How GOP presidential candidates compare on health care issues | McClatchy Washington Bureau

Six years after the passage of the Affordable Care Act, “Obamacare,” the nation’s health care remains at the center of political debate. Here’s a look at how the three remaining Republican presidential candidates view Obamacare, the cost of prescription drugs, the role of Medicare and Medicaid in confronting the nation’s provision of medical services, and abortion.

AFFORDABLE CARE ACT

Ohio Gov. John Kasich says he supports repealing the law known as Obamacare. He has, however, called the Republican Party’s 2014 pledge to repeal it “stupid.”

“It got all these conservatives all stirred up and angry because they didn’t keep their word,” Kasich said last month on “The Jay Weber Show,” a talk radio program. “I mean, what a stupid promise.”

Kasich has been criticized by some conservatives for his decision to expand Medicaid in Ohio under the Affordable Care Act.

“I’m for repealing Obamacare,” Kasich said in February. “But expanding Medicaid at this point, bringing our dollars back, is working. It’s saving money and it’s saving lives. And that’s what really matters at the end of the day.

Donald Trump also supports repealing the Affordable Care Act. He has a seven-point health care plan on his campaign website that includes modifying laws that prevent the sale of health insurance across state lines; allowing individuals to hold health savings accounts and treating those accounts as part of people’s estates so that they could be passed on without tax penalties; and letting individuals fully deduct health insurance premium payments on their tax returns.

Sen. Ted Cruz of Texas, who spoke for 21 hours on the Senate floor in 2013 in an effort to deny funding for the health care law, famously says that “on day one” of a Cruz presidency he will repeal Obamacare. “There’s no greater regulatory reform than repealing every word of Obamacare,” he said.

Cruz has posted on his website some specifics that sound similar to Trump’s: opening insurance markets across state lines, expanding HSAs and delinking health insurance from employment. He opposed expanding Medicaid in Texas, saying the poor would not be served. “Medicaid is a system that is already overburdened, and more and more people are just getting waiting lists and not actually getting health care,” he told CBS in 2015.

PRESCRIPTION DRUG PRICES

Kasich told Fox Business in February that “the whole” drug industry should undergo a review. He suspects that “We probably are paying for things in research and development that the taxpayers already funded, that perhaps companies are marking up.”

He also advocates competitive pricing, saying, “I don’t understand why people in Europe can pay much lower prices for the same drugs we pay higher for, because we paid for the R&D. To me, that’s a total ripoff on us.”

Trump has talked about giving Medicare the power to negotiate with pharmaceutical companies in order to drive prices down. He’s claimed that he could save $300 billion a year by negotiating drug prices, an assertion that Washington Post fact-checkers called “nonsense.”

Cruz said in Des Moines last November: “Part of the reason prescription prices are so expensive is it can cost over a billion dollars to take a drug to the marketplace because of the federal regulatory barriers. We need to reduce those barriers and have a lot more competition.”

Cruz and Sen. Mike Lee, R-Utah, introduced a bill to completely overhaul the Food and Drug Administration, with the objective of expediting approvals for lifesaving drugs, letting Congress intervene in FDA decisions lawmakers don’t like and expanding the availability of drugs and devices in the U.S. by allowing products approved in other countries into the American market.

MEDICARE AND MEDICAID

Kasich calls for increasing care coordination through Medicare Advantage and revamping payment practices, which his campaign claims would “increase value and quality” of care and would “help restrain Medicare spending to an average of 5.3 percent annually.”

On Medicaid, Kasich says he wants to give states more flexibility. He proposes allocating funds to states on a per-member, per-month basis. That would help “hold Medicaid’s spending growth to 3 percent annually,” his campaign says.

Trump has called for preserving Medicare and has attacked former GOP presidential rivals such as retired neurosurgeon Ben Carson for proposing sweeping changes. He’s also criticized Medicare remedies proposed by House Speaker Paul Ryan, R-Wis. That said, Trump has yet to offer specifics on how he’d preserve Medicare.

On Medicaid, Trump’s health care proposal says, “We must review basic options for Medicaid and work with states to ensure that those who want health care coverage can have it,” but provides no specifics.

“If I’m elected in November 2016, I hope to lead the effort to . . . preserve and strengthen Social Security and Medicare for decades going forward,” Cruz told Fox News’s Neil Cavuto.

Among the changes he’s advocated are increasing the retirement age and making sure cost-of-living increases do not exceed the rate of inflation. Both of those changes should apply to “younger workers – people my age,” he said, not to already-retired beneficiaries.

Cruz in 2013 opposed expanding Medicaid under Obamacare: “Our friends who are saying they want health care do not realize that expanding Medicaid will worsen health care options for the most vulnerable among us in Texas.”

ABORTION

Kasich opposes abortion and signed a bill into law in July 2011 banning most abortions after 20 weeks of pregnancy, allowing an exception only if the woman’s life is in danger. In February, he signed a bill to prohibit Ohio from contracting for health services with any organizations that perform or promote abortion – a measure aimed at Planned Parenthood.

Trump has described himself as an abortion opponent. In a 1999 “Meet the Press” interview, he said that “I am strongly for choice and yet I hate the concept of abortion.”

He stumbled on the abortion issue earlier this month, when he told MSNBC’s Chris Matthews that women who have abortions should be punished. Trump backtracked from that remark and told CBS’s “Face the Nation” that “The laws are set. And I think we have to leave it that way.” Though he has said Planned Parenthood has done “very good work for millions of women,” he supports cutting federal funding to the organization if it continues to provide abortion services.

Cruz is adamantly anti-abortion, even in cases of rape or incest. He told Megyn Kelly on Fox News earlier this month that rape “is a horrific crime against the humanity of a person and needs to be punished and punished severely. But at the same time, as horrible as that crime is, I don’t believe it’s the child’s fault.”

Cruz said it should be up to the states to decide under what conditions to ban abortion. He has advocated eliminating taxpayer funding for Planned Parenthood, which, apart from abortion services – not funded by federal funds – also provides health care to women.