Trump and Republicans are once again facing a difficult political battle over the health care law approved by Obama

WASHINGTON (AP) — President Donald Trump is once again targeting former President Barack Obama’s signature health care law, as he wades into a political battle ahead of next year’s election reminiscent of the one he lost in his first term.

At the time, Trump and his fellow Republicans tried but failed to dismantle the Affordable Care Act, a harsh defeat seen as contributing to the party’s losses in 2018.

This time, Trump appears to be reducing his ambition to repeal and replace the law. But he is struggling to allay voters’ concerns about rising costs of living — along with a looming deadline to extend expiring subsidies that help people pay for Obamacare — and it’s not clear how he plans to prevent history from repeating itself.

“You can’t address the affordability crisis by making health care less expensive,” said Jonathan Oberlander, a professor at the University of North Carolina at Chapel Hill, whose work has focused on health care policy and health reform policies under Obama.

Consumers insured through the Act’s marketplaces received notices of significant premium increases for next year if benefits are not extended by Jan. 1 — a deadline Trump said Tuesday he would not support. Unless he changes his mind, that leaves it up to Congress to find a solution or let the tax breaks expire, raising rates for the 24 million people covered by the ACA exchanges.

“Plan Concepts”

During his campaign for the White House last year, Trump called for repealing the law, but said he only had “plan concepts” to do so. It has not been explained yet.

The president has since focused on reforming coronavirus-era subsidies that have helped keep premiums low. Democrats forced the last government shutdown by demanding an extension and tied that to broader concerns about affordability that were front and center during this month’s election in which Democrats scored big victories.

Read more: Democrats are concerned about the GOP’s promise to negotiate on health care after the shutdown ends

These concerns are expected to continue until 2026 when elections may change control of Congress.

Some Republican lawmakers are open to extending the subsidies, but Trump has said he would only support a plan that sends money to individuals rather than insurance companies, which he complains are “making a fortune.”

“Congress, don’t waste your time and energy on anything else,” he wrote on social media.

“Call it Trumpcare.” Call it whatever you want to call it.”

Republicans in Congress are working behind the scenes with the White House to come up with an answer. There is no guarantee that they will succeed.

Sens. Rick Scott, R-Fla., and Bill Cassidy, R-Los Angeles, have put forward separate proposals that would create savings accounts similar to what Trump says he would support.

Majority Leader Steve Scalise, R-Los Angeles, said House Republicans are working on a series of bills “that would actually lower costs for families.” “We will continue to file these bills over the next few months.”

House Democratic Leader Hakeem Jeffries of New York criticized Trump’s idea of ​​giving money directly to those who buy insurance. He said people can actually get tax relief on a monthly basis to afford the policies.

“Donald Trump has no idea what he’s talking about,” Jeffries said. “It’s all fiction.”

Vice President J.D. Vance, without providing details, said Thursday that the administration has a “great plan for health care” and predicted it would have bipartisan support.

“This system is broken. Democrats broke it, but who cares? We will work together if they are willing to fix it,” he said.

Trump also does not care about the politics of the issue and dismisses the concerns of those who believe that health care is a “graveyard for Republicans.”

Vince Hawley, who runs the White House Domestic Policy Council, and Heidi Overton, a deputy assistant on the council, have held conversations with industry leaders and members of Congress about the issue, according to a senior White House official who spoke on the condition of anonymity to describe internal discussions.

Trump has his own ideas about what he would like to see in the proposal, according to the official, and recognizes the political need for Republicans to have a plan.

The president also said he is speaking directly with some Democratic lawmakers, though he declined to name them.

One thing is clear: Trump wants to leave his mark on a health law he has long called a “disaster.”

“Call it Trumpcare. Call it what you want,” Trump said of the sweeping reform he proposed during an interview last week on Fox News. “But anything but Obamacare.”

This discussion highlights how difficult it will be to repeal Obamacare

Democrats may have inadvertently highlighted problems with the law in their fight over the shutdown by calling attention to the need for subsidies to make coverage more affordable, said Tevye Troy of the Ronald Reagan Institute.

“Republicans were afraid to talk about this issue,” said Troye, who was deputy health secretary under Republican President George W. Bush. “And this fight has raised the issue again in a way that’s favorable to Republicans because after eight years, prices haven’t gone down” since Trump’s efforts to overturn the first term.

Troy said more Republicans are starting to realize they need to do something about rising coverage costs, but they will need to find some kind of bipartisan compromise to pass it.

Oberlander, the North Carolina professor, said the “endless war over Obamacare” since it was signed into law 15 years ago has been fueled in part by problems with it, but largely by the era of hyperpartisanship in modern politics.

“This is one front in a broader partisan war in American politics,” Oberlander said of the Affordable Care Act. “Partisan polarization makes it difficult to reach bipartisan compromise.”

He compared the law to Medicare, a program that provides health coverage for the elderly. Medicare faced an uphill battle when it was passed in 1965, but the controversy subsided, and Republicans and Democrats in the 1980s worked with Republican President Ronald Reagan to expand it.

If Trump and Republicans try to repeal Obamacare again, they will face a much tougher political fight than in 2017, when then-Sen. Senator John McCain, Republican of Arizona, gave the effort a decisive no, Oberlander said. There are more than twice as many people getting insurance through the ACA now than there were then, and some provisions of the law are popular, such as the ban on denying coverage or raising rates for people with pre-existing health conditions.

“You can’t go back to 2009,” Oberlander said. “Whatever Republicans do, they have to deal with this reality.”

Associated Press writers Lisa Mascaro and Mary Clare Jalonick contributed to this report.