You might think that two months would be enough time for Gov. Ron DeSantis to think up an answer to an obvious, direct and highly relevant question about his record on health care in Florida.
You would be wrong.
Near the end of Wednesday night’s Republican presidential debate ― held in Tuscaloosa, Alabama, and broadcast on NewsNation ― moderator Elizabeth Vargas pointed out that “Florida has more uninsured people than almost any other state.”
Given that record, Vargas said, why should voters trust DeSantis on health care?
The question was nearly identicalto one DeSantis fielded at the Republican debate in late September, when Fox News host Stuart Varney cited the same figures and asked, “Can Americans trust you on this?”
The question was important because Florida really does have more uninsured residents than almost any other state. And the single biggest reason is that it’s among a handful of Republican-run, mostly southern states that have refused to use funding from the Affordable Care Act ― aka “Obamacare” ― to expand Medicaid.
DeSantis is among the Florida Republicans who have opposed expansion.
But instead of defending that position and, more generally, his record on health care, DeSantis in September gave a short monologue about inflation and the rising price of consumer goods, followed by a bland, vague statement: “We have big pharma, big insurance, and big government and we need to tackle that and have more power for the people and the doctor-patient relationship.”
If anything, the question about health care has become even more important since then, because a full-scale repeal of Obamacare is suddenly part of the political conversation again.
In late November, former president and current GOP front-runner Donald Trump vowed ― as he did so many times during his first campaign and then his presidency ― to replace Obamacare with something better. DeSantis went on to make a similar promise.
“Obamacare hasn’t worked,” DeSantis said on NBC’s “Meet the Press.” “We are going to replace and supersede with a better plan.”
DeSantis admitted that, like Trump, he doesn’t actually have a plan yet. He said he would introduce one, “probably” in the spring. Republicans have been making ― and not fulfilling ― such promises since Obamacare first became law.
Maybe DeSantis will surprise everybody by actually producing a detailed plan that really offers a better alternative to the Affordable Care Act ― although, to be clear, he’d first have to surprise everybody by getting enough votes to remain a viable presidential candidate past the first few contests.
For now, voters trying to judge whether he can deliver on health care will have to rely on what he’s done in the past, which means looking closely at his record in Florida ― the one Vargas was asking about. And on Wednesday, as in September, DeSantis didn’t have much to say.
After acknowledging that Florida hadn’t expanded Medicaid, he implied that was the right decision because the states that had approved and implemented expansion were “struggling financially.”
He didn’t try to back up the claim and he probably couldn’t: Most states are running surpluses these days, and greater spending on Medicaid, most of which the feds pick up anyway, can mean lower spending on other programs.
More important, DeSantis never explained how blocking Medicaid would help people get health care when, by all accounts, no expansion means more people without insurance ― in other words, exactly the problem Vargas (like Varney before her) was highlighting.
DeSantis did follow up that statement with another set of platitudes, including a promise “to hold the pharmaceuticals accountable.”
It was yet another example of Republican leaders not having concrete ideas on health care ― although in this case, it was a particularly relevant one because there’s somebody running in 2024 who actually has taken action to rein in the drug industry.
That somebody is President Joe Biden, who worked with Democrats to enact a series of initiatives designed to bring down the price of prescription drugs.
Among the reforms are a cap on insulin prices for Medicare beneficiaries that the private sector has since extended to non-elderly Americans with private insurance, as well as penalties on drugmakers who raise prices faster than inflation. And then there’s a provision under which the federal government will, for the first time, negotiate the price of some high-cost drugs in Medicare.
These are all incremental steps and, like the Affordable Care Act, they will not instantly make health care more affordable for the millions who struggle with medical bills today. But they will help.
If Republicans want to prove they can do more, they’ll have to defend their records and offer concrete alternatives for the future ― two tasks that, at least for DeSantis, seem to be an ongoing challenge.