House Speaker Mike Johnson said this week that Republicans are planning for a “massive reform” of the U.S. healthcare system and the Affordable Care Act if Donald Trump wins a second term as president.
“Health care reform’s going to be a big part of the agenda,” Johnson told voters in Bethlehem, Pennsylvania, while campaigning for a Republican House candidate there. “When I say we’re going to have a very aggressive first 100 days agenda, we got a lot of things still on the table.”
In video obtained by NBC News, Johnson said “some really important ideas” are being discussed.
One attendee at the event asked, “No Obamacare?”
Johnson responded: “No Obamacare,” and rolled his eyes. “The ACA is so deeply ingrained, we need massive reform to make this work, and we got a lot of ideas on how to do that.”
Healthcare has played a lesser role in this presidential campaign than in previous cycles, but Vice President Kamala Harris and Democrats have pledged to protect and expand on the Affordable Care Act and its subsidies for coverage. Trump has said he would keep the Affordable Care Act unless Republicans can improve on it, and he famously said during his debate with Harris last month that he has “concepts of a plan” for replacing the Obama law.
The White House last month touted a report that showed that nearly 50 million people have had coverage through the Affordable Care Act marketplace over the past decade. “It’s a really big deal – and yet Republicans in Congress remain committed to taking us backward by repealing the Affordable Care Act,” the White House said in a statement at the time.
Sahil Kapur of NBC News reports that Johnson’s office declined to offer details about potential reforms or changes to the Affordable Care Act and did not say whether the speaker supports extending the coverage subsidies that are due to expire at the end of next year.
At the Pennsylvania event, Johnson told voters that a caucus of doctors among House members has “a menu of options” for changing the system. He called for taking “government bureaucrats out of the health care equation” and vast deregulation. “We want to take a blowtorch to the regulatory state,” he said, according to the video. “These agencies have been weaponized against the people. It’s crushing the free market; it’s like a boot on the neck of job creators and entrepreneurs and risk takers. And so health care is one of the sectors, and we need this across the board. And Trump’s going to go big. I mean, he’s only going to have one more term, right? Can’t run for re-election. And so he’s going to be thinking about legacy, and we’re going to fix these things.”
Any major reforms along the lines Johnson might suggest are likely to require Republican control of Congress — and even then, they could prove challenging given that some Republicans have accepted that the Affordable Care Act has become an established part of the healthcare system.
Why it matters: Johnson’s comments led a Harris campaign spokesperson to warn that “healthcare is on the ballot” in this race. “Speaker Mike Johnson is making it clear — if Donald Trump wins, he and his Project 2025 allies in Congress will make sure there is ‘no Obamacare.’ That means higher health care costs for millions of families and ripping away protections from Americans with preexisting conditions like diabetes, asthma, or cancer,” Harris campaign spokesperson Sarafina Chitika told NBC News.
A Trump campaign spokesperson told NBC that repealing Obamacare is not Trump’s position.
A big role for RFK JR? Still, the Johnson video only adds to broader concerns among critics of what a second Trump term might mean for U.S. healthcare. Those concerns were also raised by comments made this week by Robert F. Kennedy Jr., who reportedly said Monday that Trump has promised him “control” of key federal public health agencies, including the Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH) and the Food and Drug Administration (FDA).
In a video obtained by Politico, Kennedy said: “The key that President Trump has promised me is control of the public health agencies, which are HHS and its sub-agencies, CDC, FDA, NIH, and a few others.” Kennedy added that the Department of Agriculture would also be in his portfolio.
Politico notes that Kennedy, known for his anti-vaccine stance and other controversial opinions, would face significant challenges in winning Senate confirmation as HHS secretary or to another Cabinet post, if Trump were to nominate him. But Kennedy could still play a large role in any Trump administration health policy.
