The Kamala Harris presidential campaign just released a new health care plan.

It’s not her own plan, because she published that already as part of the broader economic agenda she first unveiled in late summer.

This time, it’s Donald Trump’s health care plan ― or, more precisely, what she and her team imagine that Trump would try to enact if he’s elected again.

The exercise is necessary, Harris advisers say, because health care access for many millions of Americans is at stake in the election, and Trump has sent out confusing, sometimes contradictory signals about what he would do.

He has said he still wants to repeal and replace the Affordable Care Act, for example, though he has not specified how. In his September debate with Harris, he said he only has “concepts of a plan.”

Meanwhile, Trump’s running mate, Sen. JD Vance (R-Ohio), has indicated recently Republicans would try to pursue a “deregulatory agenda” that, among other things, would not place people “into the same insurance pools.”

That is the same language Republicans used to describe their plans to repeal the Affordable Care Act, aka “Obamacare,” in 2017 when Trump was in office and spent most of his first year trying to get rid of the law.

That effort failed and provoked a strong political backlash, in no small part because of projections suggesting the number of Americans without insurance would rise by more than 10, 20 or even 30 million people depending on the bill.

The point of Monday’s paper from the Harris campaign is to remind people that Trump tried to repeal before ― and could try it again ― threatening health care access for the tens of millions who now depend on the Affordable Care Act.

Polls have shown repeatedly that such an effort could be even more unpopular than the last one, although until recently, health care has received relatively little attention in the campaign.

“They may not want Americans to see the details of their plan, but Vice President Harris and Governor Walz won’t let them get away with hiding its effects,” Harris campaign Senior Policy Advisor Brian Nelson said in a press release, provided to the media in advance of Monday’s paper. “The new report our campaign is releasing today lays out for the first time what their plan really is and how it would raise costs and remove peace of mind for millions of Americans.”

A Refresher On Trump And Obamacare

The Affordable Care Act, widely considered the signature domestic policy achievement of the Obama era, expanded eligibility for Medicaid, the government insurance program for low-income Americans. It also prohibited private insurers from hiking premiums, selling limited policies or denying coverage to people with preexisting conditions.

The latter part made private insurance more expensive in some cases, because it meant insurers could no longer avoid covering bills for people with serious medical needs. To offset those increases, the law provided subsidies in the form of tax credits worth hundreds, sometimes thousands of dollars a year.

The trade-off didn’t work out well for some Americans ― and didn’t reach others ― which is among the reasons why, even today, large numbers of Americans struggle with health care costs. But the proportion of Americans without insurance is at historic lows, while access to care, financial security and health care have improved, according to a large and still growing body of academic research.

Republicans maintain the country is still worse off as a result ― partly because they believe the combination of new government spending, regulations and taxes made health care markets less efficient. Their 2017 repeal proposals would have rolled back the Affordable Care Act’s reforms, in one way or another.

Those bills would also have dramatically reduced government spending on health care, freeing up money Republicans wanted to use in order to finance tax cuts that would have disproportionately benefited wealthy Americans.

The new Harris campaign report tries to show what a Trump-led repeal effort might look like today, extrapolating from sources like the U.S. Department of Health and Human Services, and the non-partisan organization, KFF.

In addition to tallying up the number of people who could lose insurance, the report spotlights the number of people with preexisting conditions who could lose the protection of the Affordable Care Act’s insurance rules.

The paper also notes that rural hospitals could suffer, because so many of them depend on funding from expanded Medicaid to cover their expenses.

A Look At Prescription Drugs Too

It’s not just the Affordable Care Act whose future could depend on the outcome of the election.

One of the signature Democratic accomplishments of the Biden era was a set of measures to reduce the price of prescription drugs, enacted as part of the 2022 Inflation Reduction Act.

The law gives the federal government the authority to negotiate directly with manufacturers, in order to bring down prices for certain high-priced drugs available to seniors and people with disabilities through the Medicare program.

Trump has said he wants to repeal the Inflation Reduction Act, as have Republican members of ― and candidates for ― Congress all over the country. And although he hasn’t specified whether that includes the law’s prescription drug provisions, conservative documents like Project 2025, the proposed right-wing governing agenda from the Heritage Foundation, have proposed repealing those provisions.

The conservative argument against these reforms is that they set lower prices for drugs arbitrarily, reducing revenue that underwrites research and development of better treatments. The liberal argument for these reforms is that drug companies exploit existing laws to jack up prices in ways that don’t actually lead to better research, which the public already finances through government grants.

Harris favors the latter argument, and has actually proposed expanding the existing authority to cover more drugs for more people. She also wants to renew some temporary increases in financial assistance for people buying insurance through the Affordable Care Act.

That’s a lot less likely to happen if Republicans get power, because they object to the extra government spending, just like they have always objected to the Affordable Care Act.

With Monday’s release, the Harris campaign hopes more voters learn about that.