ObamaCare and its pre-existing conditions protections have been a political third rail in recent years. But that hasn’t stopped Republican vice presidential nominee JD Vance from floating ideas in the past week that critics say could roll back the popular protections, picking a fight that Democrats are more than willing to take up.

During a campaign rally in North Carolina on Wednesday, Vance described a plan to remove federal regulations from the health care system but still ensure people get the coverage they need. 

“We’re gonna actually implement some regulatory reform in the health care system that allows people to choose a health care plan that works for them,” Vance said. 

He added the idea would be to “allow people with similar health situations to be in the same risk pools,” meaning sicker people would have to buy different insurance plans from people who were healthy. 

“That’s the biggest and most important thing that we have to change,” Vance said.  

His remarks during the rally expanded on comments he made in an interview on NBC’s “Meet the Press” last week, where he said former President Trump doesn’t believe in a “one-size-fits-all” approach that puts “a lot of people into the same insurance pools.” 

Vance did not offer any other details, so it’s not clear if his remarks represent an official Trump campaign health plan, but Trump aides have said he and Vance are broadly aligned on health care. Vance also said he’s “learned his lesson” about speaking for Trump, as he previously needed to walk back comments about Trump vetoing a national abortion ban. 

On the presidential debate stage, Trump said he had “concepts of a plan” to replace the health law if it were repealed, drawing ridicule from Democrats. Trump’s official platform doesn’t mention ObamaCare at all. 

In attempting to fill in the blanks of Trump’s plan, Vance described the same “high-risk pools” championed by conservatives in the House when they were crafting an ObamaCare replacement bill in 2017.  

Democrats were more than happy to point out the echoes. 

“This looks to me like what amounts to a de facto repeal of one of the protections everyone says they’re for around here,” Sen. Ron Wyden (D-Ore.) said during a Senate Finance Committee hearing last week. 

“The concepts proposed by JD Vance are a prescription for discriminating against those with preexisting conditions,” he added.  

The Harris campaign was also quick to amplify Vance’s comments. 

“There should be no doubt about Donald Trump’s commitment to end the Affordable Care Act — he and House Republicans tried doing it over 60 times,” Harris spokesperson Joseph Costello said in a statement. 

“Now, one of the ‘concepts’ he’s bringing back is his plan to rip away protections for pre-existing conditions, throw millions off their health care, and drive up costs for millions of Americans with pre-existing conditions.” 

A spokesman for Vance said the senator “was simply talking about the significant improvements President Trump made to the Affordable Care Act through his deregulatory approach, which aimed to bring down the cost of premiums while ensuring coverage for pre-existing conditions.”

The Affordable Care Act, or ObamaCare, has experienced a significant political renaissance. 

Almost as soon as the law was passed in 2010, it became an albatross for Democrats. It cost them control of the House and Senate, and Trump pledged to “repeal and replace” the health law on his way to winning the presidency in 2016.

But after Trump and congressional Republicans failed to repeal the law in 2017 by a single vote, its popularity soared. Democrats won back control of the House in the 2018 midterms in part by campaigning on protecting preexisting conditions.    

When Trump was elected in November 2016, just 43 percent of adults supported ObamaCare, according to a tracking poll conducted by the nonpartisan health research group KFF. The most recent poll published in May showed 62 percent of respondents view the law favorably.  

“I think there is a broad consensus across geography, party, age, ethnic group, that people should not be denied or discriminated against based on their preexisting conditions,” said Anthony Wright, CEO of the health advocacy group Families USA. “And yet, this is where we are. It is bizarre that we’re still talking about it.” 

Vance’s ideas are not unique to the Trump campaign. 

For instance, the fiscal 2025 budget proposal from the Republican Study Committee, which includes most of the House GOP caucus, recommends removing many of the existing protections for people with preexisting conditions, including allowing states to offer separate risk pools for younger, healthier people.  

Experts have said high-risk pools can work in theory if they are sufficiently subsidized by the government. For more than 35 years, before the Affordable Care Act passed, red and blue states alike used high-risk pools to cover people with expensive medical conditions separately from the rest of the insurance market.   

But the pools lacked sufficient funding and so rarely succeeded in covering people who needed insurance the most.  

“I have yet to see an example of them ever being done right,” Wright said. 

Polls show voters want to hear about plans to lower health costs. And according to a KFF tracking poll released earlier this month, voters trust Vice President Harris to do a better job than Trump on health costs by a 48-to-39-percent margin. 

Democratic groups are also painting Trump as an “existential threat” to drive voters to the polls.  

The Democratic-aligned group Protect Our Care is launching a “Lower Costs, Better Care” bus tour on Sept. 23 across battleground states. They want to highlight the efforts of the Biden-Harris administration while also “sounding the alarm about the threat Donald Trump and MAGA Republicans pose to American health care.” 

Updated: 11:05 on Sept. 23