House Speaker Mike Johnson criticizes Obamacare and promises 'massive reform' if Trump wins

House Speaker Mike Johnson took a dig at Obamacare at an event in Pennsylvania on Monday, telling a crowd there would be “massive” health care changes in America if Donald Trump wins the election.

“Health care reform’s going to be a big part of the agenda. When I say we’re going to have a very aggressive first 100 days agenda, we got a lot of things still on the table,” Johnson, R-La., said in Bethlehem as he campaigned for GOP House candidate Ryan Mackenzie, according to video obtained by NBC News.

“No Obamacare?” an attendee asked Johnson, referring to the law Democrats passed in 2010, also known as the Affordable Care Act.

“No Obamacare,” Johnson responded, rolling his eyes. “The ACA is so deeply ingrained, we need massive reform to make this work, and we got a lot of ideas on how to do that.”

Johnson made his remarks eight days before a presidential election in which Kamala Harris and Democrats are campaigning on protecting and expanding the ACA. Trump, who tried and failed to wipe out the ACA as president, has called for reopening the fight, saying on his social media platform that “Obamacare Sucks.” He has vowed to replace it but without offering specifics, saying only that he has “concepts of a plan.”

Harris insists that Trump’s only plan is to undo the ACA, which has extended coverage to nearly 50 million people in the U.S. since 2014, according to government figures.

Johnson, who voted in 2017 for a Trump-backed bill to repeal key parts of Obamacare, did not explicitly call Monday for ending the Affordable Care Act. His office declined to offer details when asked what reforms he’s eyeing, which parts of the Affordable Care Act he'd seek to keep or undo, or whether he supports extending the ACA subsidies that are expiring at the end of 2025. (Harris and Democrats have called for extending that money.)

Johnson held a back-and-forth about health care with the audience at Monday's campaign event in Pennsylvania, saying that physician members in the House Republican caucus had “a menu of options” for how to revise the system and “take government bureaucrats out of the health care equation.”

He didn’t detail what changes he would seek, but he made it clear that deregulation would be part of it.

“We want to take a blowtorch to the regulatory state. These agencies have been weaponized against the people. It’s crushing the free market; it’s like a boot on the neck of job creators and entrepreneurs and risk takers. And so health care is one of the sectors, and we need this across the board,” Johnson said. “And Trump’s going to go big. I mean, he’s only going to have one more term. Can’t run for re-election. And so he’s going to be thinking about legacy, and we’re going to fix these things.”

Sen. Tom Cotton, R-Ark., who is running to be the No. 3 GOP leader in the next Congress, has called for tackling a major health care overhaul and extending the Trump tax cuts in one big bill in 2025. It's unclear who will replace Sen. Mitch McConnell, R-Ky., as Senate GOP leader next year.

Any major rollback of ACA would require Republicans to win the presidency and control of both chambers of Congress, as Democrats would be all but certain to block such an effort. It’s also unclear what changes the GOP would find the votes to make, as some in the party have called for turning the page on the ACA fight.

The 2010 law slapped new regulations on insurance companies to prohibit turning away people with pre-existing conditions or charging higher prices to sicker customers. It also provided billions of dollars in subsidies for lower-income people to buy coverage in private marketplaces while it expanded Medicaid eligibility.

Johnson, who has crisscrossed the country to campaign for GOP House candidates, spoke only in broad terms at his event Monday.

“If you take government bureaucrats out of the health care equation and you have doctor-patient relationships, it’s better for everybody. More efficient, more effective,” he said. “That’s the free market. Trump’s going to be for the free market.”

Harris campaign spokesperson Sarafina Chitika seized on Johnson’s remarks, warning that “health care is on the ballot.”

“Speaker Mike Johnson is making it clear — if Donald Trump wins, he and his Project 2025 allies in Congress will make sure there is ‘no Obamacare.’ That means higher health care costs for millions of families and ripping away protections from Americans with preexisting conditions like diabetes, asthma, or cancer,” she said.

At a union hall event in Lansing, Michigan, on Wednesday, House Minority Leader Hakeem Jeffries, D-N.Y., said, “The top Republican in the House said one of the first things they’ll do is repeal and get rid of the Affordable Care Act as we know it. This is still on their mind. We know they’ll do it because I’m convinced that if Roe v. Wade can fall, then anything can fall.”

Johnson sought to clarify his comments after this article was published, telling NBC News in a statement on Wednesday, “Despite the dishonest characterizations from the Harris campaign, the audio and transcript make clear that I offered no such promise to end Obamacare, and in fact acknowledged that the policy is ‘deeply ingrained’ in our health care system.”

The Trump campaign’s national press secretary, Karoline Leavitt, sought to distance the ex-president from the cause of ending ACA, despite his long history of pursuing that goal. Just last month, Trump said at his presidential debate with Harris that Obamacare is "lousy" and "we're going to replace it," though he said he only had "concepts of a plan" for doing so.

“Repealing Obamacare is not President Trump’s policy position,” Leavitt said when asked about Johnson's remarks, adding that Trump “will make our health care system better by increasing transparency, promoting choice and competition, and expanding access to new affordable health care and insurance options.”

She did not elaborate on how.

Sahil Kapur is a senior national political reporter for NBC News.