Presidential hopeful and former Vice President Mike Pence announced on Wednesday that a key component of his healthcare policy as president would be to restructure Obamacare to allow for greater flexibility for states to administer low-income health services.
"Our top-down system needs to be reformed," the Pence campaign said in a statement. "States should have the ability to allocate healthcare dollars toward policies and plans that work best for their populations."
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Pence's full statement calls Obamacare a program that "created a federally controlled healthcare system that included new mandates and costly requirements for states."
Although Pence's statement does not outline detailed policy specifics, he does highlight that giving federal funds to the states in the form of flexible block grants, as opposed to categorical grants with strings attached, would give state lawmakers greater independence in establishing their own insurance subsidies and low-income healthcare services.
Repealing Obamacare was a central feature of the Republican primary during the 2016 election, with many candidates, including former President Donald Trump, promising to replace President Barack Obama's crowning domestic achievement with a conservative alternative.
Several attempts were made during the Trump-Pence administration to fulfill that promise, but Republicans failed and then lost control of the House to the Democrats in the 2018 midterm elections.
Along with several other changes, the Obamacare overhaul attempt in September 2017 would have distributed equal Medicaid funding to states in the form of block grants and allowed states to institute work requirements without prior authorization from the Department of Health and Human Services.
Pence's Obamacare announcement is part of his broader agenda of bolstering the Founding-era idea of federalism, splitting power more evenly between the states and the national government.
"Returning political power back to the states, cities, and communities gives Americans the greatest autonomy and freedom over their own lives," Pence said.
As Indiana governor, Pence accepted an increase in Medicaid funding under the Obamacare expansion, but he added several conservative caveats to the program's administration in the Hoosier State, making it a model for several Republican-controlled states striving to balance receiving federal funds with ideology.
According to a 2016 op-ed from Pence, the Healthy Indiana Plan 2.0 was different than a traditional Medicaid system because of its job training program and consumer-driven health savings account provisions. Within the first year, the plan also decreased emergency room visits and increased preventative care and routine check-ups, putting less strain on the state's healthcare system.
During the Trump-Pence administration, the Centers for Medicare and Medicaid Services approved waivers for 13 states to institute work requirements for individuals to receive Medicaid coverage. These waivers were quickly revoked by the Biden administration's new leadership at HHS.
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Other former governors in the GOP primary field also embraced the Obamacare Medicaid expansion during their tenure, including former South Carolina Gov. Nikki Haley, former New Jersey Gov. Chris Christie, and former Arkansas Gov. Asa Hutchinson. Gov. Ron DeSantis (R-FL) is the only governor in the GOP race who did not accept federal dollars to expand the Medicaid program in his state.
After officially reaching the minimum 40,000 individual donor threshold on Monday, Pence qualified to join his competitors on the debate stage on Aug. 23.