The Sounds of Silence in the Republican Debate

I had one mission last evening watching the Republican-Fox News debate among their party’s top ten presidential contenders: what, if anything, could we learn about the state of play regarding the Affordable Care Act and U.S. health policy?

What I observed: the impassioned debate about the Affordable Care Act/ACA/ObamaCare is over, even among Republicans.

Here is what I noted from the debate that referenced the ACA:

First, Ohio Governor John Kasich restated his strong support for his decision to expand Ohio’s state’s Medicaid program as enabled and financed by the ACA, invoking President Ronald Reagan as someone who “expanded Medicaid three or four times.” He emphasized Trump Kasichhow the expansion helps both Ohio’s working poor as well as the mentally ill in prisons. No apology, no retreat, and no damage or attacks from any of his rivals.

Second, asked about his prior public support for a Canadian-style single payer health care system, Donald Trump commented that “single payer works well in Canada and incredibly well in Scotland.” He said he wants a “private system without artificial lines around states” (so much for states’ rights) and opposes “insurance companies that make a fortune because they have total control of the politicians. Get rid of the artificial lines. Take care of the people who can’t take care of themselves.” Oddly, at the end of his closing statement at the very end of the program, he added, apropos of nothing: “We have to end Obamacare and make our country great again.”

Former Florida Governor Jeb Bush said he wants to “get rid of Obamacare and replace it with something that doesn’t suppress wages.” No indication of what the “something” might be.

Wisconsin Governor Scott Walker simply said he wants to “repeal Obamacare.”

That’s it. Except for Trump’s, none of the others’ closing statements mentioned the issue. Even Texas Senator Ted Cruz, in his lengthy litany of first-day-as-President actions, left executive action on the ACA off his list. Cruz, as many will recall, was the key instigator of the 2013 federal government shutdown as a final gasp to prevent implementation of the ACA’s insurance coverage expansions on January 1 2014.

The only question from the panel of three Fox news journalists relating to health reform was the one to Trump regarding his past support for single payer health insurance – more a Fox gotcha moment than a thrust into health policy.

I looked at dozens of news accounts of the program from journalists across the political spectrum. Obamacare/ACA merited no mention anywhere in the their accounts and analyses.

This is the sound of silence as the ACA disappears from the nation’s political radar screen.

Yes, U.S. health policy is becoming boring again, still a never-ending feast for the policy wonks, still a continuous hand-wringing exercise for patients and medical providers dealing with their daily challenges, and now a big nothing-burger for most Americans focused on other concerns.

On two other health related issues, we heard repeated statements of opposition to public funding for Planned Parenthood and, of course, strident statements of opposition to abortion where the focus put candidates on the defensive who are willing to allow abortion in cases of rape, incest, and to save the life of the mother.

And nothing about Ebola!

I am sure in future debates, the ACA will return and receive a higher profile. But temperatures are cooling and this program last evening was important affirmation.

Author: John McDonough

I offer insights and opinions on how to improve health care systems for everyone

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