WASHINGTON — Donald Trump surprised fellow Republicans by vowing to repeal the Affordable Care Act if he becomes president again. Republicans have largely abandoned their effort to repeal President Barack Obama’s signature health care law, the Affordable Care Act, after losing a series of legal and legislative battles that highlighted the law’s popularity.

What You Need To Know

  • While issues such as border security always come up in the Republican presidential debates, rarely does health care, and more specifically former President Barack Obama’s Affordable Care Act

  • Last month, former President Donald Trump said he would revive efforts to repeal "Obamacare" and said he was looking at other alternatives

  • Republicans had largely abandoned their effort to repeal the federal health care law, after losing a series of legal and legislative battles that highlighted the law’s popularity

  • Democrats around the country are pouncing on his new vow – including two Democrats running for Senate in Texas

While issues such as border security always come up in the Republican presidential debates, rarely does health care, and more specifically Obama’s Affordable Care Act. Some health care policy experts aren’t surprised.

“At this point, many rural areas, which have started to become an increasingly important part of their voter share, are benefiting greatly from Medicaid expansion and expansion states,” said Michael Shepherd, an assistant professor in the Department of Government and the Health and Society Program at the University of Texas at Austin. “It's not a particularly good general election issue for them.”

“However, in the primary, for a candidate like Donald Trump, or for any Republican looking to distinguish themselves, being willing to say that you're going to tackle or take on the opposing party's crowning achievement over the last decade or so is perhaps a rallying point for primary voters,” Shepherd continued.

But last month, Trump said he would revive efforts to repeal so-called "Obamacare," writing on social media, “I’m seriously looking at alternatives.”

Killing the law would fulfill a campaign promise that he did not achieve when he was president. And now Democrats around the country are pouncing on his new vow – including two Democrats running for Senate in Texas.

“I want to make sure that every Texan has access to affordable health insurance and affordable prescription drugs that should be the bare minimum that we can provide in our country. The situation we have now is a cruel situation in which the highest uninsured rate in the country, we are hurting folks who would have access to some of the best institutions and best physicians in the world, but can't get access to it. But it's also costing us a lot of money,” said Rep. Colin Allred, D-Dallas, who is running for Senate.

“Health care is an absolute right, it is not a privilege, and we've allowed private insurance companies to gain and profit off of the backs of sick people. We've got to continue to change health care so that working class families can have more money in their pockets. That's period. That's what we must do. And so keeping the Affordable Care Act is important, but moving towards a universal health care plan is something that the United States must do now,” said State Rep. Roland Gutierrez, D-San Antonio, who is running for Senate. 

Texas has the highest rate of people without health insurance in the country and the Republican-led state legislature has refused to expand Medicaid to address that gap, which is a key feature of the federal health care law.

Both candidates criticize how Sen. Ted Cruz, R-Texas, who is running for another term, has long tried to rescind the ACA. In 2013, Cruz gave a marathon speech against the law. 

“Every leading country in the world has some form of universal health care except this one, and so what does it tell you? It tells you that our health care system is dominated by corporate greed, dominated by big insurance companies, and I guess Donald Trump and others (want) to keep that kind of model in place,” Gutierrez said. 

“This is something that we should all agree on, that for life-saving drugs that you have to have, that you should be able to afford it, and that's something that I'll always be focused on in the Senate. We know where Ted Cruz stands. He wants to stay with 'Big Pharma' and keeping your costs higher,” Allred said.

Shepherd studies the public’s broader attitudes on health care policy and he said while it won’t be a defining campaign topic, he believes making an issue of health care access could score points with rural and Hispanic voters, in particular.

“Most of that's going to come down to how much of the debate gets to be a debate about the national politics of 'Obamacare,' and the Affordable Care Act versus the actual benefits that expanding something like Medicaid might have on a state like Texas, where the benefits would be phenomenal,” he said.

Cruz reportedly told NBC News last week he would love Congress to revisit the issue. His campaign and Senate office declined Spectrum News’ request for further comment.