President Trump talks to reporters as he stands with Republican Senate leaders on Capitol Hill, January 9, 2019. (Jim Young/Reuters)

President Trump announced over Twitter this morning that “some very talented people” are “now developing for me & the Republican Party” a replacement for the Affordable Care Act, aka Obamacare, that “will be on full display during the Election as a much better & less expensive alternative.” They better work quickly, and carefully. Health care is a morass. Few politicians, Democratic or Republican, emerge from the issue unscathed.


Random House defines an “aginner” as “a person who opposes a plan, proposed legislation, or any drastic change.” When it comes to the politics of health care and entitlements, aginners have the advantage. It is far safer for a candidate to attack proposed overhauls of American public insurance and pensions than it is to defend them. In 1994, Republicans benefited from public opposition to Hillary Clinton’s health reform. In 2010, Republicans won the House on the pledge to repeal Obamacare. Continued fallout from Obamacare’s troubled launch in 2013 helped the GOP retain the House and win the Senate the following year.

But aginners are not Republicans. They target both parties. They went after the GOP in 2005 when George W. Bush attempted to introduce personal accounts to Social Security. In 2018, Democrats attacked Republicans for their purported willingness to repeal Obamacare without guaranteeing that Americans with pre-existing medical conditions would be insured. Forty-one percent of respondents in the national exit poll last year said health care was the most important issue in the country. These voters broke Democratic, 75 percent to 23 percent.


The 2020 election presents aginners with a choice. Whom do they fear more: aloof Republicans or radical Democrats? Democrats will recycle the pre-existing conditions argument from 2018. Republicans, meanwhile, will denounce Progressive and democratic-socialist plans for Medicare for All and further centralization and regulation of medicine.

A Trump proposal would further complicate matters by giving Democrats a target. One is necessary, though, not only for policy reasons but to preempt the pre-existing conditions attack. Trump and Republicans have to explain how they’ll improve American health care, while retaining the elements of the system that voters like. But they can’t be seen as going too far. That would rile up the aginners. And you need them on your side.