Health policy again took a back seat to taxes and Hillary Clinton in the fourth GOP presidential debate Tuesday, but former Hewlett Packard CEO Carly Fiorina declared the Affordable Care Act “crony capitalism at its worst,” and suggested replacing it with high-risk insurance pools, while arming healthcare consumers with better information.
The Affordable Care Act had seemed to fade as an animating issue for Republicans in the debates and the broader campaign for the 2016 primaries, but the victory last week of Kentucky Gov.-elect Matt Bevin was a reminder of the party's enduring ambition to dismantle the law. Bevin has said he would roll back Kentucky's Medicaid expansion and state-based insurance exchange created under Democratic Gov. Steve Beshear.
The debate in Milwaukee, hosted by the Fox Business Network and the Wall Street Journal, focused on economic issues but also included a considerable number of exchanges on foreign policy. Very few questions or answers addressed the ACA, Medicaid or Medicare.
Fiorina, however, was asked by Fox Business Network moderator Maria Bartiromo how she would alleviate regulatory pressure on small businesses. In her question, Bartiromo referenced the ACA's mandate for businesses with 50 or more employees to offer insurance coverage. Last month Congress passed a bill that stopped the threshold from increasing to 100 employees on Jan. 1.
“Well, first we have to repeal Obamacare because it's failing,” Fiorina responded, adding that the law was written by pharmaceutical and health insurance companies. States, she said, should manage high-risk pools—a popular feature in healthcare proposals offered so far by the GOP candidates—and the government should require that price and patient-outcome information be made more readily available so that consumers could “shop smart.”
“Health insurance has always been a cozy little game between regulators and health insurance companies,” Fiorina said.
When Bartiromo pressed Fiorina for details about how she would replace the ACA, Fiorina referenced her own experience with breast cancer. “I understand that you cannot allow families to go bankrupt if they truly need help,” she said. “But I also understand that Obamacare isn't helping anyone.”
The ACA has reduced the number of uninsured Americans to the lowest figure ever measured, but public opinion of the law remains split. High-risk pools, which exist in more than 30 states and are championed by other Republican candidates, including Florida Sen. Marco Rubio and former Florida Gov. Jeb Bush, have been criticized for their high premiums and lack of sustainability. The pools also generally require significant government subsidies to be viable.
Fiorina, who started the debate season with the so-called undercard candidates but got a bump in the polls from her praised performance, has since seen her poll numbers slip from a high of about 15% in September. Recent surveys put her at about 3%, well behind front-runners Donald Trump and retired neurosurgeon Dr. Ben Carson, who are polling above 20%.
There was more discussion of the Affordable Care Act during an earlier debate Tuesday for lower-polling candidates, including recently demoted New Jersey Gov. Chris Christie and former Arkansas Gov. Mike Huckabee.
Louisiana Gov. Bobby Jindal called the ACA one of the most critical domestic issues, and touted that he had published a plan more than a year ago to eliminate it. Jindal declined to expand Medicaid under the ACA, unlike the other Republican governors running for the nomination, Christie and Ohio Gov. John Kasich.
