of thousands of people.

Any time Trump or DeSantis want to vent about Obamacare, they sharpen the contrast between the party that delivered health care for millions of people and the party that would take it away under the false illusion that they’ve got a secret plan to make it better.

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