The political world is abuzz about the naming of Ohio Senator JD Vance as former President Donald Trump’s vice presidential running mate. I will stay out of the broader political fray right now, but I thought it was worth writing about how GOP candidates increasingly do not always meet a strict GOP litmus test on every issue. This could be – I emphasize could – with Vance on healthcare.
Vance came to fame with his bestselling book, Hillbilly Elegy: A Memoir of a Family and Culture in Crisis, which recounted the social and economic problems his family faced during his upbringing in Kentucky and later in Ohio. Vance recounts the plight of poor white working-class families in Appalachia, including family struggles with alcoholism and drug dependence, as well as the embedded love of culture and country. He tells of his rise from this meager existence in a one-parent household to success at college, law school, and business.
The book has a decidedly conservative bent in it, one that is controversial among progressives. Progressives have begun the demonization of Vance, arguing his views are reactionary and to the right of even Trump. But Vance’s book shows him to not be monolithic in his views and gives insight into why Vance has espoused more compassionate views on some issues, including on healthcare. Initially an ardent opponent of Trump, he eventually embraced Trump’s populism, one rooted in some ways in his and others’ experience with poverty and dysfunction.
So where does this rightist Republican stand on certain healthcare issues and what might it mean in a Trump-Vance administration if the ticket is victorious?
Obamacare
Unlike the mantra in much of the Republican Party, Vance has criticized calls for repeal of the Affordable Care Act (ACA). This bucks in a big way Trump’s own views here. During his presidency, Trump teamed up with a Republican majority to attempt an ACA repeal that would have radically changed how much of healthcare is delivered in the nation, including devolution of healthcare dollars to states through block grants. The move would have meant huge coverage losses for millions. The effort failed in the Senate when the now deceased John McCain returned to Washington while terminally ill with brain cancer to vote against repeal.
Before being a senator, Vance penned a 2017 New York Times (NYT) op-ed where he criticized the House and Senate efforts to repeal the health law during Trump’s tenure as president. He said it would eliminate support for low-income individuals and leave too many people uninsured. In the NYT op-ed, he stated: “We’ll rail against the way the government has destroyed our health care market in one breath and resist the support offered to the poor and middle class to navigate this brokenness with the other. This is not conservative; it is incoherence masquerading as ideological purity.”
Even as he was firmly in the grips of Trump’s MAGA populism as a senator in 2023, he was one of a handful of senators who came out to question calls last year by the former president to revisit the ACA again. He noted that key planks of Obamacare are broadly popular, including denying coverage or charging more for those who have pre-existing conditions. Instead, he took a more practical approach, saying: “I don’t think there’s any effort to try to change them (the ACA) protections). I think there is a recognition though that we spend a lot of money and we don’t get a whole lot out of our healthcare system relative to some of our peer countries. So that provides some pretty ripe ground for reform.”
Vance also has suggested that we must stop reducing government commitments to healthcare, although he does have a bit of a mixed record on Medicare cuts. In 2022 he told AARP: “Finally, we have to fight back against efforts to strip money from the Medicare program to pay for other things.” In his 2017 NYT op-ed, he stated: “Many problems — the monopolization of provider networks, a regulatory framework that forces Americans to overpay for generic drugs — require both a positive Republican vision and a more robust majority to carry it out. … But devising that vision is impossible when we refuse to accept that the government bears some financial responsibility in solving a problem it helped create.” This sounds a little like Teddy Roosevelt’s New Nationalism healthcare view in 1912.
Now, will Trump team up with rightists in the House Freedom Caucus to have another go at ACA repeal anyway? It is very possible. But the Senate has always been much more of a moderate and deliberative body. Many will question the value in the upper chamber. And that Vance has already espoused reservations could impact an ACA repeal effort or at least the scope of any such effort. A total remake of government programs (principally the ACA and the Exchanges) might be far-flung policy with a VP Vance. Vance’s upbringing and experiences may make him sympathetic to not upending the coverage gains as well as government investment in healthcare generally. On making premium enhancements in the Exchanges permanent, that may be a different story.
Drug price reform
While Vance looks different from Trump on coverage and the ACA, they see more eye-to-eye on drug price reform. Admittedly, while the former president was not afraid to use his bully pulpit against Big Pharma, Trump’s drug price reform efforts had fits and starts and he never seemed to follow through on what were these atypical ideas for a Republican.
Trump proposed to reduceMedicare Part B medical drugs to international benchmarks if negotiations over costs did not save enough. A rule seeking to carry this out was published in the twilight of his administration and was pulled back by the Biden administration as it was not well thought out. He also said he wanted to extend the idea to Medicare Part D retail drugs. He did champion and pass the ability for states to import drugs from Canada.
For his part, Vance backed Medicare drug price negotiations when running for the Senate in 2022. He told AARP: “I think we have to let Medicare negotiate prescription drug prices so that our seniors aren’t paying through the roof for prescription drugs. It’s just preposterous how much our seniors … are paying for their prescription drugs.”
He went on to endorse drug importation as well, saying: “In addition to allowing Medicare to negotiate prescription drug prices, we need to allow American companies and pharmacies to import drugs from overseas. Europe pays way less for drugs, even drugs that were developed in the United States, than America pays. So, a lot of Americans, especially seniors, are subsidizing European health care. We have to have leaders who look out for our citizens first, and one of the ways is allowing drugs that are being sold at a certain price in Europe to come into our country to be sold at the same price.”
So, could both Trump’s and Vance’s brand of populism stop the rollback of Medicare drug price negotiations and perhaps drive drug price reform througout the system even further?
The policy wonk factor
Vance also is different because he is a bit of a policy wonk — something I admire. He seems to have studied healthcare well and has seasoned and nuanced explanations of American healthcare’s plight. He recognizes the huge value problem in America – spending the most and deriving so little. He articulates well the perversity of America’s drug pricing and how injurious it is to people and their health. He sounds a bit like Sen. Bernie Sanders, I-VT, when discussing the disparity between America’s drug prices and the rest of the developed world. He is not afraid to dive into how the Food and Drug Administration (FDA) regulatory rubric and patent laws drive up drug costs. He seems to recognize that one of the ugly healthcare problems is the nefarious revolving door that exists between key government healthcare regulators and the private sector. He wants to change this with a long-term ban on taking employment at a regulated entity post government service.
I find one last point interesting. In his NYT op-ed, he wrote: “The subsidy for employer-sponsored coverage has tethered health care to employment in a way that virtually no economist endorses.” It is not an indictment of what we do or an endorsement of single payer or socialized medicine. But he seems attuned to the uniqueness of America’s employer-driven coverage and the fracture, duplication, and costs associated with our system. He knows reform is needed.
Conclusion
The Biden administration’s healthcare policies are on full display each day and we know them. They are assertively pro-coverage and reasonably pro-reform. At the same time, we see the excess and irresponsibility. Trump 45 was a bit schizophrenic on healthcare – anti-coverage generally with some elements of thoughtful reform. With the election now leaning in the GOP’s direction after a dead heat over the past few months, the question to ask is the following on Vance: Could the self-avowed hillbilly’s upbringing, shirt-sleeve compassion, and wonkishness be a benefit to healthcare policy in the possible Trump 47 administration?
Sources and additional reading:
https://thehill.com/policy/healthcare/4775098-vance-healthcare-positions
https://www.semafor.com/article/11/27/2023/trump-obamcare-repeal-senate-reaction
https://states.aarp.org/ohio/bulletin-senate-q-and-a
#election2024 #trump #vance #healthcare #medicare #drugpricing #drugimportation
— Marc S. Ryan
