Washington
CNN
—
President Joe Biden and Vice President Kamala Harris squared off against Republicans on the health care issue in North Carolina on Tuesday, trying to push what they say is a winning issue ahead of the November election.
The Raleigh stop marked a rare joint appearance on the road by the president and vice president, underscoring the emphasis the duo will place on health care as they prepare to take on former President Donald Trump. It came on the same day the Supreme Court heard arguments over access to the abortion drug mifepristone, setting off a summer ruling that could have major implications for abortion rights.
Biden’s advisers believed Tuesday’s visit would create a stark contrast between the Democratic slate’s vision for health care and reproductive rights and the proposals made by Republicans. It comes amid a campaign slamming Trump for threatening to repeal the Affordable Care Act if elected to a second term.
“Donald Trump and MAGA’s friends are nothing if not constant. They tried 50 times to cancel it, it’s not a joke. Fifty times they have tried to cancel it. We’ve already stopped them every time,” Biden told the crowd at the Chavis Community Center in Raleigh, North Carolina. “Kamala and I returned to North Carolina to celebrate the ACA and remind all of us that we can take nothing for granted.”
The trip came as the Biden campaign eyed North Carolina as a possible November election opportunity after Biden lost the state to Trump by 1.3 percentage points in 2020. A Marist poll conducted this month found no clear front-runner in the Trump race receives 51% support to Biden’s 48% among registered voters, with a margin of error of 3.6 percentage points.
The North Carolina trip marks the last battleground state the president visits on his post-State of the Union tour. In less than three weeks, he traveled to Pennsylvania, Georgia, Wisconsin, Michigan, Nevada and Arizona, as well as New Hampshire and Texas. Before Tuesday’s trip, campaign officials argued that southern states like North Carolina and Georgia were a “critical part” of the president’s path to re-election.
Biden advisers have long signaled their intention to put health care at the center of the 2024 campaign, and Biden and Harris are set to make their case in the latest state to expand Medicaid to low-income adults.
The two seized on a recent budget proposal from the Republican Study Committee calling for numerous changes and cuts to Medicare, Medicaid and the Affordable Care Act, among other government programs. This would include ending federal subsidies for middle- and higher-income Americans, removing protections for people with pre-existing conditions, reversing Medicare’s ability to negotiate drug prices and making changes to state Medicaid programs.
Biden and Harris highlighted the success of the Affordable Care Act and discussed efforts to expand access to health care and lower prescription drug costs.
“If they get rid of the ACA because of Donald Trump and his MAGA Republicans in Congress, 45 million people across the country will lose their health insurance, including 1.4 million right here in North Carolina,” Biden said.
Harris, who has been the administration’s leading voice on abortion, compared the Democratic goal of protecting reproductive rights to Republican attempts to curtail them and took aim at Trump’s selection of three Supreme Court justices who helped end the the constitutional right to abortion in 2022. The campaign believes reproductive rights will be a hot-button issue for voters heading into the November election.
Biden’s team also hopes the popularity of the Affordable Care Act and proposals to lower health care and prescription drug costs will resonate with voters at the polls. Democrats seized on the GOP’s fiscal 2025 budget proposal released last week as evidence of how Republicans will manage health care if they win the White House and control of Congress this fall.
The proposed budget calls for ending federal premium subsidies for middle- and higher-income Americans. That aid, which expires at the end of 2025, was part of the 2021 American Rescue Plan and the 2022 Inflation Relief Act that Democrats pushed through Congress.
It would also remove the Affordable Care Act’s ironclad federal protections for those with pre-existing conditions and allow states to offer less comprehensive policies. The goal would be to lower the cost of coverage to attract more younger, healthier consumers and increase competition in the market. States will be able to limit how much extra insurers can charge those with pre-existing conditions, and they will operate federally subsidized pools of guaranteed coverage that will cover high-risk enrollees.
Obamacare currently limits how much insurers can charge enrollees in their 50s and early 60s, making their coverage more affordable but raising premiums for younger consumers.
The budget would also make Medicaid a so-called block grant program, giving states a fixed amount of federal funding instead of the current open-ended system that is based on state spending. It would also shift funding for children in Medicaid and the Children’s Health Insurance Program, known as CHIP, into a group subsidy that families could use to buy coverage.
Changes to the Affordable Care Act, Medicaid and CHIP will cut $4.5 trillion in federal spending over a decade, according to the White House.
The committee would also end Medicare’s ability to negotiate drug prices for the first time, a power it received as part of the Inflation Reduction Act. The Biden administration claims the provision will reduce spending and the deficit.
The committee’s proposal would also repeal other provisions of the drug law, including capping monthly insulin costs at $35 and annual drug out-of-pocket costs at $2,000 for Medicare enrollees.
Other changes to Medicare would include implementing “premium support” — which critics deride as vouchers — to allow Medicare enrollees to buy private health insurance plans. The committee says these plans would compete with traditional Medicare, but opponents say it could raise premiums for many seniors.
Meanwhile, Biden has been touting his health care record to highlight his efforts compared to his predecessor and presumed rival in the 2024 presidential election.
A record number of people – more than 21 million – have signed up for 2024 coverage in the Affordable Care Act exchanges. Increased federal premium subsidies lured many consumers to Obamacare policies.
In total, more than 45 million people gained coverage through the Affordable Care Act, according to the Biden administration.
In addition, the president has focused his efforts on lowering drug prices, primarily through the Inflation Reduction Act.
In addition, Biden called for making Obamacare’s enhanced subsidies permanent, increasing the number of drugs Medicare can cover annually to at least 50, expanding caps on insulin and out-of-pocket drug costs for those with private insurance, and provided Medicaid coverage for low-income adults in the 10 states that did not expand Medicaid.
Biden used the North Carolina stop to highlight the state’s recent expansion of health insurance to more than 400,000 residents thanks to the Affordable Care Act.
In December, North Carolina became the 40th state to expand Medicaid for low-income adults. Democratic Gov. Roy Cooper has championed the Affordable Care Act provision for years, finally convincing the Republican-led Legislature to drop its longtime opposition.
North Carolina is also the first state since 2018 to expand Medicaid through the legislative process. Since 2017, voters have approved ballot expansion in seven GOP-led states, most recently in South Dakota in 2022.
North Carolina has estimated that about 600,000 residents could become eligible under expansion. Individuals earning up to $20,783 and families of four with incomes of $43,100 are eligible.
Ten GOP-led states — including Texas, Georgia and Florida, which have among the highest uninsured rates in the nation — have yet to expand Medicaid. That leaves 1.5 million Americans in the so-called coverage gap — earning too much to qualify for Medicaid but too little to qualify for federal premium subsidies for Obamacare coverage, according to KFF, a nonpartisan research group .
The Biden administration tried to persuade more of the abstention states to expand Medicaid. Under the American Rescue Plan Act of 2021, expansion states would receive enhanced federal funding for two years, which would help offset state spending during that period.
Although several Republican legislatures have considered Medicaid expansions this year, none have yet approved them. State committees in Kansas and Georgia rejected the bills last week. Legislation to expand Medicaid in Mississippi passed the state House last month and is being considered by the Senate.
The president’s visit also comes amid what is expected to be one of the most competitive gubernatorial races this year. Attorney General Josh Stein, a moderate Democrat, and Lt. Gov. Mark Robinson, a right-winger with a history of inflammatory comments, will face off in the November race to replace Cooper, who is term-limited.
CNN’s Samantha Waldenberg contributed to this report.
This story was updated with additional developments on Tuesday.