Looking to Nevada, South Carolina primaries: will candidates offer more details on fate of ACA?

By Jack McCarthy
09:46 AM
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With important presidential primaries in South Carolina and Nevada starting this weekend, the Affordable Care Act will come in for a closer review from candidates in both parties.

Democrats Hillary Clinton and Bernie Sanders have already drawn sharp differences in their attitudes toward the ACA and will no doubt continue along the same vein.

All the Republican candidates say they would replace ACA, but the question for each is exactly how they would do so and what plan they have to replace President Obama's signature piece of legislation?

During the most recent Republican debate, Ohio Gov. John Kasich and former Florida Gov. Jeb Bush clashed over the Act.

Kasich was put on the defensive because he was one of few Republican governors to accept hundreds of millions of federal dollars made available through the ACA to expand Medicaid in in Ohio and provide health coverage to low-income people. "We leave no one behind," Kasich said, explaining that funds from the Medicaid program were used to treat the mentally ill and to offer healthcare to the working poor.

Bush criticized Kasich's policy, saying it "is creating further debt on the backs of our children and grandchildren" by allocating Medicaid dollars for the states. "We should be fighting Obamacare," he added.
Kasich retorted that Bush "knows I'm not for Obamacare," and said Bush was simply engaging in a negative campaign.

In the Feb. 6 Republican debate, Texas Sen. Ted Cruz said the ACA amounted to "socialized medicine," promising if elected to repeal "every word of Obamacare."

"And once we do that, we will adopt common sense reforms. Number one, we'll allow people to purchase health insurance across state lines that will drive down prices and expand the availability of low-cost catastrophic insurance," Cruz said. "We'll expand health savings accounts; and we will de-link health insurance from employment so that you don't lose your health insurance when you lose your job, and that way health insurance can be personal, portable and affordable and we keep government from getting between us and our doctors."

Donald Trump said during that same debate that said he would repeal the ACA, focusing on health insurance companies, which he said, "are getting rich on healthcare and health services and everything having to do with health."

Florida Sen. Marco Rubio, for his part, has not spoken often publicly of his plans beyond repealing the ACA. He published a three-part plan in August for delivering affordable health coverage that would offer tax credits to help purchase insurance; reform insurance regulations and establish funding pools for people with preexisting conditions; and offering Medicaid block grants while moving Medicare to a premium support system

"Instead of relying on an outdated big-government approach," Rubio wrote, "I will utilize modern, consumer-centered reforms that lower costs, embrace innovation in healthcare and actually increase choices and improve quality of care."

And Ben Carson, MD, appears to be sticking with what he calls a "health empowerment account system," wherein everyone gets an account at birth that includes the ability to shift money such that "each family basically becomes its own insurance company without a middleman; that saves a lot of money." 

Exactly how any of the candidates' plans will actually work, well, that remains to be seen.