Why Democrats see health care as a prescription for revival

While health care was not a major focus in the 2024 presidential election, it has become a central front between the parties during President Donald Trump’s tumultuous second term, as the government shutdown that appears inevitable this week will demonstrate again.

The increased focus on health care could have important implications for the 2026 election because polls show that it is an issue on which the public expresses more confidence in Democrats than Republicans.

Few health debates have galvanized public attention as much as Trump’s 2017 effort to repeal the Affordable Care Act. But the panoramic disruption that Trump and his Health and Human Services Secretary Robert F. Kennedy Jr. are bringing to the health care system cumulatively exceeds the changes he pursued during his first term, many experts agree.

Even compared to the first-term repeal fight, Trump’s second-term health care agenda, “just paints a much broader picture of an assault on the health care system that we all rely on,” said Anthony Wright, executive director of the consumer group Families USA.

The battles are now sprawling across virtually every aspect of the federal role in health care — including the regulation of childhood vaccines, funding for basic medical research, and the historic reductions in Medicaid coverage approved as part of the GOP’s tax and spending reconciliation bill last summer. In the coming shutdown confrontation, the core Democratic demand is that Republicans extend the enhanced ACA insurance subsidies approved under former President Joe Biden.

Two aspects of this expanding struggle compound its potential political impact. One is the breadth of the confrontation: the multiplying skirmishes are affecting people at every stage of life, from vaccines for newborns to seniors who rely on Medicaid. “That’s the power of the health care issue,” said Leslie Dach, chair of Protect Our Care, a liberal advocacy group that focuses on health care access. “It’s a cradle to the grave issue for people and they are affecting it at each step along the way.”

Adding to the volatility is the virtually unprecedented political alignment of these confrontations. Past Washington battles over health care have usually pit industry groups against advocates for consumers, with Republican presidents usually aligning more with the former and Democrats with the latter.

But many of the second-term Trump battles have involved the administration and congressional Republicans opposing the medical industry and consumer groups alike. Instead, the Republican health care agenda now reflects the skepticism of both the federal government and medical professionals that surged among conservatives after the Covid-19 pandemic and has catalyzed the growth of Kennedy’s Make America Healthy Again movement.

“All of this is just an anti-establishment backlash-whether you are talking about the public health community, the research community, red states’ anger over what happened during Covid, or Trump’s backlash against official Washington, the deep state, the mainstream media,” said Michael Cannon, director of health policy studies at the libertarian Cato Institute.

While many Americans are dissatisfied with aspects of the medical system, it’s far from clear the GOP can sustain public support for an agenda that simultaneously challenges mainstream medicine and retrenches the federal government’s role in promoting health. Polls consistently show that many aspects of the Trump health care agenda face enormous public resistance — as even his principal 2024 campaign pollster has noted in a series of sharply worded recent public memos. “These may be principled moves for some people,” said Larry Levitt, executive vice president for health policy at KFF, a nonpartisan think tank that extensively polls on public attitudes about health care issues. “But they are certainly not popular with voters.”

Unfinished business

The sweep of Trump’s second-term health care plans represents unfinished business from two seismic events during his first term.

One was Trump’s failure in the principal health care fight of his first four years: the 2017 attempt to repeal the ACA signed into law by former President Barack Obama. House Republicans passed a repeal bill in spring 2017, but it failed in the upper chamber, with the late Sen. John McCain dooming it with his dramatic thumbs-down gesture on the Senate floor.

Through the remainder of Trump’s first term, his administration tweaked the ACA in ways that made it more difficult to enroll but didn’t again pursue outright repeal. Under Biden, Democrats utilized both legislation (sweetening the ACA subsidies) and administrative action to cover significantly more people under the law and raise the total number of Americans with health insurance to about 92%, a record high, the Census Bureau reported.

With the law touching so many voters, Trump through the 2024 campaign downplayed his focus on the ACA, insisting, “I would only change it if we come up with something that’s better and less expensive.” Once Trump returned to the White House, Congressional Republicans did not propose a full-scale repeal of the ACA and Trump, more explicitly than in the campaign, pledged not to cut Medicaid.

