The Republican presidential candidates want Obamacare to be repealed, but only a few have detailed their plans for replacing the massive health care law, leaving a gap in the public debate over what to do about President Obama’s signature achievement.
Obamacare is about to return to the front pages as the Supreme Court rules this month on whether the federal government can continue to pay subsidies to all exchange customers or whether it must limit such payments to residents in states that set up their own health care marketplaces.
That technical ruling could create an opening for Congress to revisit the entire health care law. Republicans are trying to have replacement plans ready, but presidential candidates in their party have lagged behind.
Sen. Rand Paul of Kentucky, an ophthalmologist, vows on his campaign website “to ensure that real free-market principles are applied to the American health care system” and endorses the idea of purchasing insurance across state lines, but hasn’t introduced an Obamacare replacement. A representative of his congressional office said he intends to have a plan in place.
Former Arkansas Gov. Mike Huckabee also rips apart Obamacare on his campaign website, promising to repeal the law and “fight for real health care reform.”
Asked whether Mr. Huckabee has a replacement plan, Alice Stewart, a campaign spokeswoman, said her boss has spent decades pushing “for common-sense preventive health care investments to address diabetes, heart disease, cancer and other conditions rather than a costly intervention-based approach to medicine.”
“He’s also pushed to transform our system of ‘sick care’ that is crushing families with skyrocketing medical costs and provides no financial rewards for people, patients and doctors to keeping people healthy,” she said.
Doug Watts, a spokesman for Ben Carson, said the retired neurosurgeon has not laid out his plan on paper but has endorsed ideas in presentations, including expanding the use of health care savings accounts.
“He has outlined the principles and some of the math, the reasoning and the logic of his approach,” Mr. Watts said. “It is not just platitudes.”
Representatives for former Florida Gov. Jeb Bush and Wisconsin Gov. Scott Walker did not respond to email seeking comment.
Lanhee Chen, a research fellow at the Hoover Institution at Stanford University who served as a top adviser to Mitt Romney’s 2012 campaign, said it makes sense that candidates would want to see a court decision before they commit to any specific plans but warned that they must be ready to respond.
“It is going to be important no matter how the court sides,” Mr. Chen said. “I think part of it is they are waiting to see what happens with the Supreme Court case because it could impact things significantly. So I cut them some slack so far.”
Some have been more proactive.
Louisiana Gov. Bobby Jindal, who is expected to join the campaign this month, rolled out a 23-page policy proposal last year that, among other things, called for a standard tax deduction for individuals who buy their own insurance, federal subsidies for states to help low-income individuals and those with pre-existing conditions purchase coverage.
His plan also promoted health care savings accounts, the sale of health insurance across state lines and block granting Medicaid funding to the states.
“He is probably one of the few potential candidates who actually understands how health care works,” said Henry Goodwin, a communications adviser to the American Future Project, a political group that backs Mr. Jindal for president. “He is very comfortable with the big picture politics and the detail policy of it, and if other candidates aren’t confident like that then they may feel reluctant to” take a firm stand.
Sen. Ted Cruz of Texas, who led an effort to defund Obamacare that resulted in a 16-day partial government shutdown, introduced the Health Care Choice Act of 2015, which calls for the end of the individual mandate as well as for health insurance to be sold across state lines.
Others have backed plans to bridge a court ruling and floated ideas, but have not offered full replacement proposals.
Sen. Lindsey Graham of South Carolina signed on as a co-sponsor to a bill to that would allow Americans to keep health care plans they like and allow Obamacare’s subsidies to continue until August 2017.
Sen. Marco Rubio of Florida floated a three-part plan in a March op-ed that endorsed the idea of refundable tax credits to purchase coverage, expanded health care savings accounts and transitioning Medicare into a premium support system. His office did not respond to emails seeking comment.
The politics of the issue are tricky for Republicans, many of whom hope the justices blow a major hole through Obamacare but don’t want to be blamed for millions of people losing insurance coverage.
A Washington-Post/ABC News poll released this week showed that by a 55 percent to 38 percent margin, respondents said the Supreme Court should not stop the subsidies from flowing to the whole country. But 54 percent of them opposed the law, compared with 39 percent who supported it.
Mr. Obama said this week that he is confident the Supreme Court will rule in the administration’s favor.
“If the Supreme Court does end up getting rid of the subsidies, it is potentially going to be a real issue for the 2016 guys,” Mr. Chen said. “This is potentially a very tricky issue for the 16 candidates.”
Mr. Chen said that if the court rules against the Obama administration, the best scenario for Republican presidential candidates is if lawmakers in Congress find common ground on an alternative “and they draft off that.”
“The more difficult position is if Congress is stalemated,” he said. “My advice to all of them is you have to give it some thought — especially if the decision comes down on the side of the plaintiffs and Congress can’t get their act together.”