Trump renews health care battle for 2020, but who wins?

With the Russia meddling probe complete, US President Donald Trump has unexpectedly pivoted to health care, alarming fellow Republicans who warn there is no coherent Obamacare replacement ready and galvanising Democrats.

The president trumpeted his renewed belligerence against the Affordable Care Act (ACA) this week when the Justice Department announced it was siding with a federal court ruling that declared the health care law, which has reduced the numbers of uninsured Americans by 20 million, unconstitutional.

"Obamacare is a disaster" that must be repealed, Trump tweeted on Thursday, repeating a newly framed campaign narrative that Republicans will become "the party of great health care" when it unveils a better plan.

'Trolling the Democrats'

But Trump, who was only recently cleared by Special Counsel Robert Mueller of colluding with Russia over election interference, offered no specifics or timetable for a replacement.

Will the political gamble help Trump's 2020 re-election efforts, as he moves to reassure supporters that he is honouring a campaign pledge to dismantle his predecessor Barack Obama's signature domestic achievement? Or does it play into Democratic hands?

Some Republicans are confounded by Trump's pivot, with moderate Senator Susan Collins saying she remained "vehemently opposed to the administration seeking to invalidate the entire ACA."

Top House Republican Kevin McCarthy reportedly told the president he disagreed with the administration's push to invalidate Obamacare.

Even Republicans who enthusiastically support Trump acknowledge no fresh Obamacare replacement plan is in the offing, and its likelihood of passing a divided Congress would be minimal.

Some strategists say Trump is looking instead at injecting himself into the ongoing primary battle between some 15 Democratic presidential hopefuls, many of whom are advocating various versions of universal health care, such as Medicare for all.

"He's trolling the Democrats by doing this," conservative consultant Patrick Hynes, an advisor to former presidential candidates John McCain and Mitt Romney, told AFP news agency on Thursday.

"By throwing this stink bomb into the public debate, the president is going to force all Democrat candidates and most Democratic officials to the hard left on... a policy proposal that is indefensible on its finances."

'War' on Obamacare

Democrats, who ran successfully on shoring up health care for more Americans in last year's mid-term elections, were relishing the chance to do so again.

"Now the president wants to go back to repeal and replace again? Make our day," proclaimed Senate Minority Leader Chuck Schumer from the Senate floor.

House Speaker Nancy Pelosi weighed in to criticise Trump's renewed "war on America's healthcare," and promised to fight against the Obamacare repeal effort in Congress, where her Democrats rule the House, in the courts, and "in the court of public opinion."

Several Democratic presidential hopefuls also joined the escalating battle, lobbing criticism at Trump's administration for seeking to kick millions off health care and return to an era when insurance companies could deny coverage to people with pre-existing conditions.

"Enough," tweeted liberal Senator Bernie Sanders. "We must defend the ACA and move forward to pass Medicare for All."

Reforming health care

At the heart of 2010's hugely consequential ACA was a mandate that Americans buy health insurance, while also forcing insurance companies to accept all applicants, even those with pre-existing health conditions.

Democrats saw the law as a historic step to getting tens of millions of Americans who had no health coverage to participate in what is a highly uneven and often inaccessible system.

Republicans have attacked the law from the start, especially the mandate on buying insurance, as government overreach.

They have whittled away at the law and managed to scrap the penalty imposed on anyone who fails to get insurance.

But the dozens of legislative attempts to repeal Obamacare have failed, and many Republicans have embraced the protections for those with pre-existing conditions.

Several have complained that Trump turned too swiftly to the toxic health care fight, saying he should instead enjoy a victory lap after Attorney General Bill Barr, having received Mueller's report, cleared the president of collusion with Russia.

"I would have liked to see him bask in his post-Mueller report a bit longer before shifting to policy issues," said Hynes, the Republican consultant.

Larry Sabato, director of the University of Virginia's Center for Politics, said Democrats hold an "enormous advantage" because Americans trust Democrats over Republicans on reforming health care.

While Sabato said it is already too late to pass an alternative health care plan through Congress before the election, Trump's goal is to rally conservatives who oppose Obamacare.

"Trump has had one priority since the day he entered the race: to please his hard-core base," Sabato said.