The vice-presidential nominee’s story about family members’ new health coverage illustrates how Republicans inherited — and benefited — from the current system.
Donald Trump’s running mate has hit on a new strategy to defend the GOP’s oft-criticized health-care record: talk about his own family’s experience.
“Members of my family actually got private health insurance, at least, for the first time … under Donald Trump’s leadership,” Sen. JD Vance (R-Ohio) said at this month’s vice-presidential debate, repeating a line he has used on the stump. Vance added that his family members switched off Medicaid, the government health insurance program for low-income Americans, while Trump was in office between 2017 and 2021.
Vance was referring to his mother, who purchased private health insurance through the Affordable Care Act’s insurance marketplace run by Ohio after she overcame substance-abuse challenges, became financially stable and subsequently made too much money to remain on Medicaid, a campaign spokesman told The Washington Post. Vance also was invoking a cousin in Florida who obtained private insurance for the the first time through the state’s marketplace, spokesman William Martin said.
In Vance’s telling, his family members’ experience reflects Trump’s stewardship of the nation’s health-care markets — a perspective shared by some conservatives, who say that Trump took steps to stabilize the Affordable Care Act after Republican repeal efforts collapsed in 2017. Even as the president publicly demeaned the law — “Obamacare is a joke!” Trump wrote on social media in 2020 — his administration continued to administer most of its initiatives, and some consumers saw the cost of their insurance premiums decline.
“Donald Trump could have destroyed the program,” Vance said at his debate with Sen. Tim Walz (D-Minn.) “Instead, he worked in a bipartisan way to ensure that Americans had access to affordable care.”
But to many health policy experts, Vance’s story reveals something else: the benefits of “Obamacare,” even to its critics, and the audacity of Trump’s attempts to take credit for the work of President Barack Obama and Democrats, who crafted and defended the Affordable Care Act at great political cost. After Democrats enacted the law in 2010, Republicans spent the next seven years vowing to overturn it, culminating in a Trump-led repeal effort that fell one vote short.
“If any Vance family members transitioned to the marketplace because they earned out of Medicaid, they should be grateful that Trump and Republicans in Congress failed to repeal and replace the marketplace with an alternative that would have provided far less affordable coverage,” Andrew Sprung, an independent health analyst who has been tracking Vance’s policy proposals, wrote in an email.
Daniel Skinner, an Ohio University health professor who has been critical of Vance, called the senator’s comments on the Affordable Care Act “a delicate if disingenuous dance.”
“I think Vance’s debate tactic with the Affordable Care Act was brilliant subterfuge,” Skinner added in a text message. “Vance knows that the ACA is now pretty popular, despite a good portion of Trump’s MAGA base insisting that he get behind repealing it again.”
Obama himself waded in Thursday night, criticizing Vance for “the nerve to say Donald Trump salvaged the Affordable Care Act.”
The dust-up over Vance’s comments represents the latest chapter in the long-running political battle over the Affordable Care Act, which overhauled the nation’s health insurance markets. The law created online marketplaces in which individuals could shop for health plans, established subsidies to defray the costs of that coverage and provided new protections for people with preexisting health conditions — including substance abuse.
The law also offered a pathway for states to expand their Medicaid programs. By 2018, more than 1.2 million Ohioans had been covered through that expansion, with about half having received treatment for mental illness or substance use disorder, according to a state report.
But the law was not immediately popular politically, and dozens of congressional Democrats who voted for it were subsequently defeated. Just 38 percent of U.S. adults held favorable views of the Affordable Care Act in April 2014, according to polling by KFF, a nonpartisan health-care think tank.
Vance, who was elected to the Senate in 2022, has often framed his policy arguments using his family’s experiences in Appalachia, as they shuttled between Kentucky and Ohio. His 2016 memoir, “Hillbilly Elegy,” detailed the struggles of family and friends to pay for health coverage and get treatment — situations that might have benefited from the protections of the Affordable Care Act, health policy experts have noted — amid their broader financial challenges.
Vance’s mother, Beverly Aikins, endured drug and alcohol addiction but recently told the New York Times she has been sober for about a decade. The campaign declined to make Aikins available for an interview.
Vance’s personal experiences also shaped his criticism of Trump and Republicans’ 2017 efforts to repeal the Affordable Care Act, with Vance warning their replacement proposals would eviscerate coverage for low-income Americans.
“The ‘full repeal’ bill is nothing of the sort — it preserves the regulatory structure of Obamacare, but withdraws its supports for the poor,” Vance wrote in a 2017 column in the New York Times, warning that millions of Americans would be “unable to pay for basic health care.”
Avik Roy, a longtime health policy adviser to GOP politicians, said Vance was particularly worried about proposed cuts to the Affordable Care Act’s Medicaid expansion, pointing to some of his public remarks.
Now on the campaign trail, Vance has worked to cast Trump as a defender of the Affordable Care Act, which became politically popular after Republicans’ failed repeal efforts inadvertently catalyzed support for the law. Sixty-two percent of adults held favorable views of the law in April, according to KFF, and nearly 50 million people have used the law to obtain private health insurance since its passage, the White House announced last month.
Vance and other conservatives have also credited the Trump administration’s push to encourage alternatives to the Affordable Care Act, such as expanding access to health plans offered by industry associations that did not meet the law’s requirements but offered a measure of health coverage at lower cost.
“I think that Donald Trump has earned the right to put in place some better health-care policies,” Vance said this month. “He’s earned it because he did it successfully the first time.”
Lanhee Chen, a fellow at the conservative-leaning Hoover Institution at Stanford University, said the Trump administration’s actions on health care did go beyond the 2017 fight over repealing the Affordable Care Act.
“If you look at the bulk of the activity during the administration’s time in office, you can point to a number of things that support the broader claims that they’re making” about health care, Chen said, citing the Trump administration’s work to boost price transparency, encourage enrollment in the association health plans and additional measures.
But other policy experts have criticized those skimpy, less-expensive health coverage options introduced under Trump, noting they weren’t as comprehensive as required under the Affordable Care Act. Those experts also contend that a common claim by Trump’s allies — that he helped stabilize the Affordable Care Act by cutting some payments to health insurers, prompting some of the law’s health plans to become less expensive for consumers — was inadvertent.
“That was done in the context of trying to repeal and replace the ACA, and when unsuccessful, implementing other policies that were designed to weaken the law,” said Lisa Dubay of the Urban Institute, a nonprofit organization specializing in policy research and analysis.
Vance’s team did not point to evidence that any measures taken by Trump enabled his mother’s access to the Affordable Care Act, and policy experts declined to comment on her situation without knowing details. But experts in Ohio and Kentucky noted that regional enrollment in the Affordable Care Act exchanges fell — and the uninsured rate rose — while Trump was in office.
Joseph Benitez, a University of Kentucky health economist who has studied health coverage trends in Appalachia, said it was not uncommon for residents of the region to shift between Medicaid and private health insurance, and he credited policies established before the Trump administration — such as the Affordable Care Act’s expanded access to Medicaid coverage — for helping provide key support.
Amy Rohling McGee, president of the nonpartisan Health Policy Institute of Ohio, said she could not identify any “unilateral actions” by the Trump administration to improve the Affordable Care Act.
“Many more people have coverage through the marketplace today, because of the expanded subsidies that have been made available during the Biden administration,” she added. The Trump campaign has signaled that he would do away with those subsidies.
Peter Jamison contributed to this report.
