Joe Biden To Focus On Obamacare In A State Where It Just Got More Vital

President Joe Biden is about to spend another day reminding voters that health care is on the ballot in 2024. 

And this time hes doing it in a swing state that suddenly has 350,000 more people for whom the health care debate is personal.

In a visit Tuesday to Raleigh, North Carolina , Biden and Vice President Kamala Harris will tout a series of recently enacted Democratic initiatives designed to make health care more affordable, White House officials said. Those new initiatives include programs designed to reduce the price of prescription drugs  as well as additional financial assistance for people buying private insurance through the Affordable Care Act, also known as Obamacare.

Biden and Harris wont just talk about the past, the White House officials said. They also plan to lay out a vision for how theyd like to expand on these initiatives by, for example, giving the federal government even more leverage over prescription drug prices. These are the same ideas that Biden mentioned in his State of the Union address earlier this month.

But in what is likely to be the most politically charged part of their speeches, Biden and Harris will contrast their administrations record and vision with the Republicans stand.

That will mean highlighting the GOPs history of trying to repeal the Affordable Care Act and make severe cuts in Medicaid. It will also mean citing a new budget plan from House Republicans that seeks to undo the Affordable Care Acts core elements while rolling back big pieces of the new drug pricing laws.

Former President Donald Trump is, of course, a big part of the GOP history on the Affordable Care Act. He tried to lead repeal efforts in 2017, the first year of his presidency. Now, the partys presumptive nominee for 2024 has indicated he would try to repeal it again  if he wins the election.

The Trump and GOP agendas on health care would cause dramatic changes in every state. But the greatest effect would be in states that have expanded their Medicaid programs , with money from the Affordable Care Act, so that most legal residents living below or just above the poverty line are eligible.

Thats what makes the issue especially important for North Carolina. 

North Carolina Just Expanded Medicaid

The state expanded its Medicaid program last year, becoming the 40th state to do so . And it was a watershed moment, because it was Republican lawmakers who approved the legislation that Democratic Gov. Roy Cooper, a longtime champion for Medicaid expansion, signed into law.

As of February, nearly 350,000 low-income residents had signed up for expanded Medicaid, according to the states Department of Health and Human Services. Thats more than half the newly eligible population.

All of them now have something to lose if that money from the Affordable Care Act goes away. And thats on top of all the other people , both in North Carolina and the nation as a whole, who could lose access to traditional Medicaid or subsidized private insurance through Obamacare if GOP plans to roll back the law succeed.

Republicans at the national level have long argued that the money going into Medicaid and subsidized private insurance through the Affordable Care Act distorts the natural market for health care while driving up government spending to unsustainable levels. Republicans have also argued that the new income taxes to pay for coverage expansion, which fall on the wealthy, harm the economy.

North Carolinas Republicans said similar things while they were blocking Medicaid expansion, going all the way back to votes in 2013. But many of them changed their minds in the last few years after hearing stories about uninsured farmers and small-business owners who would become eligible for the program and hearing from rural hospitals that were struggling financially because so many of their patients had no way to pay their bills.

The prospect of scaling back federal assistance for health insurance, leaving millions or even tens of millions more Americans uninsured, proved highly unpopular in 2017, when Trump was in office and trying to push repeal legislation. Even many of the people who said they werent happy with Obamacare or thought it had left them worse off thought the Republican alternatives seemed less appealing.

Today, there is still a significant chunk of the U.S. population struggling with health care costs . But the number without health insurance is at an all-time low while enrollment in the Affordable Care Acts private insurance options is at a record high. And the law itself is more popular than ever, according to polls.

The prescription drug reforms that Biden and the Democrats achieved are also quite popular , according to the polls, although the same surveys suggest large numbers of Americans arent aware of the reforms.

A primary goal of Tuesdays visit, along with other past events and those likely to come, is to make sure Americans know about these accomplishments and the jeopardy these efforts would face if Republicans have enough control in Washington to pass laws again. 

Abortion Is Also On The Ballot

The Affordable Care Act and prescription drugs arent the only health care topics that will come up in Tuesdays appearances, White House officials said. Harris plans to focus her remarks on the administrations defense of abortion rights.

Abortion will already be in the news Tuesday because the U.S. Supreme Court is holding oral arguments on a case about the availability and legality of abortion pills .

Reproductive rights have been heavily contested in North Carolina, as they have been across the country, since the Supreme Court in 2022 overturned Roe v. Wade, the 1973 decision that had made access to abortion a federal right. A new state law , enacted after Republicans in the legislature overrode Coopers veto, has introduced a series of restrictions and bans the procedure under most circumstances after 12 weeks of pregnancy.

In November, abortion rights advocates in the state hope to make gains in the legislature and, no less important, to defeat GOP gubernatorial nominee Mark Robinson, an outspoken right-wing politician who has called abortion a scourge and said he wants to push the limit on abortion to six weeks .

Robinson has also compared the Affordable Care Act to enslavement, as first reported in the Daily Beast . 

He has also posted on Facebook that he doesnt want repeal and replace, the usual GOP slogan that implies Republicans will come up with a better alternative to the Affordable Care Act. Instead, Robinson wrote, I just want REPEAL!

When it comes to insurance/healthcare, the federal government can just kick rocks, Robinson wrote in a post that appeared in 2017. 

White House senior adviser Anita Dunn, who on Monday briefed reporters about the North Carolina visit, would not say whether Biden or Harris planned to mention Robinson in their remarks. But Dunn said that anybody listening to the speeches would get a clear sense of two very different visions for moving this country forward.

CORRECTION: A previous version of this article misidentified the Republican North Carolina gubernatorial candidate as Mark Johnson. His name is Mark Robinson.