WASHINGTON — Six days after President Donald Trump's administration asked the Supreme Court to overturn Obamacare, voters in deeply red Oklahoma effectively voted to embrace the law by adopting its Medicaid expansion.
The narrow victory for Obamacare came in a state that Trump won by 36 points in 2016, highlighting a growing gap between the president and his own base on health care as he asks Americans to give him four more years. The tension comes as anxieties are rising amid a coronavirus resurgence that has forced some states to pause or roll back the reopening.
Oklahomans joined voters in other red states like Utah, Nebraska and Idaho in expanding Medicaid under the 2010 law, which the Supreme Court made optional. Trump does not appear in any danger of losing these states on Nov. 3, but Democrats intend to weaponize the issue elsewhere — in battleground states.
For Trump, health care could go from being a vulnerability to a fatal political wound. It was the top issue for voters in the 2018 elections and those who cited it preferred Democratic candidates by 52 points in House races, according to exit polls.
Joe Biden is hoping to replicate that this fall by criticizing Trump's attempts to undo Obamacare's protections for pre-existing conditions and expansion of Medicaid coverage for low-income people.
"He just keeps giving us more ammunition," said Guy Cecil, the chair of the Democratic super PAC Priorities USA.
Obamacare enrollment surged by 46 percent in June, compared to the same time last year, according to a report by the Department of Health and Human Services. Nearly half a million consumers gained coverage through the law, which is one of the few options for people who lost their employer-based health care plans during the coronavirus pandemic.
The other option is COBRA, which allows Americans who lost their job to keep their employer-based plan by paying 102 percent of the cost. That is an unaffordable sum for many.
A Fox News poll taken mid-June found that 39 percent of Americans approve of Trump's handling of health care, while 53 percent disapprove. A recent Quinnipiac poll found that Biden has a 14-point lead over Trump among respondents asked which candidate would better handle health care.
The issue also could have implications for Republicans in competitive congressional races.
Sen. Susan Collins, R-Maine, who faces a difficult re-election battle this fall, said the Trump administration's attempt to eliminate the ACA in court was wrong on the law and the policy.
"Congress maintained important consumer protections in the ACA for people with pre-existing conditions such as asthma, arthritis, cancer, diabetes and heart disease," she said. "The administration's decision to submit this new brief is the wrong policy at the worst possible time as our nation is in the midst of a pandemic. The Affordable Care Act remains the law of the land, and it is the Department of Justice's duty to defend it."
Collins was a rare Republican who voted against the repeal of Obamacare in 2017. Other vulnerable GOP lawmakers like Sen. Cory Gardner, R-Colo., and Sen. Martha McSally, R-Ariz., supported it.
Republicans have successfully fought to eliminate several unpopular provisions in the law, such as the individual requirement for most people to buy coverage and taxes on medical devices and the so-called Cadillac tax on high-cost plans.
Trump's ongoing determination to eliminate the 2010 law is consistent with two driving forces in his presidency: Fight for his most passionate supporters and undo President Barack Obama's initiatives. But while "Obamacare" continues to be viewed negatively by Republicans, the law's remaining provisions are popular. Medicaid expansion proponents in red states have notably refrained from using the nickname for the Affordable Care Act.
The White House defended its attempts to roll back the ACA.
"A global pandemic does not change what Americans know: Obamacare has been an unlawful failure and further illustrates the need to focus on patient care," White House spokesman Judd Deere said, arguing that the law has limited consumer choice of plans and providers and that Trump has fought to improve those issues. "The American people deserve for Congress to work on a bipartisan basis with the President to provide quality, affordable care."
But the White House has not offered an alternative plan.
The replacement proposals that Trump endorsed in 2017, which fell short of passing the Republican-controlled Congress, would have rolled back Medicaid coverage and weakened protections for pre-existing conditions due to state waivers allowing insurers to charge people more for coverage on the basis of factors like health status.
"People, even Trump voters, want their Medicaid. Trump just wants applause from right-wing Twitter for taking it away," said Democratic consultant Jesse Ferguson, who worked on Hillary Clinton's 2016 campaign. "The 2020 election will be pretty simple: if you want more sick people without health care coughing on you, vote Trump."