Where do the GOP presidential debate candidates stand on health care?

Health care costs are a significant issue facing American families and the federal government, with Republican presidential contenders having an opportunity to address those concerns at Wednesday night’s debate on FOX Business.

Health care costs have been on the rise for individuals and businesses in recent years, with recent forecasts from benefit consulting firms projecting that health care costs will see their biggest jump in a decade in 2024. Medicare is a major source of federal spending, and its hospital trust fund is set to be depleted 10 years from now which could result in an automatic cut of 10% in hospital spending if Congress doesn’t shore it up.

If the GOP presidential nominee wins the White House next year and Republicans hold majorities in both chambers of Congress they could make another attempt at health care reform. 

During the first two years of the Trump administration, Republicans had unified control of Congress and the White House and attempted to pass legislation to repeal and replace the Affordable Care Act, commonly known Obamacare. Although the House managed to pass its version of a health care reform bill, Senate Republicans were unable to coalesce enough support around a proposal of their own and the reconciliation process failed.

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The second Republican presidential debate is set to be held on Wednesday, September 27 in Simi Valley, California. The debate will be hosted by Fox Business and Univision from the Ronald Reagan Presidential Foundation and Institute.

Here’s a look at the GOP contenders’ stances on health care policies:

Ron DeSantis

Florida Governor Ron DeSantis this spring signed legislation aimed at protecting Floridians’ medical freedom, including legislation prohibiting businesses and governmental entities from requiring individuals to provide proof of vaccination to enter and barring employers from taking adverse employment actions based on vaccination status.

During his time as governor, DeSantis and Republicans in the state legislature have opted against expanding Medicaid, making it one of 10 states that haven’t broadened Medicaid eligibility to adults making up to 138% of the federal poverty line since Obamacare incentivized states to do so.

While serving in Congress, DeSantis was among the House Republicans who voted in favor of the American Health Care Act, the House GOP’s bill to repeal and replace Obamacare. The bill ultimately failed to advance in the Senate. He also supported a non-binding budget resolution that called for reforming Medicare by raising the eligibility age for future enrollees and transitioning it to a premium support system in which the federal government gave individuals money to spend on private insurance. 

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Vivek Ramaswamy

Entrepreneur Vivek Ramaswamy, a former biotechnology executive, criticized former President Donald Trump for failing to fulfill his promise to repeal and replace Obamacare.

"My friend Donald Trump promised us: repeal and replace Obamacare. Eight years later, did it happen? No, it did not. It is a false promise if it is contingent on Congress," Ramaswamy said per the AP.

Ramaswamy has also called for the U.S. to reduce its reliance on pharmaceutical products made in China.

Nikki Haley

Former South Carolina Governor Nikki Haley has called for reforms to Medicare by raising the eligibility age for future enrollees without impacting current retirees. 

"We’re not taking it from seniors," Haley said at a March campaign event in South Carolina according to the AP. Haley also suggested she would be open to means-testing that would limit federal benefits for the wealthy in entitlement programs as well as expanding Medicare Advantage, a program in which private companies offer health plans that the federal government reimburses.

While serving as governor, Haley opposed the expansion of Medicaid in the Palmetto State, which remains one of the 10 states that hasn’t yet expanded Medicaid per the Kaiser Family Foundation.

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Mike Pence

Former Vice President Mike Pence on his campaign website criticized the impact of Obamacare for creating "a federally controlled health care system that included new mandates and costly requirements for states" and blamed it for causing health insurance premiums to double and contributing to a doctor shortage.

Pence’s platform states that federal dollars spent on insurance subsidies and low-income healthcare services, the latter a reference to Medicaid, should be given to states in the form of a block grant so they could "allocate health care dollars toward policies and plans that work best for their populations."

Pence implemented Medicaid expansion while serving as governor of Indiana using a waiver, which allows states to operate their Medicaid programs in ways that otherwise wouldn’t comply with federal law. In Indiana’s case, it included a provision requiring enrollees to pay monthly premiums and manage health savings accounts.

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Tim Scott

South Carolina Senator Tim Scott has said that he would focus efforts to ensure Medicare’s solvency on finding cost efficiencies and reducing waste. The Des Moines Register reported that he said at an event in Iowa this summer, "We’re going to reduce the costs and make sure we never, ever cut Medicare or Social Security benefits."

Scott’s Senate website expresses support for allowing health insurance to be sold across state lines, giving businesses and the self-employed a tax deduction for health insurance premiums, encouraging states to use high-risk pools to help people with preexisting conditions afford insurance, along with association health plans for small businesses to pool coverage and medical malpractice reform.

Scott voted in favor of Senate Republicans’ proposal known as the Better Care Reconciliation Act, to repeal and replace Obamacare in 2017, when the chamber considered the measure and ultimately failed to advance it. 

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Chris Christie

Former New Jersey Governor Chris Christie has proposed raising the eligibility age for Medicare for Americans under the age of 50 to reform the program while giving younger Americans time to plan, as well as means-testing benefits to phase them out for higher income individuals. 

"We can make real savings over the long term by playing with eligibility," Christie said at conservative radio host Erick Erickson’s conference last month. He recently criticized President Joe Biden and other politicians for saying they’re not going to do anything to entitlement programs, saying at that event, "[They’re] a group of liars and cowards, because they know that in 10 years, Medicare will be bankrupt."

While serving as governor, Christie was one of the first governors in the nation to move to expand Medicaid. Christie touted the move in 2016, two-and-a-half years after implementing the change, saying, "There were naysayers, both inside the state and around the country. They were wrong then, and they’re proven wrong now," per Politico.

Doug Burgum

North Dakota Governor Doug Burgum suggested some health care reform proposals to the Trump administration in 2017, including health care information technology (IT) improvements, while criticizing federal mandates in that area as an "abject failure," according to a readout of a call on the governor’s website.

Republican majorities in the North Dakota legislature recently overrode Burgum’s veto of a bill that would’ve prevented health insurance companies and Medicaid from excluding certain health care providers. The Bismarck Tribune reported that Burgum criticized the bill for targeting only one health insurance plan in the state and expressed concern it would risk increasing costs for 13,000 enrollees.

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Former President Donald Trump is also seeking the GOP presidential nomination for 2024 but has declined to participate in the first two primary debates.