NEW YORK (AP) — Former President Donald Trump threatened over the weekend to reopen the contentious fight over the Affordable Care Act after failing to repeal it while in the White House, saying he is “seriously looking at alternatives” if he wins a second term.

Trump's comments drew rebuke from Democratic President Joe Biden 's campaign, which cast them as another “extremist” proposal from the GOP front-runner.

“Donald Trump’s America is one where millions of people lose their health insurance and seniors and families across the country face exorbitant costs just to stay healthy. Those are the stakes next November,” said Biden-Harris 2024 spokesperson Ammar Moussa in a statement.

The back-and-forth points to what could be a key issue in a general election rematch between Trump and Biden if both win their parties' nominations as widely expected.

Biden's team has long operated under the assumption that Trump would be the GOP nominee, given his commanding lead in the polls, and has stepped up efforts in recent weeks to cast his proposals as extreme and to paint him as a danger to democracy. Biden, in particular, has begun painting a vision of a catastrophic future if Trump wins — a strategy that could motivate lukewarm Democratic voters who may be driven more by a desire to stop Trump than to deliver a second term to Biden amid lingering concerns over high inflation, the direction of the country and his age.

Health care has generally been a better issue for Democrats than Republicans, who have largely abandoned efforts to repeal the law in recent years.

Trump has not spent much time discussing healthcare as he has laid out an aggressive agenda for a potential second term that has focused on immigration crackdowns and mass deportations, as well as efforts to target political rivals.

But Trump weighed in on the issue Saturday morning on his Truth Social site.

“The cost of Obamacare is out of control, plus, it’s not good Healthcare. I’m seriously looking at alternatives,” he wrote. “We had a couple of Republican Senators who campaigned for 6 years against it, and then raised their hands not to terminate it. It was a low point for the Republican Party, but we should never give up!”

He was referring to July 2017, when the late Sen. John McCain (R-Ariz.) blocked Trump’s long effort to repeal the healthcare law.

About 6 in 10 Americans say they have a favorable opinion of the health reform bill signed into law in 2010, known commonly as the Affordable Care Act, or Obamacare, according to a KFF poll conducted in May 2023.

A recent ABC News/Ipsos poll found 37% of Americans trust Democrats to do a better job than Republicans on handling healthcare, versus about 1 in 5 — 18% — who trust Republicans over Democrats on this issue. About one-third (34%) trust neither party.

Still, a June 2023 AP-NORC poll showed a minority of U.S. adults — 44% — approving of how Biden was handling health care, with 53% disapproving. That included 69% of Democrats and 17% of Republicans — measurements in line with Biden’s overall job approval.

Trump's comments came in response to a Wall Street Journal op-ed he shared highlighting concerns raised by Sens. Elizabeth Warren (D-Mass.) and Mike Braun (R-Ind.) that large insurance companies are using their pharmacies “to evade federal requirements that limit the percentage of premium dollars spent on profits and administration, known as the Medical Loss Ratio (MLR), resulting in sky-high prescription drug costs and excessive corporate profits.”

Biden's Department of Health and Human Services says more than 40 million are insured through coverage related to provisions of the Affordable Care Act.

Moussa said Trump “would try to rip it away if he returns to power. He was one vote away from getting it done when he was president – and we should take him at his word that he’ll try to do it again.”

___ Associated Press writers Zeke Miller and Linley Sanders contributed to this report from Washington.