Since the 1990s, healthcare has been a dominant issue in most U.S. presidential elections. Voters and candidates fiercely debated how to lower healthcare costs, expand coverage, and what role the government should play in reforming the system. However, in the current election cycle, healthcare has taken a back seat to other pressing issues like inflation, taxes, immigration, and trade. According to Gallup, only 2% of respondents identified healthcare as the nation’s top problem, a stark shift from previous election cycles.
One reason healthcare has receded as a major voter concern is the success of the Affordable Care Act (ACA), signed into law by President Barack Obama in 2010. Known as “Obamacare,” the ACA has quietly become one of the most significant healthcare reforms in U.S. history, now covering a record number of Americans. Despite its rocky start and initial unpopularity, the ACA has evolved into a vital source of coverage for approximately 45 million Americans, or 15% of the U.S. population.
The Early Struggles of Obamacare
When the ACA’s key provisions took effect in 2014, it faced significant challenges. Many Americans who had individual insurance plans lost their coverage and were forced to purchase more expensive plans that included benefits they did not necessarily want. President Obama’s famous statement, “If you like your healthcare plan, you can keep it,” was rated as the “lie of the year” by Politifact. During its first year, the ACA covered only a few million people, but rising premiums and coverage restrictions fueled public resentment. Between 2014 and 2017, the law remained largely unpopular, with more people disapproving of it than supporting it.
Despite this, the ACA survived multiple Republican-led efforts to dismantle it. After Trump’s election in 2016, he pledged to “repeal and replace” Obamacare. However, a Republican-led attempt to repeal the law failed in Congress in 2017, even though the party controlled both the House and Senate. Obamacare persisted as a cornerstone of the U.S. healthcare system, and its significance only grew in the years that followed.
Biden’s Pragmatic Approach to Healthcare Reform
During the 2020 Democratic primaries, healthcare was once again a hotly debated issue. Progressive candidates like Senators Bernie Sanders and Elizabeth Warren, as well as Kamala Harris, advocated for “Medicare for All,” a sweeping government-run healthcare system that would replace private insurance. Many felt that Obamacare did not go far enough in providing comprehensive coverage to Americans. However, Joe Biden took a different approach, proposing a more pragmatic solution: rather than replacing the ACA, he pledged to strengthen and expand it.
Biden’s approach resonated with Democratic voters, helping him win the nomination and ultimately the presidency. Since taking office, Biden has fulfilled his promise by passing legislation that expanded eligibility for Obamacare and provided additional subsidies for higher-income families. These enhancements are set to last through 2025, and they have pushed coverage under the ACA to record levels. Today, approximately 45 million Americans receive health insurance through the ACA, either through marketplace plans or Medicaid expansion.
The Growing Popularity of the ACA
As more Americans benefit from Obamacare, public support for the program has surged. In 2023, the uninsured rate in the U.S. dropped to 7.7%, compared to 16% in 2010 when the ACA was first enacted. Public approval of the ACA has risen dramatically, from a low of 33% in 2013 to 62% today. The law has become an integral part of the healthcare system, with many Americans now relying on it for affordable coverage.
However, there are still some limitations to the ACA’s reach. Ten states, including Florida, Georgia, Texas, and Wisconsin, have not adopted Medicaid expansion, leaving many low-income residents without access to affordable healthcare options. The remaining uninsured population largely consists of people who don’t qualify for employer-sponsored insurance and either can’t afford individual plans or choose not to purchase them.
Despite some ongoing challenges, the ACA’s success in expanding healthcare coverage has helped diminish healthcare as a major election issue. This shift is reflected in the current political landscape, where other pressing concerns like inflation, taxes, and immigration are taking center stage.
Harris’s Evolving Healthcare Stance
As the Democratic presidential nominee, Kamala Harris recognizes the importance of healthcare but has adapted her policy approach since the 2020 primaries. Once a vocal advocate of Medicare for All, Harris has since moved away from that position and is now focused on more targeted reforms. Her current healthcare agenda includes measures to address medical debt, negotiate lower prescription drug prices through Medicare, and make permanent the ACA subsidies that are set to expire in 2025.
Harris frames healthcare as an economic issue, emphasizing its impact on household finances and overall economic well-being. While she no longer pushes for sweeping reforms like Medicare for All, her policies aim to address ongoing issues within the system, one step at a time.
Trump’s Shifting Healthcare Position
On the Republican side, Donald Trump’s stance on healthcare has also evolved. In 2016, Trump campaigned on a promise to repeal and replace Obamacare. However, after the failed repeal attempt in 2017, he has since softened his position. In the current election cycle, Trump has criticized Obamacare, saying “it sucks,” but he has not provided a detailed plan for how he would improve or replace it. Instead, he has vaguely promised to make healthcare better and more affordable, without offering specifics.
This shift in tone likely reflects the reality that Obamacare is now more popular than ever, with an approval rating nearly 20 points higher than Trump’s. Voters, particularly those who rely on the ACA for coverage, appreciate the stability and security it provides.
Conclusion
Healthcare, once a defining issue in U.S. elections, has taken a back seat in the 2024 campaign. The Affordable Care Act, a program that was once polarizing, is now widely accepted and more popular than ever. Thanks to the ACA’s success in expanding coverage to millions of Americans, healthcare has become less of a voter concern, allowing candidates like Kamala Harris and Donald Trump to focus on other pressing issues. As the election unfolds, it remains to be seen how much attention healthcare will receive, but for now, it appears to have taken a backseat in the broader political conversation.