JD Vance has endorsed an old policy that would strip protections for people with preexisting conditions — and many Republicans in Congress, having been through this fight before, are sprinting away from the idea.
“I don’t think you’re going to see an effort to repeal the ACA,” said Sen. Lisa Murkowski, the Alaska Republican who helped block a GOP attempt to scrap Obamacare in the summer of 2017.
“Repealing Obamacare isn’t going to happen,” Sen. Cynthia Lummis of Wyoming bluntly told NOTUS on Thursday. “It isn’t even going to be debated.”
With Vance’s suggestion that Republicans turn to “high-risk pools” — which, prior to the passage of the Affordable Care Act in 2010, separated very sick people into a more expensive insurance market — he revived a fiercely contested debate that his Senate GOP colleagues seem to still have nightmares about.
In 2017, the party had a painful fight over whether to end insurance protections guaranteed by the ACA. Republican lawmakers spent months that year bickering and ultimately failed to pass a health care law, which had been a signature campaign trail promise from Donald Trump.
In interviews with NOTUS on Thursday, Republican senators politely said they’re willing to have the conversation and tried not to criticize Vance for bringing it up. But it was clear nobody really believes an “Obamacare repeal” is possible at this point, nor that some kind of zombie replacement act could or should be the party’s first priority if they win control of the government.
Sen. Bill Cassidy of Louisiana, a physician who played a high-profile role in the 2017 debate, declined outright to weigh in on the likelihood it could happen again.
“Obamacare repeal would require us getting a trifecta,” he said on Thursday, referring to unified Republican control of government. “So when I see the trifecta, I’ll answer the question.”
And Sen. James Lankford of Oklahoma, who was also serving at the time, said it would be even more difficult to repeal the Affordable Care Act next year than it was during Trump’s first year in office.
“The hard part now is how to separate what is Obamacare and what is just health care,” he told NOTUS. “In America, it’s been health care now for more than a decade, and every business has reconfigured.”
“It’s not just as easy as turning off and turning on anymore,” he added. “It’s well established.”
If Republican leaders do take another stab at a health care bill, Lankford said, they should “have everybody at the table” first and make sure to “actually have agreement before you vote.”
The seven years after 2017 have been a historic and chaotic period in American politics. But congressional aides and members who were here during the Obamacare repeal attempt that year broadly acknowledge there really hasn’t been a moment quite like it since.
From the very start, Republicans were divided on how to make their campaign rhetoric a reality — reconfiguring roughly 20% of the nation’s economy is a tall order on its own, especially so with immense outside pressure not to change the law.
Capitol police dragged protesters with disabilities out of a hearing on a repeal bill as one Republican told them to “shut up”; lawmakers’ offices were inundated with thousands of calls each week from constituents and activists; Trump had no real idea of how to steer the party’s debate as members fought openly; and one Republican senator even patrolled the halls of the Capitol with a copy machine, in search of the health care bill that GOP leaders were considering in private.
At one point, exhausted Senate Republicans — unsure of how to repeal the ACA without hurting people with preexisting conditions — went so far as to ask their House colleagues not to pass their bill if the Senate managed to advance it because they hadn’t yet ironed out the details and wanted to fix it before sending it to Trump for his signature. (Their House peers, also exhausted and ready to end the fight, refused to make that commitment.)
The effort culminated with Sen. John McCain’s dramatic thumbs-down one late night in July. His “no” vote, alongside two other Republicans and every Democrat, ended the debate over repeal once and for all — or so they hoped.
The ordeal still looms large, even among members who weren’t serving at the time.
“We need to talk about true reform that’s doable,” Lummis said when asked about Vance’s comments.
But what does that look like?
Lummis didn’t even pretend to have a clue: “I don’t know yet,” she said.
Sen. Rick Scott of Florida also avoided talking about policy details. “We’ve got to think through, how do we make sure people can get health care at a price they can afford?” he told NOTUS.
Pressed on Vance’s comments, Scott said he hadn’t seen them and repeated that he wants to talk about how to get people “health care that they can afford.”
Does he want to repeal Obamacare, though?
“I want to get people health care they can afford,” Scott said, sidestepping again.
Democrats are thrilled Vance has waded into the topic. Campaign operatives had already been talking about advertisements in tough races, focusing on health care proposals in the conservative Heritage Foundation’s Project 2025. But to have Trump’s running mate actively embracing a return to high-risk pools made it more salient on the campaign trail for members on both sides of the Capitol.
“It will absolutely hurt down-ballot Republicans,” said Viet Shelton, spokesperson for the Democratic Congressional Campaign Committee. “All cycle, House Democrats have been running on lowering prescription drug costs and expanding access to affordable health care — which is a contrast we will make clear in the remaining weeks of the campaign.”
It’s clear some in the Republican Party likewise don’t view attacking the Affordable Care Act as a political or policy winner at this point.
When asked about Vance’s comments, Sen. Josh Hawley of Missouri said he would prefer to cap the prices of more prescription drugs instead.
“I’m kind of skeptical,” Hawley said of returning to high-risk pools. “I have experience with this in my own family, with one of my kids. If you’ve got a preexisting condition, I don’t think you should be discriminated against. I think that you ought to be able to have the same range of choices at the same prices that other people are paying right now.”
Hawley cautioned that he doesn’t believe any final Trump-Vance health care plan would result in this, but, “I wouldn’t want to do anything that would force people who have preexisting conditions, through no fault of their own obviously, into a different system where it’s like, ‘Oh hey, congratulations, you’re going to pay three times as much, and you’re going to have no options.’”
Only a couple of Republicans on Thursday seemed willing to dive into the conversation.
“It’s a good idea to take a close look at how Obamacare has worked or not worked, and to look for ways to improve it,” Sen. Mitt Romney of Utah told NOTUS. “I don’t know that you’re going to see us eliminate the program as it exists because so many people depend upon it. But I’m sure it can be improved.”
Romney, who is retiring, wouldn’t personally have to suffer through the legislative process, however. And he doesn’t think either party will end up with a “dominating position” after November, which he thinks would be necessary for anyone to significantly rewrite health care laws.
Either way, Sen. John Cornyn of Texas said that he’s “happy to have that conversation.”
“There are things we can do to improve access to health care,” he told NOTUS. Still, Cornyn acknowledged, any attempt is “going to be really hard.”
Cornyn was the Senate GOP conference’s vote counter during the 2017 Obamacare repeal effort. His lesson from that year is simple.
“You’ve got to get the votes,” he said. “If you don’t have the votes, you can’t do it.”
—
Haley Byrd Wilt is a reporter at NOTUS.