Donald Trump's decision to revive the health care debate has stirred a debate among Republicans on how best to approach the divisive issue heading into the 2020 election.
Failing to repeal and replace the ACA, otherwise known as Obamacare, is one of the biggest shortcomings of the president's first term. It left Republicans with a broken campaign promise, dismal approval ratings and a narrative they haven't been able to shake — that they don't support protecting those with pre-existing medical conditions from high-cost care. In some races, it cost Republican seats last fall, flipping House control to Democrats.
What's unclear is whether a Trump-Care bill will emerge from the White House or Capitol Hill to replace the Affordable Care Act or if the president's push for a policy outcome fades to little more than a topic for the campaign trail. For Trump, returning to health care shows his commitment to a 2016 campaign pledge and his desire to frame the 2020 debate on his terms.
"We are working very hard on that," said Trump as he was heading out to the Michigan rally, singling out Republican senators John Barrasso, Rick Scott and Bill Cassidy among those involved. But McConnell has made it clear he would rather see Republicans spend their time attacking the Democratic plans to expand existing health care programs, namely the Medicare for All plans embraced by some of the Democrats running to unseat Trump. He sees it as their best option for reversing public opinion heading toward 2020 when he, too, faces re-election. McConnell derides the high cost of a government-run system as "Medicare for None.
House Republicans, though, face a different calculus. They lost dozens of seats last fall in part because Democrats successfully attacked them over the GOP proposals to replace Obamacare. Americans have warmed to the 2010 health care law and, in particular, its provision that prevents insurers from charging more to patients pre-existing conditions.
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