Moderators Jake Tapper and Dana Bash should utilize the February 7 CNN debate between Sens. Bernie Sanders (I-VT) and Ted Cruz (R-TX) on “the future of Obamacare” to ask targeted questions about the GOP’s plans to replace the Affordable Care Act (ACA) and how that will affect the American health care system. As CNN’s town hall with House Speaker Paul Ryan (R-WI) demonstrated, these forums can serve as opportunities to fact-check misinformation, but they can also fail to substantively engage on specific policy issues. Moderators should be prepared to pose specific questions to Cruz, the representative for “the viewpoint of President Trump and the Republican party,” on distinct policies proposed by the GOP to repeal and replace the ACA.
While there is no shortage of important questions about the negative impacts of repealing the ACA on Medicare, job growth, LGBTQ equality, the budget deficit, and mental health care services, moderators must prioritize the subjects they can address in the time allotted. Here are five of the most important questions that CNN should ask Cruz in tonight’s debate.
1. Will The GOP Replacement Cover As Many People As The ACA, Which Has Reduced The Number Of Uninsured Americans By More Than 20 Million People?
Implementation of the ACA has resulted in a record low number of uninsured Americans -- merely 8.6 percent in June 2016, down from over 16 percent in 2010. Numerous reports have noted that Republican politicians continue to obfuscate about whether their replacement for the ACA would cover as many people as Obamacare does, likely because none of their proposed policies would. Vox’s Sarah Kliff analyzed the existing replacement plans and found that all of them would reduce coverage, with the number of people impacted ranging by between 3 million and 21 million people.
Given that Cruz himself dodged this question during a 2016 Republican presidential primary debate, this new venue provides a unique opportunity to press the senator on whether the Republican replacement will maintain existing coverage levels.
2. Will The Replacement Plan Rescind ACA Provisions That Pertain To Women’s Health, Like The Contraception Mandate, The Prohibition On Gender Rating, And The Sex Discrimination Ban?
Congressional Republicans, including President Donald Trump’s nominee to lead the Department of Health and Human Services, Tom Price (R-GA), have publicly opposed some ACA provisions regarding women’s health care. As CBS News noted, the debate over the ACA resurrects the risk of “a return to higher premiums for women” and “gaps in coverage for birth control and breast pumps.” The ACA also banned discriminatory practices, like sex discrimination and gender rating, while significantly reducing out-of-pocket costs for women’s birth control.
Tapper and Bash should ask about the future of women’s health care, making sure to reference the specific gains made by the ACA to prevent generic answers that dodge the question.
3. Can You Guarantee That Medicaid Block Grants Won’t Result In Benefit Cuts For Recipients?
One of the leading GOP proposals for reforming the health care system revolves around changing Medicaid’s funding structure to a block grant system, which caps the amount of funding a state receives from the federal government. While conservatives typically discuss block grant proposals in terms of allowing states to “innovate,” in reality, most block grant proposals shift Medicaid costs to the states, which would cause chaos on state budgets and force draconian cuts in services covered by Medicaid.
Under the ACA, the Medicaid expansion extended health insurance to millions of low-income Americans, making a discussion of proposed changes a necessity during the debate.
4. How Is It Possible For An ACA Replacement To Keep Popular Parts Of The Law, Like The Ban On Denying Coverage To Those With Pre-Existing Conditions, While Also Eliminating The Individual Mandate?
Numerous conservatives, including Trump, have pledged to keep certain parts of the ACA, like the ban on denying coverage to people with pre-existing conditions and the provision that allows young adults to remain on their parents’ insurance until age 26. But they simultaneously promise to get rid of other provisions, like the individual mandate and the varied taxes, which provide the revenue to fund the popular parts of the law.
As New York Times columnist Nicholas Kristof wrote, it’s “impossible” to keep certain popular provisions “while eliminating unpopular parts,” because the “good and the bad depend on each other.” This tension is a central fault line in discussions about the ACA and should be a central theme in CNN’s town hall.
5. Given The Terrible Track Record Of High-Risk Pools, Would Resurrecting Such A System Simply Repeat The Mistakes Of The Past?
One of the few specific health care policies Republicans have championed in pushing to repeal and replace the ACA involves the resurrection of high-risk pools. Despite conservative attempts to repackage high-risk pools as a new idea, they have a long history of problems, as they typically are chronically underfunded, are prohibitively expensive for customers, and provide inadequate coverage. As the Los Angeles Times’ Michael Hiltzik noted, 35 states used high-risk pools prior to the implementation of the ACA’s protections for people with pre-existing conditions, and the experience was “almost universally grim.”
Moderators should ask about high-risk pools, because they would degrade access to health care to those who are most vulnerable and need care the most.