On Donald J. Trump’s first day as president, he signed an executive order to repeal Obamacare.
His first major legislative push was an unsuccessful effort to “repeal and replace” the law, officially the Affordable Care Act. He would have done so by restructuring Medicaid, weakening protections for Americans with pre-existing conditions, and shifting funding for private insurance away from the poorer and sicker to the healthier and wealthier.
His first year in office was punctuated by a series of regulatory decisions that tended to weaken already rickety Obamacare marketplaces. He cut spending on advertising and enrollment assistance. His government circulated videos and Twitter posts criticizing the law. His health officials shortened the window when Americans could sign up for coverage, and took the website offline for 12 hours each weekend during that period for maintenance.
“We’ll let Obamacare fail,” Mr. Trump said in July 2017, when the repeal bills were struggling. “And then the Democrats are going to come to us.”
But in recent debate performances, both Mr. Trump and his running mate, Senator JD Vance of Ohio, have been telling voters that Mr. Trump saved Obamacare.
It is more accurate to say he simply failed in his efforts to kill it.
Mr. Trump promised to repeal Obamacare, which was then unpopular, during his winning campaign. Such promises had helped many Republicans win office since the law’s passage in early 2010. But his administration’s unsuccessful efforts to eliminate it reversed public opinion, by highlighting trade-offs inherent in the original bill. While the law had tended to increase insurance premiums for certain groups, it had also substantially expanded coverage for others.
As the repeal debate unfolded, a majority of Americans approved of Obamacare for the first time. That trend has only intensified in the years since. Democrats successfully seized on the repeal effort to highlight the most popular part of the law: its protections for Americans with prior illnesses. Messages about pre-existing conditions featured prominently in 2018 midterm campaigns. Democrats retook control of the House, effectively thwarting other parts of Mr. Trump’s legislative agenda.
As the politics of Obamacare changed, Mr. Trump tried to retool his position on it. In the later years of his presidency, he no longer endorsed specific reforms, though he periodically would say a better plan was on the horizon. He turned to other health care priorities, like a big push to improve the transparency of health prices. He frequently referred to this agenda as “bigger than health care reform.”
His administration also took some regulatory actions that helped Obamacare markets, particularly allowing state plans to reimburse health insurers for the most expensive patients.
But he also supported a lawsuit aimed at toppling the entire law as late as 2020. It went all the way to the Supreme Court, but did not succeed.
In this year’s election, Democrats have once again begun trying to pin Mr. Trump’s repeal record on him. Until recently, that was hard, since he barely spoke about the topic. But the debates put him and his running mate on the spot.
In the September presidential debate, he was asked if he had a health care plan at the ready. He responded that he had “concepts of a plan,” and offered a defense of his presidential record on Obamacare.
“I had a choice to make: Do I save it and make it as good as it can be or let it rot?” he said. “And I saved it.”
Those remarks left open an attack from Vice President Kamala Harris’s campaign, which issued a report on possible consequences of a full Obamacare repeal and began running a television ad on the topic this week.
In the vice-presidential debate on Tuesday, Mr. Vance took a similar tack, saying that Mr. Trump’s policies “salvaged Obamacare,” and that a new Trump administration would pursue minor regulatory fixes meant to improve markets.
“When Obamacare was crushing under the weight of its own regulatory burden in health care costs, Donald Trump could have destroyed the program,” Mr. Vance said. “Instead he worked in a bipartisan way.”
There was virtually no bipartisan action on Obamacare during Mr. Trump’s presidency, aside from the bipartisan votes in the Senate to defeat the repeal bills. Senator John McCain of Arizona, who had voted against the Affordable Care Act in 2010, famously joined his Republican colleagues Susan Collins of Maine and Lisa Murkowski of Alaska in casting the votes that defeated the last repeal effort in the Senate.
The one major legislative change to the health law — the repeal of its unpopular requirement that individuals obtain health insurance — passed Congress without a single Democratic vote.
It is true that Obamacare survived the Trump years and did not collapse. But fewer Americans enrolled in Obamacare plans than had before. Enrollment dropped not just overall, but also among younger Americans, a group Mr. Vance said Mr. Trump’s policies had been designed to help.
The markets have grown in recent years. The Biden administration reversed several Trump-era regulations. And Democrats in Congress have passed legislation to increase federal subsidies that help Americans buy insurance — a change that has led to record enrollment and more participation by insurers, though at substantial cost to taxpayers.
If Mr. Trump is re-elected, it is unlikely Obamacare repeal will be a top priority again. Many Republicans in Congress are uninterested in revisiting the issue. And, as both Mr. Trump and Mr. Vance noted when discussing “concepts of a plan,” there is no detailed legislative blueprint for a replacement.
But that does not change Mr. Trump’s record. If he could have repealed Obamacare, he would have.
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