Biden and Harris team up for a rare joint appearance in North Carolina to take on GOP over health care

By Arlette Saenz and Tami Luhby, CNN

Washington (CNN) — President Joe Biden and Vice President Kamala Harris took on Republicans over health care in North Carolina on Tuesday, looking to press what they believe is a winning issue ahead of November’s election.

The Raleigh stop marked a rare joint appearance on the road by the president and vice president, highlighting the emphasis the duo will place on health care as they prepare to face off against former President Donald Trump. It came the same day the Supreme Court heard arguments on access to the abortion medication mifepristone, teeing up a summer decision that could have major implications for abortion rights.

Biden’s advisers believed Tuesday’s visit would provide a stark contrast between the Democratic ticket’s vision for health care and reproductive rights and proposals put forth by Republicans. It’s taking place on the heels of a campaign push slamming Trump for threatening to repeal the Affordable Care Act if he’s elected to a second term.

“Donald Trump and MAGA friends are nothing if not persistent. They’ve tried to repeal it 50 times, not a joke. Fifty times they’ve tried to repeal it. We stopped them every time now,” Biden said to the crowd at Chavis Community Center in Raleigh, North Carolina. “Kamala and I have come back to North Carolina to celebrate the ACA and to remind all of us, we can’t take anything for granted.”

The trip came as the Biden campaign is looking to North Carolina as a possible pickup opportunity in November’s election after Biden lost the state to Trump by 1.3 percentage points in 2020. A Marist poll conducted this month found no clear leader in the race, with Trump receiving 51% support to Biden’s 48% among registered voters, with a margin of error of 3.6 percentage points.

The North Carolina trip marked the final battleground state the president is visiting in his post-State of the Union tour. In less than three weeks, he’s traveled to Pennsylvania, Georgia, Wisconsin, Michigan, Nevada and Arizona, as well as to New Hampshire and Texas. Ahead of Tuesday’s trip, campaign officials argued Southern swing states such as North Carolina and Georgia are a “critical piece” of the president’s path to reelection.

Biden’s advisers have long signaled their intent to put health care front and center in the 2024 campaign, and Biden and Harris are set to make their arguments in the latest state to expand Medicaid to low-income adults.

The pair seized on a recent budget proposal from the Republican Study Committee calling for a multitude of changes and cuts to Medicare, Medicaid and the Affordable Care Act, among other government programs. It would include ending federal subsidies for middle- and higher-income Americans, eliminating protections for individuals with preexisting conditions, reversing Medicare’s ability to negotiate drug prices, and making changes to Medicaid programs in states.

Biden and Harris highlighted the success of the Affordable Care Act and discussed efforts to expand access to health care and lower prescription drugs costs.

“If they get rid of the ACA because of Donald Trump and his MAGA Republicans in Congress, 45 million people nationwide would lose their health insurance, including 1.4 million right here in North Carolina,” Biden said.

Harris, who has served as the administration’s lead voice on abortion, compared Democrats’ aim of protecting reproductive rights with Republican attempts to limit them, and took aim at Trump’s selection of three Supreme Court justices who helped end the constitutional right to an abortion in 2022. The campaign believes reproductive rights will be a galvanizing issue for voters heading into November’s elections.

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 ballot box. Democrats have seized on the Republican Study Committee’s fiscal year 2025 budget proposal released last week as evidence of how Republicans would govern on health care issues if they win the White House and control of Congress this fall.

What’s in the Republican Study Committee’s proposal

The proposed budget calls for ending federal premium subsidies for middle- and higher-income Americans. This assistance, which is set to expire at the end of 2025, was part of the American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022, which Democrats pushed through Congress.

It would also eliminate the Affordable Care Act’s ironclad federal protections for those with preexisting conditions and allow states to offer less comprehensive policies. The goal would be to reduce the cost of coverage to attract more younger, healthier consumers and to increase market competition. States would be able to restrain how much extra insurers could charge those with preexisting conditions, and they would run federally subsidized guaranteed coverage pools that would cover high-risk enrollees.

Currently, Obamacare restricts how much more insurers can charge enrollees in their 50s and early 60s, making their coverage more affordable but increasing premiums for younger consumers.

The budget would also turn Medicaid into a so-called block grant program, providing states with a fixed amount of federal funding instead of the current open-ended system that is based on states’ costs. It would also shift funding for children in Medicaid and the Children’s Health Insurance Program, known as CHIP, into a block grant that families could use to buy coverage.

The changes to the Affordable Care Act, Medicaid and CHIP would slash $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 argues the provision will reduce costs and the deficit.

The committee’s proposal would also repeal the law’s other drug provisions, including capping monthly insulin costs at $35 and annual out-of-pocket drug 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 argues these plans would compete with traditional Medicare, but opponents say it could raise premiums for many seniors.

Biden’s record

Meanwhile, Biden has been touting his health care achievements to highlight his efforts as compared with his predecessor and presumptive 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. The enhanced federal premium subsidies have lured many consumers to Obamacare policies.

More than 45 million people in total have gained coverage through the Affordable Care Act, according to the Biden administration.

Also, the president has focused on his efforts to reduce drug prices, mainly through the Inflation Reduction Act.

In addition, Biden has called for making the enhanced Obamacare subsidies permanent, increasing the number of drugs Medicare can negotiate annually to at least 50, expanding the caps on insulin and out-of-pocket drug costs to those with private insurance, and providing Medicaid-like coverage to low-income adults in the 10 states that haven’t expanded Medicaid.

North Carolina’s Medicaid expansion

Biden used the North Carolina stop to highlight the state’s recent expansion of health insurance coverage to more than 400,000 residents, thanks to the Affordable Care Act.

In December, North Carolina became the 40th state to expand Medicaid to low-income adults. Democratic Gov. Roy Cooper had advocated for the Affordable Care Act provision for years, finally convincing the Republican-led legislature to drop its long-standing opposition.

North Carolina is also the first state since 2018 to broaden Medicaid through the legislative process. Since 2017, voters have approved expansion at the ballot box 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 be eligible for federal premium subsidies for Obamacare coverage, according to KFF, a nonpartisan research group.

The Biden administration has sought to persuade more of the holdout states to expand Medicaid. Under the American Rescue Plan Act of 2021, states that expand receive enhanced federal funding for two years, which would help offset state costs during that period.

Though several Republican legislatures were considering Medicaid expansion this year, none have yet approved them. Statehouse committees in Kansas and Georgia voted down bills last week. Legislation to expand Medicaid in Mississippi was passed by the state’s House last month and is being considered by the Senate.

The president’s visit also comes against the backdrop of what’s expected to be one of this year’s most competitive governor’s races. Attorney General Josh Stein, a moderate Democrat, and Lt. Gov. Mark Robinson, a right-wing firebrand with a history of inflammatory comments, are set to face off in November’s contest to replace Cooper, who is term limited.

CNN’s Samantha Waldenberg contributed to this report.

This story has been updated with additional developments on Tuesday.

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