Sen. J.D. Vance (R-OH) and Gov. Tim Walz (D-MN) engaged in a spirited healthcare policy back-and-forth largely centered on the history of Obamacare in Tuesday evening’s vice presidential debate.
Vance has had to play interference on healthcare policy in recent weeks since the debate between former President Donald Trump and Vice President Kamala Harris, during which the Republican Party leader said he had “concepts of a plan” to replace Obamacare.
Although Vance said it would “bore everybody to tears” to go through an entire healthcare proposal on a debate stage, Vance adeptly navigated the complex history of the Trump administration’s tweaks to the 2010 law that fundamentally transformed the healthcare system.
Walz, who served in the House of Representatives during the initial passage of the Affordable Care Act, as well as the failed efforts to repeal it under the Trump administration, said that “being an old guy” gave him an advantage over the junior Ohio senator.
Here are the details on three key health coverage and cost topics during Tuesday’s debate.
1. Vance says Trump saved Obamacare
Although Trump ran for the presidency in 2016 promising to repeal and replace Obamacare, Vance made the argument on Tuesday that the former president “salvaged Obamacare, which was doing disastrously until Donald Trump came along.”
“When Obamacare was crushing under the weight of its own regulatory burden and healthcare costs, Donald Trump could have destroyed the program. Instead, he worked in a bipartisan way to ensure that Americans had access to affordable care,” Vance said.
Vance’s campaign did not respond to the Washington Examiner’s request for clarification about the specific policies the vice presidential candidate was intending to reference.
Trump and Republicans tried to repeal and replace Obamacare in 2017 but failed. The Trump administration subsequently made myriad piecemeal changes to the law.
The Trump administration did roll back regulation of insurance markets imposed by Obamacare and consulted with private-sector experts to implement policies to lower insurance premiums nationwide.
Trump also relaxed standards for state waivers to change aspects of how state governments implemented Obamacare, such as allowing short-term plans that did not necessarily cover preexisting conditions to count as coverage under federal law.
“He saved the very program from a Democratic administration that was collapsing and would have collapsed absent his leadership,” Vance said of Trump.
Walz was quick to highlight the former president’s more forceful actions intended to thwart Obamacare.
“On day one, he tried to sign an executive order to repeal the ACA. He signed on to a lawsuit to repeal the ACA but lost at the Supreme Court, and he would have repealed the ACA had it not been for the courage of John McCain to save that bill,” Walz said.
Walz was referencing when the late Arizona Republican Sen. John McCain broke with conservative ranks to vote against passing the Obamacare replacement legislation that passed the House, effectively ending the skirmish to dismantle the ACA in a singular piece of legislation.
2. Walz forgets individual mandate was repealed
One of the most controversial aspects of Obamacare during the mid 2010s was the mandate that consumers nationwide purchase health insurance coverage or pay a penalty.
In theory, the individual mandate incentivized young, healthy people who did not necessarily need health insurance coverage to enter the market. This effectively subsidized those with higher healthcare expenses, particularly those with preexisting conditions.
Walz broached the matter of the individual mandate in a critique of Vance’s position that Trump’s healthcare plan would still be able to cover preexisting conditions without requiring healthy people to purchase unnecessary insurance.
“I think the idea of making sure the risk pool is broad enough to cover everyone, that’s the only way insurance works,” Walz said. “When it doesn’t, it collapses.”
The individual mandate was arguably the most unpopular facet of Obamacare, with nearly 40% of voters under 65 in 2017 disapproving of the policy.
The Republican-led majority in Congress eliminated the monetary penalty for not purchasing health insurance, effective as of 2019.
The public approval rating of the ACA has grown steadily since the individual mandate was repealed, and the overall Obamacare marketplace has stabilized, reaching 59% in popularity as of February 2024.
Vance did not directly address that the mandate had been repealed under the Trump administration, but he did say that his running mate strengthened Obamacare “in a way that preserved people’s access to coverage who had preexisting conditions.”
“We currently have laws and regulations in place right now to protect people with preexisting conditions. We want to keep those regulations in place, but we also want to make the health insurance marketplace function a little bit better,” Vance said.
3. Walz highlights Biden administration record on Medicare drug price negotiations
Walz went to great lengths to give Harris credit for the ability of the Centers for Medicare and Medicaid Services to negotiate prescription drug prices with pharmaceutical companies directly, a key component of President Joe Biden’s Inflation Reduction Act.
“Kamala Harris negotiated drug prices for the first time with Medicare,” Walz said. “We have 10 drugs that will come online, the most common ones that will be there.”
Under the Inflation Reduction Act plan, the CMS is able to set a price for the most expensive drugs for the Medicare Part D program, which covers patient-administered drugs. Pharmaceutical companies either must agree to the CMS price or pay high excise taxes to sell their products to Medicare patients.
Negotiations do not necessarily cover the most common medications used by Medicare beneficiaries, as Walz claimed.
The new prices for the 10 drugs selected this year for the program are slated to take effect in 2026, resulting in an estimated $1.5 billion in lower out-of-pocket costs for beneficiaries that year.
Vance wanted to comment on the drug price negotiation program, but the CBS News moderators cut the conversation short to move on to other topics.
Harris has lauded on the campaign trail that she was the tiebreaking vote in the Senate to pass the Inflation Reduction Act in 2022, and she has promised to accelerate the pace of negotiations for the successive rounds of negotiations to take place each year.
Vance has a history of being a strong proponent of allowing Medicare and private prescription buyers to negotiate drug prices with the pharmaceutical industry directly, a touch of his economic populism that breaks with the conservative orthodoxy of the GOP.
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But voters from both sides of the aisle are largely unaware of the details of the current arrangement under the Inflation Reduction Act despite the Harris-Walz campaign’s reliance on the achievement.
Polls from September found that nearly two-thirds of voters were unaware that the law allowed for Medicare to negotiate the price of prescriptions, including 65% of seniors over age 65, who are generally covered by Medicare.