But the GOP’s tax and spending reconciliation bill — the so-called One Big Beautiful Bill — nonetheless imposed large reductions in future spending on Medicaid, primarily by imposing work requirements on adults who had received coverage in the 40 states that had expanded eligibility for the program under the ACA. In addition, the GOP budget bill chose not to extend the enhanced ACA subsidies that Democrats had approved, but which expire at the end of 2025. Those subsidies will be the crux of the likely showdown.

The Congressional Budget Office projected that 11 million people would lose coverage because of the Medicaid changes and another 5 million from the choice to let the ACA subsidies expire. That wasn’t as much as the CBO’s estimate of the coverage loss from the House’s 2017 repeal bill (about 23 million). But it still revoked health coverage from more people than any enacted legislation ever, according to Edwin Park, a research professor at Georgetown University’s Center for Children and Families. Millions more will face much higher premiums if the ACA subsidies are allowed to expire.

This all means that without repeating 2017’s failed frontal assault on the ACA, Republicans nonetheless succeeded in significantly retrenching it. “It’s not that they didn’t go after the ACA; they just did it back-door,” said Jeanne Lambrew, director of health care reform at the Century Foundation and a former White House health policy aide to Obama during the ACA’s implementation.

The new fronts

Even as this fight unfolded, the Trump administration opened new fronts in the health-care struggle. These were rooted in the second key event shaping Trump’s health agenda: the conservative backlash against the government response to the Covid-19 epidemic and the growing skepticism about vaccines in particular, and federal scientific agencies in general, among broad segments of the right.

Propelled by that skepticism, Kennedy has upended the major public health agencies and launched a sustained effort to question vaccine safety, particularly for children. Trump joined that drive in rambling but unequivocal fashion last week at a press conference in which the administration linked autism to the use of Tylenol during pregnancy — a conclusion considered premature if not flatly wrong by many medical researchers. He also made several sweeping comments around vaccines — generally off-topic and devoid of facts — and then doubled down on this variety of topics in a Truth Social post Friday.

Simultaneously, the administration has imposed sweeping cuts on federal health research spending and rescinded grants to an array of prominent universities (mostly in blue cities) over their policies on unrelated issues, such as diversity in admissions. Looming is a potential fight over access to the abortion medication mifepristone: In a letter to state Republican attorneys general last week, Kennedy signaled receptivity to rolling back changes the FDA approved under Obama and Biden that allowed patients to access the drug without visiting a doctor.

The debate over the Medicaid cuts in the reconciliation bill — and the enhanced ACA subsidies in this week’s likely shutdown — sort the parties in familiar ways. Just as President Bill Clinton did in repeated confrontations with the Newt Gingrich-led Republican Congress in the 1990s, Democrats today are arguing that Republicans are cutting health care programs for average families to fund tax cuts for the rich.

Republicans and conservatives in turn maintain that they are merely trying to demand work and personal responsibility from those receiving Medicaid, and that spending on the program will continue to grow, just not as fast as previously projected. “It’s a slower rate of growth; it’s not a cut,” Cannon said. Trump, Kennedy and other administration officials have also stressed that argument. But so did Gingrich, without much success, in the 1990s when Clinton revived his presidency by condemning the GOP budget plans with much the same arguments Democrats are wielding today.

The twist is that Kennedy and his allies present the perennial core of this debate — the dispute about how much government should spend to expand insurance coverage — as largely irrelevant to public health. Kennedy has dismissed the implications of reducing Medicaid spending (“Do you think…the $900 billion that we’re sending to Medicaid every year has made Americans healthy?” he asked at his confirmation hearing) and said that worrying whether insurers or patients pay for care amounts to “rearranging deck chairs on the Titanic” while Americans suffer from over-medication, poor diets and unhealthy lifestyles.

The partisan grooves are not cut nearly as deeply on the post-Covid fights that Kennedy and his allies emphasize. Wright, from Families USA, says the confrontations over vaccines and federal research spending present challenges to progressive advocates because they involve aspects of the health care system that have not been controversial before.

