Obamacare Is On The Ballot In 2024 — And That's What Joe Biden Wants

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It has been 14 years since then-President Barack Obama signed the Affordable Care Act, with Vice President Joe Biden at his side. It was one of that administration’s crowning achievements — or, as Biden said in a famous hot mic moment, a “big fucking deal.”

On Saturday, Biden and Obama plan to mark the anniversary with a virtual campaign event, as part of a broader effort to put the law at the center of Biden’s presidential reelection campaign. The idea is to remind voters about what the Affordable Care Act has accomplished ― and what could happen to it if Donald Trump retakes the White House.

There is a lot to say on both counts.

Tens of millions of Americans now get health insurance through the Affordable Care Act, either via expanded state Medicaid programs that the ACA funds or subsidized private coverage that the ACA makes available. Together, those features have brought the proportion of Americans without health insurance to historic lows.

The law also introduced legal guarantees of coverage for people with preexisting conditions. Those matter because, back in the day, insurance companies could charge higher premiums to people with diabetes or a history of cancer ― or deny them insurance altogether. They could also sell policies that left out whole swaths of coverage, like maternity care or treatment for mental illness.

Now with Trump on the ballot again, those changes could be in jeopardy ― for reasons that are right out in plain view, but aren’t getting the close look they deserve.

Repeal And The Mythical Obamacare Alternative

When Trump ran for president in 2016, repealing the law was a central promise. Once he got