Vice presidential candidates clash over Trump's plans for Obamacare

Ohio Sen. JD Vance and Minnesota Gov. Tim Walz clashed Tuesday in New York over what the return of Donald Trump to the White House might mean for the Affordable Care Act ban on medical underwriting in major medical insurance sales.

Vance, Trump’s running mate, described Trump as someone who improved Obamacare while he was president, from 2017 through 2020, and as someone who would try to keep the most popular parts of the Obamacare intact if he returned to the White House.

Walz, Kamala Harris’s running mate, described Trump as someone who would continue to try to kill the Affordable Care Act and cause terrible hardship for people with health problems.

Vance and Walz talked about the future of the Affordable Care Act in a second Trump administration during a vice presidential candidate debate organized by CBS News.

“When Obamacare was crushing under the weight of its own regulatory burden and health care costs, Donald Trump could have destroyed the program,” Vance said during the debate. “Instead, he worked in a bipartisan way to ensure that Americans had access to affordable care.”

Walz predicted that Trump would try to return the U.S. health insurance market to pre-ACA rules.

“What that means to you is you lose your pre-existing conditions,” Walz said. “If you’re sitting at home and you’ve got asthma, too bad.”

The backdrop: Vance last week talked briefly about the Affordable Care Act during an appearance on Meet the Press. He suggested that Trump would try to maximize consumers’ flexibility and improve state health insurance risk pools.

Related: Trump’s running mate revives debate about high-risk pools for pre-existing conditions

Many observers, including members of Kamala Harris’s campaign staff, believed Vance was calling for a return to medical underwriting, with use of “risk pools,” or special health insurance arrangements, to provide coverage for people with health problems.

Vance’s views: Vance said he was referring to reinsurance when he mentioned risk pools on “Meet the Press,” not a return of medical underwriting for health coverage applicants.

He implied during the debate that he believes Trump would keep the ACA restrictions on medical underwriting mostly in place.

“We’re going to cover Americans with preexisting conditions,” Vance said. “We currently have laws and regulations in place, right now, that protect people with preexisting conditions. We want to keep those regulations in place, but we also want to make the health insurance marketplace functions a little bit better.”

Vance said Trump set health care price transparency rules when he was president.

“You go into a hospital, you try to buy something, and nobody knows what it actually costs,” Vance said. “That price transparency will actually give American consumers a little bit more choice and will also drive down costs.”

Walz’ views: Walz, a former U.S. House member who now serves as the governor of Minnesota, scoffed at the idea that Trump was a protector of the Affordable Care Act.

“All right, here’s where being an old guy gives you some history,” Walz said. “I was there at the creation of the ACA, and, so, what I know is, under Kamala Harris, more people are covered.”

Walz recalls that, when Trump was running in 2016, Trump emphasized the idea of repealing the ACA.

“On day one, he tried to sign an executive order to repeal the ACA,” Walz said. “He signed onto a lawsuit to repeal the ACA but lost at the Supreme Court. And he would have repealed the ACA had it not been for the courage of John McCain to save that bill.”

Walz predicted a Trump victory would eliminate the ACA and bring back medical underwriting for purchasers of individual health insurance.

“What they’re saying is, if you’re healthy, why should you be paying more?” Walz said. “So, what they’re going to do is let insurance companies pick who they insure. Broke your foot during football? They might kick you out… Those of you who are a little older, gray, you know, got cancer? You’re going to get kicked out.”

Unlike Trump, “Kamala Harris will protect and enhance the ACA,” Walz said.

Walz pointed to the Biden-Harris administration’s efforts to bargain with drug makers for better prices for 10 prescription drugs covered by Medicare as an example of how Harris has worked to improve the ACA and health policy in general.

The ACA individual mandate: At one point, Walz mentioned the ACA individual coverage mandate. The provision, now zeroed out, once imposed a tax penalty on individuals who failed to have what the ACA classified as “minimum essential coverage,” or basic health coverage.

“You think the individual mandate’s a good idea?” Vance asked Walz, appearing to be genuinely curious about Walz’s answer.

“I think the idea of making sure the risk pool is broad enough to cover everyone, that’s the only way insurance works,” Walz said. “When we incentivize people to be in the market, when we help people who might not be able to afford it get there.”

Without those kinds of efforts to keep the health insurance market risk pool broad enough, health insurance collapses, Walz said.

Walz rolled his eyes at the thought of people trying to avoid paying health insurance during periods when they feel healthy.

“I’ve heard people say, well, ‘I don’t want to buy into Medicare,’ or whatever,” Walz said. “Good luck buying health care once you get past 70.”

Paid leave: Vance and Walz agreed to some extent on the need for improvements in paid leave.

Vance said that he has seen the need for leave being an issue for his wife, even though she’s a successful corporate lawyer.

“The cultural pressure on young families, and especially young women, I think, makes it really hard for people to choose the family model they want,” Vance said. “A lot of young women would like to go back to work immediately. Some would like to spend a little time home with the kids. Some would like to spend longer at home with the kids. We should have a family care model that makes choice possible.”

Walz noted that Minnesota has adopted a paid-leave requirement for new parents and people dealing with health issues.

“What we know is that gets the child off to a better start,” Walz said. “The family works better. So Kamala Harris has made it a priority. Those of you out there who don’t have it, just imagine what happens if you get cancer or your child gets sick. You end up staying home. In some places, that means no paycheck, because you’ve got no protection on that. ”

If Trump were president, he would not fight for adequate paid leave, Walz said.

“ He’s willing to give those tax breaks to the wealthiest,” Walz said. “He’s willing to say, ‘Bust those unions up. Do whatever.’ What we’re saying is the economy works best when it works for all of us.”