Obamacare Makes Surprise Cameo in Second GOP Debate

Derick Alison
Derick Alison
10 Min Read

Seven Republican candidates for president shared their views on Obamacare, gender-affirming care, the nation’s fentanyl crisis, and abortion during the second primary debate on Wednesday night.

Former vice president Mike Pence was put in the hot seat when Fox News host and moderator Dana Perino brought up his failed 2016 pledge to repeal all Obamacare mandates, which he repeated last month. Asked whether Obamacare was “here to stay,” Pence initially ducked the question and steered his response to mass shootings, noting that he would urge Congress to pass “a federal expedited death penalty for anyone involved in a mass shooting.”

When pressed further, Pence said as president he would aim to make the federal government smaller, not larger, by giving back to states “those resources and programs that are rightfully theirs. Under the 10th Amendment of the Constitution, that means all Obamacare funding, all housing funding, all HHS funding, all of it goes back to the states.”

Meanwhile, Florida Gov. Ron DeSantis was asked about the 2.5 million people in his state who lack health insurance. DeSantis placed the blame squarely on “Bidenomics,” and Biden himself for overspending and over-regulating healthcare.

“What we need to do with healthcare is recognize our healthcare is putting patients at the back of the bus. We have ‘big pharma,’ ‘big insurance,’ and ‘big government,’ and we need to tackle that and have more power for the people and the doctor-patient relationship,” he said.

Asked why Florida’s coverage rates are so poor — falling below the national average — DeSantis defended his state, noting it does not support “a lot of welfare benefits.” While the program was not mentioned by name, Florida is one of 10 states that has not adopted Medicaid expansion.

“We’re basically [saying] this is a field of dreams. You can do well in the state, but we’re not going to be like California and have massive numbers of people on government programs without work requirements,” he said, adding that that is a standard he holds for all welfare benefits.

Nikki Haley, the former governor of South Carolina and former ambassador to the United Nations, was asked about healthcare as a major driver of bankruptcy for Americans.

Haley suggested that the opacity in healthcare is one core reason for these bankruptcies. If elected, she said, “we will break all of it [down], from the insurance company, to the hospitals, to the doctors’ offices, to the PBMs [pharmacy benefit managers], to the pharmaceutical companies. We will make it all transparent because when you do that, you will realize that’s what the problem is.”

Haley also pledged to bring competition back into the healthcare space by eliminating “certificate of need systems” — permissions from state planning authorities often required to expand services — and allowing companies to compete.

She also called for giving patients more autonomy.

“Once we give the patient the ability to decide their healthcare, deciding which plan they want, that is when we will see magic happen, but we’re going to have to make every part of the industry open up and show us where their warts are because they all have them,” she said.

Transgender Care, Parental Notice

When Pence was asked how he would protect LGBTQ individuals, given a rise in hate crime, he said that he would defend the “safety and civil liberties of all Americans,” then steered his response to the issue of education and parental rights.

He pointed out that children at Lin-Marr Community Schools in Cedar Rapids, Iowa need a permission slip to get Tylenol, but don’t need a parent’s permission to obtain a gender transition plan. (Pence has publicly shown his support for parents who are suing the school.)

“That’s not bad policy. That’s crazy. We’re going to stand up for the rights of parents, and we’re going to pass a federal ban on transgender chemical or surgical [treatment] anywhere in the country,” he said.

Asked his thoughts on whether parental notification should be required, Vivek Ramaswamy, a biotech engineer, said, “I have to be very clear about this. Transgenderism, especially in kids, is a mental health disorder.” (The World Health Organization stopped classifying gender identity disorder as a mental health condition in 2019.)

He went on to describe a meeting with two women who “de-transitioned” after double mastectomies, and in one woman’s case a hysterectomy, leaving her unable to have children, noting that he would “ban genital mutilation or chemical castration.”

With regard to parental notice, Ramaswamy argued that the same people who claim gender incongruity increases suicide risk are also arguing that parents don’t have the right to know their child bears that increased risk.

“And I’m sorry, it is not compassionate, to affirm a kid’s confusion. That is not compassion. That is cruelty,” he said.

Fentanyl Overdoses, Mental Health

Ramaswamy was also asked about how to keep fentanyl from entering the country.

He stressed that this is both a supply and a demand issue. While tightening the U.S. border can help tamp down the supply of fentanyl, there will still be demand because of the nation’s mental health crisis.

He recalled meeting the parents of a 17-year-old boy who died in Iowa after purchasing fentanyl-laced oxycodone (Percocet) through Snapchat.

“That is closer to bioterrorism, not a drug overdose. That is poisoning,” Ramaswamy said, and the government bears the responsibility for ensuring it doesn’t happen again.

“But it’s also our job to make sure that 17-year-olds don’t turn to Percocet via Snapchat. We have to bring back mental health care in this country. Not with pumping pharmaceuticals [into people] but with … faith-based approaches that restore purpose and meaning in the next generation of Americans,” he noted.

Ramaswamy also said that he would ban social media for kids 16 and younger, given that it’s “addictive” and also used as a channel for buying drugs. Ending access to social media would both “revive” young people’s mental health and help to end the fentanyl epidemic, he added.

Abortion and Winning Elections

Given that abortion was on the ballot in six states in 2022 and Republicans lost in all six of those states, DeSantis was asked how he planned to win an election without support from pro-choice independent voters.

He pointed out that he had already won in Florida in “places like Miami-Dade County, Palm Beach, that nobody thought [were] possible.”

“I reject this idea that pro-lifers are to blame for midterm defeats,” he said, claiming that there were other reasons for those losses.

He also called out former President Donald Trump as “missing in action” — as several other candidates had done — arguing that he should have to answer for his comments and explain how “pro-life protections are somehow a terrible thing.” (In an interview on “Meet the Press,” Trump called Florida’s 6-week abortion ban a “terrible thing.”)

As for the claim that Republicans can’t win elections if they oppose abortion, DeSantis said, “I think we should stand for what we believe in. I think we should hold the Democrats accountable for their extremism, supporting abortion all the way up until the moment of birth. That is infanticide, and that is wrong.”

Democrats, including Vice President Kamala Harris, have disputed this claim.

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    Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

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