It started with Trump saying last month he had "concepts of a plan" for replacing the Affordable Care Act — aka Obamacare — and continued Tuesday night at the vice presidential debate in New York.
On this week's stage, GOP vice presidential nominee JD Vance seemed to recast Trump's previous repeated repeal attempts as a victory for Americans and also tried to assure voters that he didn't want to return to an era when pre-existing conditions could be grounds for a denial of coverage.
"I think you can make a really good argument that [Trump’s actions] salvaged Obamacare," Vance said.
"Trump could have destroyed the program. Instead, he worked in a bipartisan way to ensure that Americans had access to affordable care," he added.
It was a claim that raised more than a few eyebrows.
As nearly every post-debate fact check made sure to note, then-President Trump used his presidential powers to undermine the 2010 law, and he also pushed Congress to try to repeal it entirely.
The effort came up short only when some members of Trump’s own party — most famously then-Sen. John McCain of Arizona — voted no.
Senator and Republican vice presidential candidate J.D. Vance arrives to participate in the Vice Presidential debate hosted by CBS News in New York City on October 1. (CHARLY TRIBALLEAU/AFP via Getty Images) ·CHARLY TRIBALLEAU via Getty Images
Trump's actions in office, including making enrollment on the program's health insurance exchanges more burdensome, also helped lead to a decline in enrollment from 2016 to 2020, according to government data.
Vance nonetheless contended that it was Trump who "saved the very program from a Democratic administration that was collapsing and would have collapsed absent his leadership."
Beyond the numerous fact checks, Tuesday's exchange was also telling about the shifting politics of healthcare with growing enrollments and public support for Barack Obama's signature accomplishment that Republicans have sought to repeal from the moment it was enacted.
Since Biden took office, the number of exchange enrollees has now surged with more than 21 million people currently enrolled in plans through the law's marketplaces. Polling shows the law growing in popularity.
After years of Republican attacks, it's an issue that the Harris campaign hopes could be a liability for Republicans in the last month of the campaign. Minnesota Governor Tim Walz responded to the claims on the debate stage by saying that the exchanges have thrived and grown in recent years because they are popular.
"Look, people are using it," Walz said, "the system works."
Other key fronts: Insulin prices and price transparency
Tuesday night's back-and-forth covered an array of healthcare topics and was just the latest attempt from Vance to recast healthcare issues and Trump's record in office on them.
The cost of prescriptions is another key flash point. At a recent rally, Vance said it was the Republicans that got "insulin down to $35 a vial."
"Thank Donald Trump for that," he added.
Vance is correct that the former president made efforts toward $35 insulin and signed a 2020 executive order designed to save money for seniors enrolled in Medicare Part D. But the effort was notably only a voluntary one.
On Tuesday, Vance also touted regulations announced during Trump's term around forcing hospitals to publicly disclose the prices that insurance companies pay, saying, "That price transparency will actually give American consumers a little bit more choice and will also drive down costs."
But the effect of the change remains unclear, according to a New York Times fact check, with economists still split about what effect Trump's rules will ultimately have on overall prices.
Sen. JD Vance and Gov. Tim Walz shake hands at the CBS Broadcast Center in New York City during their debate. (Michele Crowe/CBS via Getty Images) ·CBS Photo Archive via Getty Images
The phrase that started it all: 'Concepts of a plan'
The healthcare discussion has grown in recent weeks following a debate moment on Sept. 10 when Trump faced off against Harris and nodded to his push to replace Obamacare with something better — but then declined to offer any details.
"I would only change it if we come up with something better and less expensive," he added, promising a plan "in the not-too-distant future."
Vance this week also sought to defend Trump's comments on the issue, calling it "simple common sense" that a 900-page bill wouldn't be presented on stage.
"It would bore everybody to tears, and it wouldn't actually mean anything," Vance added, overlooking that Trump has given no indication, debate promises notwithstanding, that a plan is forthcoming.
Vice President Kamala Harris and former President Donald Trump during their debate at the National Constitution Center in Philadelphia on Sept. 10. (Demetrius Freeman/The Washington Post via Getty Images) ·The Washington Post via Getty Images
And when Vance recently seemed to offer some potential details of a Trump-Vance healthcare plan, he faced political blowback.
What Vance discussed was the idea that insurers could be given more power to differentiate those with chronic conditions into special "risk pools." It immediately raised fears of a return to a time when insurance companies could deny coverage or charge exorbitant prices to those with preexisting conditions.
"What he explained is pre-Obamacare," Governor Walz charged Tuesday night of the GOP healthcare proposal, saying that what Trump and Vance "are going to do is let insurance companies pick who they insure."
As for the weeks ahead, don't expect this issue to go anywhere. The Harris campaign on Tuesday launched the first in what it promises will be a series of healthcare-focused ads to air in the coming weeks.
Ben Werschkul is Washington correspondent for Yahoo Finance.
