This week, JD Vance reminded us exactly what the extreme Trump-Vance Project 2025 agenda on health care would do: rip away access to affordable health care coverage from millions of Americans, including people with pre-existing conditions. After Trump tried (and failed) to repeal the Affordable Care Act, Vance is making clear that it is a “priority” for him and Donald Trump to “terminate” the ACA — and they absolutely will if given the chance.

Here’s what they are saying about the Trump-Vance agenda to gut protections for pre-existing conditions:

Washington Post: “Vance floats new health plans for chronically ill, reopening ACA debate”

Key Point: “Sen. JD Vance (R-Ohio) this week said the Trump campaign wants to roll back the Affordable Care Act’s approach to how chronically ill Americans shop for health insurance, with the Republican vice-presidential candidate reopening a health-care debate that Democrats are eager to have — and resurrecting a fight that has repeatedly burned the GOP.

“Speaking in North Carolina on Wednesday, Vance floated an idea to group chronically ill patients together in health-insurance pools based on their elevated risks. That would reverse a shift driven by the Affordable Care Act, which largely ended the practice of shunting chronically ill patients into what are known as high-risk pools and provided new protections for patients with preexisting conditions.”

New York Magazine: “Vance: Trump’s Health-Care Plan Is to Let Insurers Charge More for Preexisting Conditions”

Key Point: “What Vance came up with is not only surprising but, if understood properly, far more damaging than Trump’s original statement. The Trump plan, according to Vance, is to permit insurance companies to discriminate against people with preexisting conditions.

The New Republic: “J.D. Vance Reveals Atrocious Little Detail of Trump’s Health Care Plan”

Key Point: “Vance said that under Donald Trump’s plan, Americans wouldn’t be put ‘into the same risk pools.’… But doing so, as Vance suggests, would come at the expense of much higher charges for everyone else—especially older Americans and those with pre-existing conditions. Right now, the law allows insurance companies to bill older people up to three times as much as they do for the young, Vance is talking about making that gap even higher.”

Bloomberg: “JD Vance’s Pitch Puts Obamacare Repeal Efforts Back in the Spotlight”

Key Point: “Democrats are seizing on JD Vance’s pitch to do away with a bedrock part of the Affordable Care Act, saying it would cause costs for chronically ill people to spike.

“At a rally on Wednesday, Vance said a second Trump administration would work to separate people into different risk pools, allowing them ‘to choose a health care plan that works for them.’

“Such a policy would effectively end the ACA’s guarantee that people pay the same prices and get the same benefits regardless of their health status, a popular part of the program.”

Politico: “How JD Vance reopened the health care fight”

Key Point: “Vance on Meet the Press last Sunday and in Raleigh on Wednesday, outlined a plan to ‘deregulate’ health care while somehow still making sure everyone had coverage, including the tens of millions of Americans with pre-existing conditions.

“‘You also want to implement some deregulatory agenda so that people can choose a health care plan that fits them,’ he said. ‘And we want to make sure everybody is covered.

“‘But the best way to do that is to actually promote some more choice in our health care system and not have a one-size-fits-all approach that puts a lot of people into the same insurance pools, into the same risk pools, that actually makes it harder for people to make the right choices for their families,’ Vance added.”

The Hill: “Vance revives old GOP fights on ObamaCare insurance coverage”

Key Point: “Republican vice presidential nominee Sen. JD Vance (R-Ohio) on Sunday floated an idea that would turn back the clock on covering people with preexisting conditions, relitigating a position that was a hallmark of GOP proposals to replace ObamaCare during Donald Trump’s presidency.

“In an interview on NBC’s ‘Meet the Press,’ Vance said Trump’s health plan would ‘promote choice’ in the health system by separating sicker people into different health insurance coverage pools from the healthier populations.”

The 19th: “Health plan floated by JD Vance could weaken protections for pregnant people”

Key Point: “A health care proposal suggested by Republican vice presidential candidate JD Vance could gut a popular Affordable Care Act protection, making it legal for companies to charge more for or deny coverage of expensive medical conditions, including pregnancy.

“Speaking at a Wednesday event in North Carolina, Vance said that if elected, former President Donald Trump would change health insurance regulations so that people who are healthier and use their insurance less can have cheaper coverage, while those with chronic conditions or who use health care more would have different insurance.”

Vox: “Trump’s health care plan exposes the truth about his ‘populism’”

Key Point: “On that program, NBC’s Kristen Welker asked Vance to explain what — if anything — Trump planned to change about America’s health care system. 

[…]

“[T]he one concrete policy Vance did detail would actually involve making health care coverage less affordable for those with chronic illnesses.”

Semafor: “JD Vance reopens the pre-existing condition debates”

Key Point: “Vance’s comments in the same interview appeared to reference policy ideas advanced by Trump during his presidency that would have significantly changed, pared back, or eliminated aspects of the law’s protections for people with pre-existing conditions.

[…]

“He also criticized the law for putting people into ‘the same risk pools’ with a ‘one-size-fits-all approach’ — a seeming reference to prior Republican proposals to offer insurance to people with expensive conditions in separate ‘high risk pools’ rather than require insurers to cover everyone together under similar plans.”

Washington Post: “Opinion: Trump’s ‘concepts of a plan’ would destroy the health-care system”

Key Point: “Vance is referring to letting insurance companies offer different plans and pricing based on whether patients have preexisting conditions or might need more medical care because of their age, health status, gender, etc., or perhaps even their genetic profile. Rather than spreading the insurance risk around to a larger group of people who to some extent cross-subsidize one another, Vance wants to segment riskier patients into their own ‘pools.’ Sicker, higher-risk, more expensive people can ‘choose’ to go into one pool; healthier, less risky, cheaper-to-insure people can ‘choose’ to land in another.

“Allowing insurers to discriminate based on age or preexisting conditions has long been politically unpopular. But politics aside, the bigger problem with this design is that it would probably cause insurance markets to implode.”