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Trump and GOP Rivals' Positions on Major Healthcare Issues

— Here's where the top candidates stand on abortion, the ACA, and gender-affirming care

MedpageToday
A photo of former president Donald Trump speaking at a Republican Party of Iowa Lincoln Dinner in Des Moines, Iowa

After former President Donald Trump swept Monday's Iowa Republican caucus with , the presidential candidates, including Florida Gov. Ron DeSantis who received 21% of the votes and former South Carolina Gov. Nikki Haley who garnered 19%, are now shifting their focus to the New Hampshire primary on January 23.

Their stance on various healthcare issues is likely to factor into the decisions of Granite State voters and those voting in other upcoming primary elections.

Abortion and Winning Elections

Last week during a town hall, Trump took credit for helping to reverse Roe v. Wade in June 2022. As president, he appointed three conservative justices to the Supreme Court, all of whom voted to overrule the 1973 decision that had established the federal right to an abortion.

While Trump said he is anti-abortion, he believes in exceptions for the life of the mother, rape, and incest. He's also said he opposes a 6-week abortion ban, given that "a lot of women don't know if they're pregnant in 5 or 6 weeks."

During the town hall, Trump implied that GOP candidates need to make some compromises on this issue. "You have to win elections," he said. "Otherwise, you're going to be back where you were, and you can't let that happen again."

Recent abortion rights victories -- including a constitutional amendment protecting access to abortion, which passed in Ohio in November -- have raised doubts about whether a candidate with a hardline anti-abortion approach can win the election. At the same time, Susan B. Anthony Pro-Life America, an influential anti-abortion group, said in August that it may withhold endorsements for candidates who do not support a .

Last April, DeSantis signed , a 6-week abortion ban, which prohibits abortion once there is a detectable heartbeat. That ban will only be implemented if the state's 15-week legislation by the state Supreme Court.

During a in Des Moines last week, DeSantis chastised Trump for calling 6-week abortion bans a "terrible thing," noting that "he's given a gift to the left to weaponize that against pro-lifers, and that's wrong."

During a November primary debate, Haley said she would support a 15-week federal ban on abortion and "anything that would pass." However, she has also repeatedly said that realistically there are not enough votes in Congress to pass such a ban. Instead, she has called for "consensus" on banning late-term abortions, encouraging "good-quality adoptions," making contraception accessible, and ensuring that no state law would criminalize a woman who obtains an abortion.

DeSantis characterized Haley as "confused on the issue. I think she's trying to speak to different groups with different things."

Gender-Affirming Care

During a primary debate in December, DeSantis underscored his opposition to gender-affirming care for minors: "As a parent, you do not have the right to abuse your kids," he said. "I signed legislation in Florida banning the mutilation of minors because it is wrong. We cannot allow this to happen in this country."

DeSantis's remarks received a quick rebuke from the Endocrine Society, which said in a that "comments characterizing gender-affirming care for transgender and gender-diverse youth as child abuse and genital mutilation do not reflect the healthcare landscape," and that several established medical and specialty societies, including the American Medical Association, agree.

At the CNN debate, Haley said "we shouldn't have any gender transitions before the age of 18. Just like we don't have tattoos before the age of 18, we shouldn't have gender transformation or puberty blockers."

For his part, Trump released a on the social media platform Truth Social in early 2023, stating that if elected president, he would call on Congress to stop federal taxpayer dollars from being used to promote or pay for gender-affirming procedures "and pass a law prohibiting child sexual mutilation in all 50 states."

Trump also said that he would block any healthcare provider who took part in the "chemical or physical mutilation of minor youth" from participating in Medicare and Medicaid.

Affordable Care Act, Medicaid Expansion

Late last year, Trump resurrected his war on the Affordable Care Act (ACA), promising to replace it with "." He also made a similar promise in 2016. To date, he has not put forward a replacement plan.

During a primary debate in September, DeSantis was asked to address the problem of 2.5 million people in his state lacking health insurance. Florida is one of 10 states that has .

DeSantis placed the blame for the number of uninsured Floridians squarely on "Bidenomics," and President Biden himself for overspending and over-regulating healthcare. He also argued that his state does not support "a lot of welfare benefits."

As for the ACA, DeSantis said during an that "Obamacare hasn't worked" and that he would replace it with "a better plan," with "more transparency, more consumer choice, more affordable options, less red tape, less bureaucracy weighing everybody down."

In response to a question on the high costs of healthcare at the primary debate in September, Haley said that, if elected, "we will break all of it [down], from the insurance company, to the hospitals, to the doctors' offices, to the PBMs [pharmacy benefit managers], to the pharmaceutical companies. We will make it all transparent because when you do that, you will realize that's what the problem is."

When asked during the debate last week whether she would allow the 40 states who currently have expanded Medicaid to continue their policy, she did not provide a clear answer. South Carolina has not expanded Medicaid.

Haley has also been a vocal critic of the ACA, but she whether she would attempt to repeal the law if elected president.

  • author['full_name']

    Shannon Firth has been reporting on health policy as MedPage Today's Washington correspondent since 2014. She is also a member of the site's Enterprise & Investigative Reporting team.

  • author['full_name']

    Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy.