WASHINGTON _ President Donald Trump has again bound himself and congressional Republicans to getting rid of Obamacare but now the move comes as voters are getting daily reminders about their own healthcare vulnerabilities.
A legal brief his administration filed Thursday on the Affordable Care Act and its protections for patients with preexisting conditions underscores how big a bet his campaign is making on energizing his most enthusiastic supporters rather than following the traditional strategy of reaching out to wavering voters as the election nears.
Democrats rode the healthcare issue in the 2018 midterm elections to retake control of the House and they're planning to do it again in November, when the White House and both chambers of Congress will be on the line. They seized on the administration's filing with the Supreme Court supporting a suit to invalidate the law and tied it to the coronavirus pandemic that's led to more than 120,000 deaths in the U.S.
"If Donald Trump won't end his senseless crusade against health coverage, I look forward to ending it for him," Joe Biden, the presumptive Democratic presidential nominee, said in a speech Thursday in Lancaster, Pennsylvania.
The coronavirus pandemic and the wave of job losses it has produced has only focused more attention on the fragility of employer-provided insurance and the importance of healthcare access. Through May, nearly half a million people enrolled in Obamacare after the end of the annual sign-up period because they lost their previous insurance, a 46% jump from last year.
The Trump administration filed its brief with the Supreme Court _ brought by a group of Republican state attorneys general _ just as surging coronavirus cases in Sunbelt states raised new fears the pandemic is again getting out of control. The court is set to hear arguments on the case around the time of the November election, meaning the gambit will be capturing the nation's attention as voters prepare to cast ballots.
Solicitor General Noel Francisco argued that because the Republican-controlled Congress eliminated Obamacare's tax penalty for being uninsured, other provisions of the law _ including protection for preexisting conditions _ "must also fall."
Polls consistently show healthcare at or near the top of issues important to voters, but Trump has gotten consistently low marks from the public for his handling of it. In a June 13-16 Fox News poll, 39% said they approved of the way the president handles healthcare, in line with answers to the question in the poll over the past three years and with other recent polls.
Yet, like many issues, there is a clear partisan divide. Three-quarters of Republicans still oppose Obamacare even as swing voters_those who haven't already decided their presidential vote_back the insurance plan 58% to 34%, according to a May poll by the Kaiser Family Foundation.
The Affordable Care Act has become far more popular than it was when it first passed a decade ago, and Republicans have yet to propose an alternative that would ensure the same protections for people with preexisting conditions and replace the ACA's marketplaces, subsidies and Medicaid expansion without kicking millions of people off of insurance.
A White House spokesman said Trump was undeterred in his opposition to his predecessor's signature healthcare program.
"A global pandemic does not change what Americans know: Obamacare has been an unlawful failure and further illustrates the need to focus on patient care," Trump spokesman Judd Deere said in an email. "During this pandemic, President Trump has continued to work to improve healthcare more broadly, including protecting the vulnerable, those with preexisting conditions, and cutting red tape to allow more choice."
Republicans have been playing defense now for years on the subject.
Sen. Susan Collins of Maine, who has gone from one of the most popular senators to one of the most endangered, has come under fire from Democrats because she provided a key vote for the 2017 GOP tax law ending the individual mandate, without which there would be no case.
Sen. Martha McSally in Arizona has a television ad promising to protect people with preexisting conditions. She lost her race against Democrat Kyrsten Sinema two years ago after she voted for a House Republican bill that undermined those protections, including state waivers that would have let insurers charge sick people more. She was appointed to her current seat and faces voters again in November.
Likewise Thom Tillis of North Carolina has proposed legislation intending to restore pre-existing conditions protections if the court overturns the ACA, but no GOP bill would fully restore the ACA's benefits that aid people with preexisting conditions, like guaranteed coverage for prescription drugs, hospital stays, maternity, an end to lifetime caps and so on.
All three Republicans are regarded as vulnerable to Democratic challenges in the November election.
West Virginia Sen. Joe Manchin has credited the lawsuit against Obamacare in large part with helping him win reelection as a Democrat in state where Trump got 68% of the vote two years earlier. Manchin used a mend-it, don't-end-it message and cut a campaign commercial blasting the suit, which was supported by his Republican opponent. He also had personally warned Trump that repeal would be unpopular.
On Friday, he blistered the latest effort to overturn the law given the pandemic.
"I've said again and again that the ACA is not perfect but we simply cannot throw the baby out with the bath water, especially during a global health crisis that has already killed 92 West Virginians and over 120,000 Americans," Manchin said in a statement.
The legal fight stems from a provision known as the individual mandate, which originally required people to acquire health insurance or pay a tax penalty.
The Supreme Court upheld that provision in 2012, with Chief Justice John Roberts calling it a legitimate use of Congress's taxing power. A Republican-controlled Congress later joined with Trump to zero-out the tax penalty, leaving the mandate without any practical consequences.
