No talk of Obamacare. Or abortion.

At the Republican National Convention in Milwaukee this week, where delegates officially nominated Donald Trump as the party’s 2024 presidential candidate, health care issues received little attention from prime-time speakers.

The silence is surprising, given health care makes up the largest chunk of the federal budget, nearly $2 trillion, as well as 17% of U.S. economic output.

It also stands in stark contrast to the GOP’s priorities when it first nominated Trump.

In 2016, the last time Republicans gathered en masse for a presidential convention, repealing the Affordable Care Act was a favorite topic. So was overturning Roe v. Wade and its constitutional protections for abortion.

The change in tone reflects Trump’s political sensitivities. The failed attempt under the former president to repeal Obamacare in 2017 contributed to a crushing GOP defeat in the 2018 congressional elections, and the law now enjoys broad support. Abortion, too, has become a treacherous topic for Republicans since Roe was overturned in 2022, with most Americans opposed to a national ban.

In one of the only pieces of health policy in the GOP’s 2024 platform, the former president vows not to cut Social Security or Medicare, the health program for older and disabled Americans, or change the federal retirement age.

In his speech accepting the nomination Thursday night, Trump promised to protect Medicare and find cures for Alzheimer’s disease and cancer. But he did not outline any health care proposals for a second term. “Democrats are going to destroy Social Security and Medicare,” he said.

Health care isn’t a winning subject for Republicans, said Charles Coughlin, CEO of a Phoenix public affairs firm who was a longtime GOP political operative before he became an independent in 2017.

Speakers at the convention have instead focused on inflation, crime, and immigration. “They have the tried-and-true polling data to show those are winning issues for them, and that’s where they want to keep the narrative focused,” he said.

Immigration has bled into a few health issues, including the U.S. opioid crisis and public insurance coverage. Some Republicans — including Georgia U.S. House Rep. Marjorie Taylor Greene, who addressed the convention on July 15 — have claimed an increase in people crossing the southern border has caused a surge of drug overdoses and deaths.

However, most fentanyl seized at the border with Mexico enters through legal ports of entry, according to the Cato Institute, a libertarian think tank, and most people sentenced in the U.S. for fentanyl trafficking are American citizens, according to the U.S. Sentencing Commission.

Speaking on July 17, U.S. House Rep. Monica De La Cruz of Texas claimed Democratic policies allow people who come into the country without authorization to receive government benefits, even though they are largely not eligible for federal health programs.

De La Cruz also said the Biden administration had cut Medicare Advantage for seniors. While the Biden administration this year modestly cut spending on the private plans, the federal government still spends more money per beneficiary on Medicare Advantage than for those in the traditional Medicare program.

The paucity of convention speakers focused on health care reflects the new GOP platform, a document hewing closely to both the substance and tone of Trump’s views. Along with its promise to protect Medicare, the 28-page document vows that Republicans will expand veterans’ health care choices, as well as access to “new Affordable Healthcare and prescription drug options” more broadly, without elaboration.

On abortion, the party stripped from the platform its decades-old call for federal limits, including instead language suggesting the 14th Amendment prohibits abortion. The platform also says the party supports state-level elections on abortion policy and opposes “Late Term Abortion.” Only about 1% of abortions in the U.S. occur after 21 weeks of pregnancy, according to KFF, a health information nonprofit that includes KFF Health News.

In contrast, the 2016 platform — a 66-page document — also called for shifting open-ended federal Medicaid funding into block grants and introducing a Medicare “premium-support model” to cap spending. It also called for limiting payouts from medical malpractice lawsuits and combating drug abuse.

The word “abortion” appears 32 times in the 2016 platform, compared with once in the 2024 document.

“The GOP is in a headlong sprint away from that issue,” Coughlin said.

During the week of the convention, video of a call between independent presidential candidate Robert F. Kennedy Jr. and Trump appeared online. In the video, Trump is heard sharing disproven claims about childhood vaccines, saying falsely that the shots can cause a baby to “change radically” and dismissing their health benefits.

As a candidate, Kennedy has repeatedly made false claims about the safety and efficacy of vaccines. Trump has long entertained vaccine skeptics. (Before Trump took the oath of office in 2017, Kennedy told reporters Trump had invited him to chair a presidential commission on vaccines, though the commission never materialized.) But as president, Trump ordered the creation of the “Operation Warp Speed” program in 2020 that helped drive development of covid-19 vaccines.

Since the start of the pandemic, however, vaccine skepticism has blossomed in the Republican Party. Just 36% of Republicans say they’re confident covid vaccines are safe, and 44% of Republicans and Republican-leaning independents say parents should be able to decide not to vaccinate their children against measles, mumps, and rubella “even if that may create health risks for other children and adults,” according to KFF polling.

This story was published by KFF Health News on July 19, 2024. It is republished with permission.