“We have the muscle (memory) about defending the ACA and Medicaid,” Wright said. “Whereas some of these other attacks are novel and I think some groups are still finding their voice on how to incorporate them.”

Levitt said KFF’s polling shows clear receptivity to portions of Kennedy’s case against the medical establishment. “You see criticism that doctors and hospitals, drug companies, insurance companies are all profit-driven — that it’s all part of one medical-industrial complex,” Levitt said. “But people like their health insurance and they want to have health insurance. I don’t know that that (Kennedy’s) agenda will really resonate with a broad swath of voters.”

Indeed, many of the specific Trump and Kennedy health care policies face substantial public opposition. Polls find that while there is support for work requirements in Medicaid, most Americans oppose the reconciliation bill’s large cuts, particularly when they are tied to tax cuts primarily benefiting the affluent.

Public support for the ACA has remained elevated since the 2017 repeal fight: Last June, a KFF survey found that two-thirds of Americans viewed the law favorably, the highest share ever. Surveys by KFF and the Washington Post, as well as CBS, have found that overwhelming majorities of American parents, including a preponderant share of Republicans, support school vaccination mandates and believe the major childhood vaccinations are safe. In a Quinnipiac University survey released last week, disapproval of Kennedy’s job performance exceeded approval by 21 percentage points.

Tony Fabrizio, one of Trump’s lead pollsters in the 2024 campaign, warned in two public memos this summer that the administration was staking precarious ground in the key health care debates. “While there remains partisan polarization around COVID vaccines,” Fabrizio and his partner Bob Ward wrote, it would be “folly” to assume that meant “Republican voters are against all vaccinations.” Moreover, they added, “support for vaccines is sky-high among Swing voters.” In another memo, they warned that “broad bi-partisan” majorities, including “solid majorities of Trump voters and Swing voters” support extending the enhanced ACA subsidies.

Where the health care fight is headed

Kennedy’s movement has generated undeniable energy — in fact, his allies organized rallies across the country on Saturday to support him. But these polling results signal that the movement’s reach remains limited. Levitt says Kennedy’s hostility to vaccines is eclipsing other elements of his message — such as his critiques of food additives — that have broader appeal. Even Cannon, who is sympathetic to some of Kennedy’s goals, said, “there is really no countervailing political pressure to curtail the government’s growing involvement in health care.”

If anything, the intensifying health care fights of Trump’s second term look like a classic wedge issue for Democrats, in that they unite their side and divide the other party. While virtually all Republicans voted for the reconciliation bill that included the big Medicaid reductions, the party is openly feuding over whether to extend the ACA subsidies. Meanwhile, Kennedy’s attacks on accepted scientific consensus are generating more open dissent from Senate Republicans such as Louisiana Sen. Bill Cassidy, a physician and chair of the Health, Education, Labor and Pensions Committee.

For Democrats, there’s one other big incentive to lean into the health care debate. While polling generally shows the party facing some of its worst public assessments in decades — with voters usually preferring the GOP by substantial margins on the economy, immigration and crime — surveys consistently show that more Americans trust Democrats on health care and vaccines.

In CBS News/YouGov polling in June, for example, substantially more voters said they trusted the Democratic Party than the Republican Party to handle health care. And a CBS News/YouGov poll this month showed 74% percent of Americans want the government to make vaccines more available — which is generally the Democratic position.

The implications of Republican policies for the “health of Americans is more obvious to voters than it ever has been,” said Democratic pollster Geoff Garin, who has polled extensively on the issue for years. “The Medicaid cuts are a huge part of that, but so are the massive cuts in medical research and Kennedy’s anti-vaccine mania. These things have broken through to voters to a significant degree, and there is good reason to expect that the GOP war on healthcare will be high profile in next year’s campaigns.”

Health care alone can’t solve all the Democrats’ 2026 challenges. But the aggressive actions by Trump and Kennedy are raising the relevance of one of the few issues where the public intrinsically places more trust in Democrats.

Although Republicans failed to repeal the ACA in Trump’s first term, the attempt still cost the party in the 2018 midterm election. This time, Trump has made much more progress at advancing his health care agenda. The question is whether success now could prove as politically perilous as failure was then.