There is a formidable historical arc to health care policy: Every modern US president has sought to expand coverage. Democrats eagerly placed the issue on the agenda. Republicans vociferously opposed Democratic proposals but countered with creative ways to expand coverage on their own terms. Democrats eventually absorbed elements of the latest Republican plan—which Republicans, in turn, attacked, and the cycle began anew. The dynamic interaction between the parties slowly, often haphazardly, expanded health insurance as each sought to extend coverage in its own way. We speculate about whether the recent Republican efforts to repeal the Affordable Care Act constitute a sharp break with the past, perhaps because opposition to government, exacerbated by racial anxieties, has changed the Republican calculus. Alternatively, there are still some reasons to conclude that the arc of health policy continues to bend toward increasing coverage.