Under President Donald Trump, the Republican Party is gearing up to overhaul Obamacare — the sweeping health care law enacted in 2010 that covers some 20 million Americans.
At a special CNN town hall debate Tuesday night, two senators with diametrically opposed views of the government’s role in health care — Ted Cruz and Bernie Sanders — will face off and field questions from Americans about the future of the country’s health care system.
Both men unsuccessfully ran for president in 2016. Each senator has a national following — Cruz as a spokesperson of the conservative right and Sanders as a representative of liberal ideals.
The prime-time event, moderated by CNN’s Jake Tapper and Dana Bash, is certain to highlight the many challenges surrounding efforts to dismantle the Affordable Care Act. And it comes as the GOP grapples with how quickly to repeal the law, with Trump acknowledging recently that it might not happen this year.
Several policy issues are at the center of the ongoing battle about reforming Obamacare, including the popular provision to protect people with pre-existing conditions and the controversial mandate that nearly all Americans get coverage. Republican lawmakers are also wrestling with how to live up to their promises to make Obamacare more affordable and to reform Medicaid.
Under the Affordable Care Act, insurers were no longer allowed to discriminate against those with pre-existing conditions. Republicans are considering keeping the provision, but only for those who have maintained insurance coverage. The uninsured could face higher premiums or be excluded when they apply for policies.
Republicans also want to revive state-based, high-risk pools for those with pre-existing conditions. While Republicans have long favored high-risk pools, they suffered from severe funding shortages before they were essentially shut down by Obamacare.
On the flip side, Republicans want to jettison the individual mandate, but that leaves them with a big problem. The Obama administration put the requirement in place to attract younger, healthier Americans, who help pay for older enrollees and those with pre-existing conditions. The GOP must find a way to lure these healthy consumers into the individual market.
Another area where the parties disagree is on Medicaid. Democrats championed expanding coverage for low-income Americans by expanding Medicaid to more adults. Republicans, on the other hand, want to curtail federal responsibility for the program by capping funding.
Both Cruz and Sanders have their own ideas on reforming the health care system and making coverage more affordable for everyone. Their approaches, however, are drastically different.
Sanders is a proponent of a “single-payer” federal health care system, or as he refers to it: “Medicare for All.” During the presidential campaign, the Vermont senator outlined a government-run program that would offer Americans comprehensive care covering everything from doctors’ visits to hospital stays, to vision, dental and mental health services.
He is a proponent of hiking taxes on the wealthy to pay for his proposed system.
Cruz, meanwhile, has railed against Obamacare for years and has vowed to fully repeal “every word” of the law. The Texas firebrand made his name in national politics in 2013 when he gave a more than 20-hour marathon speech to oppose funding for the Affordable Care Act.
Tuesday’s CNN debate comes as congressional Republicans are paving the way to repeal significant portions of Obamacare. Senior lawmakers are currently crafting an Obamacare repeal bill that requires just a simple majority of senators for approval.
But the discussions over creating an alternative to the controversial law has exposed tensions within the GOP. Many Republican lawmakers have grown increasingly wary of the political consequences of a quick and sweeping repeal of Obamacare, and some have more openly begun to discuss “repairing” the law and keeping aspects of it that are popular.
That note of caution clashes with impatience among some conservative members of the GOP conference, who fear that anything short of a swift repeal of Obamacare will be unacceptable to their constituents.
Trump, who campaigned on repealing and replacing Obamacare, said over the weekend that rolling out a new healthcare system will likely be a drawn-out process.
“I would like to say by the end of the year at least the rudiments, but we should have something within the year and the following year,” Trump said.