While the candidates' commentary and critiques on healthcare were generalized in the fourth Republican presidential primary debate Dec. 6, mentions of the topic suggest its return as an issue for the 2024 election.
Four candidates took part in the debate: former New Jersey Gov. Chris Christie, Florida Gov. Ron DeSantis, former U.N. Ambassador Nikki Haley and entrepreneur Vivek Ramaswamy. Former President Donald Trump, who is the front-runner in the polls, skipped the debate.
The 2022 elections were the first in more than a decade in which security of the Affordable Care Act was not a central issue and Republicans set aside their long-standing efforts to repeal it. Now, President Joe Biden is preparing a package of second-term healthcare measures after contenders for the Republican presidential nomination suggested they plan to replace the Affordable Care Act.
Here are five key insights pertaining to healthcare from the latest GOP debate, a transcript of which can be found here:
1. Mr. DeSantis paints with a broad brush. Mr. DeSantis made headlines in the days leading up to the debate with his aim to "replace and supersede" the Affordable Care Act if successful in the 2024 presidential election, following similar remarks made by Mr. Trump.
Debate moderator Elizabeth Vargas noted that Mr. DeSantis is promising a better healthcare law than the ACA, "but Florida has more uninsured people than almost any other state. Why should Americans trust you more than any other Republicans who've disappointed them on this issue?"
Mr. DeSantis responded by saying there are millions of Americans who do not have access to affordable healthcare, "millions and millions of people that don't have access to good doctors and good hospitals," and people are "paying too much for everything." Without distinguishing how his replacement and superseding healthcare plan would differ from the ACA, Mr. DeSantis targeted unnamed institutions and corporations in his remarks.
"You need to hold the pharmaceuticals accountable. You need to hold big insurance and big government accountable, and we're going to get that done. I think it's very, very important economically. I think it's very, very important for the country that we get that done," the governor said.
2. Mr. Ramaswamy goes after insurers. Mr. Ramaswamy's wife, Apoorva Ramaswamy, MD, is a laryngologist with the Ohio State University Comprehensive Cancer Center in Columbus who specializes in treating swallowing and voice disorders that can occur in patients who have undergone treatment for cancer.
Speaking after Mr. DeSantis, Mr. Ramaswamy was not asked a specific question by the moderators when he shared that his wife has lent him a closer view into the reimbursement and payment discrepancies that occur between healthcare providers and insurers.
Seemingly referring to insurers, the candidate said, "They'll pay for anything, like feeding tubes, doctors to be pill pushers, but for the procedures that can actually make these patients better, we have a broken healthcare system that doesn't pay for it. My wife, in many cases, does not get paid for those procedures. She does them anyway because it's the right thing to do, but that does not work systemwide."
Mr. Ramaswamy used the common critique that the U.S. has a sick care system, not a healthcare system, and needs diverse insurance options in a competitive marketplace. "And here's how we deliver that: End the antitrust exemptions for health insurance companies. That's where the competitive marketplace begins," he said.
3. Gender care for minors is a talking point. While the candidates were light on details for the healthcare policy changes they want to enact, gender care for minors was one issue mentioned at various points throughout the debate.
Mr. DeSantis pointed to Florida's ban on gender-affirming care for minors, enacted in May, as a testament to his steadfast commitment to conservative values. Mr. DeSantis alleged Ms. Haley does not oppose "gender mutilation for minors"; she stated that she believes children should be 18 years old for such medical care. ("If you have to be 18 to get a tattoo, you should be 18 to have anything done to change your gender," she said.)
Mr. Christie defended his position against outright bans on gender care for minors, noting that "Republicans believe in less government, not more" and decisions about children's healthcare should be made by children's parents.
Mr. Ramaswamy said he believes "transgenderism is a mental health disorder" and advocated for the establishment of a federal-level minimum age for participation in gender care, similar to the federal minimum ages in place for use of tobacco and alcohol.
4. The debate stream cuts out on COVID-19 vaccines. The streamed debate was interrupted when moderator Megyn Kelly began to tee up a question about COVID-19 vaccines one hour and 42 minutes into the program.
"Okay, through Operation Warp Speed, the Trump administration and private industry developed a COVID vaccine in record time," Ms. Kelly's question began. Transcript of the debate shows the program then cut to commercial, as many viewers also experienced when watching the debate live on Rumble. By the time the debate returned several minutes later, moderator Eliana Johnson said it was time for the final question for the candidates: Which former president would you draw inspiration from for your own presidency and why?
The timing of the disruption has prompted a number of unproven theories from viewers and social media users, as Newsweek reports.
5. Abortion goes unmentioned. The topic was noticeably missing from the fourth GOP debate, which is in line with the de-emphasis abortion has received among party hopefuls who are trying to avoid alienating women or swing voters. Three in 10 registered voters (30%) and a third of women voters (35%) say they will only vote for a candidate who shares their views on abortion, according to KFF.