For the first time, being against Obamacare is dividing two Republicans instead of uniting them.
President Obama’s healthcare law has emerged as a major line of attack between the two top GOP contenders for the White House: Sen. Ted Cruz, who won the Iowa caucuses last week, and billionaire businessman Donald Trump, who came in second.
Both men express deep discontent with the Affordable Care Act, which has been a crucial position for Republicans since Congress passed the law in 2010. But that’s where the similarities end. The pair could hardly sound more different when it comes to questions of how they would replace it.
Cruz, who has built his political career around opposition to Obamacare, even forcing the 2013 government shutdown over it, touts some long-standing conservative ideas to reform healthcare. That includes allowing plans to be sold across state lines and expanding tax-free health spending accounts. Cruz also wants to separate health insurance from employment so people don’t have to rely on their job to provide coverage.
But the Texas Republican hasn’t gotten more specific about how he would reform the U.S. healthcare system, which experts agree is still troubled by rapid spending growth, waste and too much focus on treating healthcare ailments instead of preventing them. Instead, he mainly emphasizes getting rid of it.
“First of all, we have seen now in six years of Obamacare that it has been a disaster,” Cruz said at a Fox News debate last month. “If I am elected president, we will repeal every word of Obamacare.”
Trump has been even less specific than Cruz, and the ideas he has mentioned sound like more government involvement. He has suggested the government should “work with hospitals” to ensure everyone who needs care gets it, which at face value sounds like a public healthcare plan. Trump insists it’s not, but he has praised single-payer systems, including Canada’s.
“The Canadian plan also helps Canadians live longer and healthier than America … We need, as a nation, to reexamine the single-payer plan, as many individual states are doing,” Trump wrote in his 2000 book The America We Deserve.
Even recently, Trump has suggested that those who don’t support a plan ensuring healthcare for all Americans aren’t compassionate. “I have a heart, I want people taken care of,” he told ABC last month. “If people have no money, we have to help people. But that doesn’t mean single-payer. It means we have to help people.”
Supporting a single-payer, government healthcare system or other liberal ideas, such as allowing Medicare to negotiate drug prices, which Trump also supports, would have meant death to most GOP candidates in recent elections.
And now Cruz is starting to capitalize on Trump’s healthcare positions, running ads in which he equates “Trumpcare” with “Obamacare” and “Hillarycare.” Political strategists agree Trump’s position on the issue could start to hurt him with Republican voters.
“Sheer force of personality,” said Jim Manley, a Democratic strategist with QGA Public Affairs, when asked how Trump has managed to win over so many Republican primary voters despite his past, and perhaps current, support for universal health coverage.
“So far, he hasn’t let facts get in the way of his campaign, and there’s no better example of that than when it comes to healthcare,” he said.
Polls show that while Republican voters are less concerned about healthcare than in past elections, they’re still overwhelmingly opposed to Obamacare. It could be one reason Trump insists he hates the law despite a history of supporting more government involvement in healthcare.
But with Cruz drawing attention to the issue, it could be more difficult for Trump to get by with simply opposing the law without also supporting conservative replacement ideas. Cruz, for his part, has long touted himself as the most anti-Obamacare candidate, bragging about his well-known 2013 quest to defund the law by refusing to fund the government for two weeks.
“Cruz is running his attack on Obamacare out of the conservative playbook,” said Republican strategist Ron Bonjean. “Trump is making himself dangerously vulnerable to attack by the Cruz campaign and Republican challengers by backing left-wing policies that are the pillars of the Democratic Party.”
Indeed, the idea of allowing the Medicare program to require lower prices from drug companies has been endorsed by leading Democratic contender Hillary Clinton and her close-trailing opponent, Sen. Bernie Sanders. Trump is the only Republican contender to support that idea.
It’s a wonky policy issue, and one that might not bother some Republican voters who otherwise like Trump’s braggadocious style.
But it’s sure to deepen resentment of Trump among most Republican lawmakers and policymakers, who have fought Democrats for years over the issue.
“Healthcare policy is a good illustration of the problems Republican candidates would have with Trump as the nominee,” said Bill McInturff, a partner at the GOP polling company Public Opinion Strategies.
As for Cruz, remaining vague on exactly how he would replace Obamacare shouldn’t be damaging among Republican voters, since he already has established himself as a conservative on the issue, strategists say. Manley said he doesn’t expect more details from Cruz’s campaign until the general election, assuming the Texan wins the nomination, even though a representative told the Washington Examiner last week that the senator “hopes” to offer up more specifics.
“They’ll find some way to get out of it, but at some point he’s going to have to lay something out,” Manley said.
