One of the scariest prospects of a second presidential term for Donald Trump is his threat to repeal the Affordable Care Act, often called Obamacare, that has 24 million Americans enrolled in basic health care plans.

Never mind his dictatorial promises to mass deport millions of immigrants or punish his political enemies, the idea of kicking out millions of Americans from their medical plans is not only inhumane, but would create enormous havoc in the nation’s health care systems.

“The cost of Obamacare is out of control; plus it’s not good Healthcare. I’m seriously looking at alternatives,” Trump wrote on his Truth Social site.

Meanwhile, Trump’s comments drew rebuke from President Biden’s campaign, which cast them as another “extremist” proposal from the GOP presumptive nominee, according to Jill Colvin and Zeke Miller, reporters for the Associated Press who are on the campaign trail.

Democrats are moving rapidly to mobilize a response, including new advertising in battleground states contrasting Biden’s efforts to lower drug costs with Trump’s comments, the AP reported.

“Donald Trump is campaigning on the threat to rip away health care from millions of Americans, so we’re going to use every tool in our arsenal to make sure the American people know that lives are literally on the line next November,” said Biden campaign communications director Michael Tyler.

What Trump hasn’t said is what kind of plan would replace Obamacare. This is a continuing saga for Republicans who opposed the ACA from its onset nearly 15 years ago. The mantra of “repeal and replace” never led to an actual proposal for a replacement.

The health care debate points to what could be a key issue in a general election rematch between Biden and Trump. Health care has been a better topic for Democrats than Republicans, who have largely abandoned efforts to repeal the ACA in recent years.

The GOP generally has steered away from criticizing Obamacare much as it has from attacking Social Security, often called the third-rail of politics. But as I’ve stated in previous columns, Trump is a slow learner and quick to deflect his campaign mistakes to media bias.

Trump has carried a grudge against Obamacare since he lost by one vote in the U.S. Senate to end the program in 2017 when Republicans controlled Congress. That single vote was cast by the late Sen. John McCain, who was attacked by Trump as “not a hero” despite spending years as a prisoner of war in North Vietnam.

Trump isn’t the only one who detests the ACA. Look at the state of Texas that repeatedly refused to enact any version of the plan despite the federal government allowing states to adopt their own plans under the laws. Ruby-red states like Arkansas and Louisiana have joined the ACA to receive billions in revenue.

Texas has foregone hundreds of billion by refusing to enact similar legislation to pump money into local communities. Scores of Texas hospitals, mostly in rural communities, have closed since the ACA was enacted while Republican Govs. Rick Perry and Greg Abbott sneer at their needy constituents.