What would a Nikki Haley presidency seem like for well being care?

Republican presidential hopeful Nikki Haley will find out how her marketing campaign is resonating with voters after the Jan. 15 Iowa caucuses, the primary presidential nominating contest of this election yr.

Already, the previous South Carolina governor — who turned effectively generally known as one of many Reasonably priced Care Act’s loudest critics throughout her tenure in workplace from 2011 to 2017 — has raised questions on what her presidency may imply for the nation’s well being care coverage.

“I’d be very involved,” stated Sue Berkowitz, coverage director and particular counsel for the South Carolina Appleseed Authorized Justice Middle. “South Carolina is on the backside of so many issues in rankings in our nation due to various the selections she made whereas governor.”

Whereas politicians from each events rallied behind Haley when she urged lawmakers to take away the Accomplice battle flag from statehouse grounds following the 2015 church capturing on this coastal metropolis, her politics diverged sharply from these of her Democratic colleagues when it got here to most well being care points.

Haley’s marketing campaign didn’t reply to a number of requests for remark, however statements she’s made throughout latest debates provide clues about her well being care positions.

She has criticized the Biden administration for top federal spending on covid aid and for the variety of folks on Medicaid, a program she has argued the federal authorities ought to give states extra flexibility in funding and administering.

She has additionally emphasised the necessity to discover consensus on banning abortions late in being pregnant. And on Jan. 10, throughout her heated sound-off with Florida Gov. Ron DeSantis within the ultimate debate earlier than the Iowa caucuses, she reiterated her important stance on gender-affirming care.

“I’ve all the time stated that boys want to enter boys’ loos, women want to enter women’ loos, that we shouldn’t have any gender transitions earlier than the age of 18,” she stated. “Identical to we don’t have tattoos earlier than the age of 18, we shouldn’t have gender transformation or puberty blockers.”

On the marketing campaign path, she’s addressed reforming Medicare and Social Safety. However her tenure as governor, which overlapped with a number of tumultuous years of nationwide well being care reform, presents a fair clearer image of how a Haley presidency would possibly look.

Former South Carolina Medicaid Director Anthony Keck identified that one in all her early achievements as governor was fixing a $228 million Medicaid deficit.

“Folks neglect what dire straits the Medicaid program was in when she got here into workplace and the way it took us a pair years to proper the ship,” stated Keck, now govt vp for system innovation at Ballad Well being in Tennessee.

Past that, Keck stated Haley understood that the price of well being care was “rising quicker than most individuals’s paychecks,” including that affordability and entry had been “actually vital to her.”

As Haley eyes the White Home, here is a recap of her well being care report as South Carolina governor, a publish she left in 2017 after Trump appointed her as ambassador to the United Nations.

Reasonably priced Care Act

In 2011, Haley convened an advisory committee to determine if South Carolina ought to construct its personal medical health insurance market as an alternative of collaborating within the federal one established below the Reasonably priced Care Act.

However earlier than the group gathered for its first assembly, Haley wrote in an electronic mail to her advisers that the “entire level of this fee must be to determine the right way to decide out and the right way to keep away from a federal takeover, NOT create a state alternate,” based on a report printed by The Publish and Courier.

When that electronic mail was made public, then-Sen. Tom Harkin (D-Iowa) requested a federal investigation to seek out out if Haley had predetermined the end result of the committee. She was ultimately cleared of any wrongdoing.

All through her time in workplace, Haley repeatedly advocated for the repeal and substitute of the ACA, however she has not given a definitive reply on the marketing campaign path about whether or not she’d attempt to repeal the legislation if elected president, The New York Instances has reported.

Medicaid

In 2012, when the U.S. Supreme Courtroom upheld the constitutionality of the ACA and made Medicaid growth an possibility for each state, Haley declined to develop it in South Carolina. Christian Soura, one in all her former cupboard members, estimated in 2019 that “a number of hundred” folks within the Palmetto State had died due to the choice.

On the presidential marketing campaign path, Haley’s stance on Medicaid growth has remained unchanged, at the same time as individuals who dwell in nonexpansion states broadly help it, based on KFF polling.

South Carolina stays one in all 10 states that haven’t expanded Medicaid eligibility below the ACA, leaving greater than 90,000 residents in a medical health insurance protection hole, based on a 2023 KFF report.

Even so, Medicaid enrollment and spending in South Carolina throughout Haley’s tenure grew considerably, drawing criticism from some conservatives.

In 2012, her administration selected to implement a federal program that robotically issued new Medicaid protection to kids from low-income households based mostly on knowledge from welfare help and the Supplemental Diet Help Program, previously generally known as meals stamps. A 2013 case research discovered that the Categorical Lane Eligibility initiative grew Medicaid enrollment in South Carolina by greater than 92,000 kids in lower than a yr and that the simplified course of “resulted in giant enrollment and retention enhancements.”

Haley’s administration was additionally broadly applauded for establishing a coalition of well being insurers, hospitals, and well being care suppliers to enhance beginning outcomes in a state the place Medicaid pays for greater than 60% of all deliveries. Toddler and maternal dying charges in South Carolina have lengthy ranked among the many worst within the nation.

Current analysis suggests, nevertheless, that a few of the insurance policies Haley’s administration prioritized, similar to a house visiting program and a marketing campaign to forestall early elective deliveries, did not enhance maternal or toddler well being outcomes.

Abortion

On the one-year anniversary of the U.S. Supreme Courtroom’s Dobbs v. Jackson Ladies’s Well being Group ruling, which allowed state legislatures to outlaw abortion, Haley known as the choice a “victory for all times and democracy.”

Her place aligned with a controversial invoice she signed into state legislation in 2016 that banned the process in South Carolina after 20 weeks of gestation — roughly the midpoint of a girl’s being pregnant.

When she signed the legislation, it affected solely hospitals as a result of the state’s three outpatient abortion clinics already did not administer abortions after 15 weeks of gestation. The invoice, which she championed, made exceptions for if the fetus had been recognized with an “anomaly” and would die or if the mom’s life had been threatened. However no exceptions had been made for rape or incest.

Throughout the latest debate in Iowa, Haley known as herself “unapologetically pro-life.”

“Not as a result of the Republican Social gathering tells me to be, however as a result of my husband is adopted, and I’ve acquired my two candy kids sitting in entrance of me, and I had hassle having each of them,” she stated. “Our objective must be how can we save as many infants as doable and help as many mothers as doable.”

On the marketing campaign path, Haley has tried to string the needle between being pro-life and recognizing the problem of enacting a nationwide abortion ban. She has spoken of discovering areas which might be winnable for Republicans, together with rising entry to contraception and supporting adoption. That stated, Haley indicated she would signal a nationwide abortion ban as president if such a invoice reached the Oval Workplace.

Certificates of want

Throughout her first time period, Haley vetoed greater than $1 million from the state price range that had been allotted to manage the well being division’s long-standing “certificates of want” program. This system required hospitals and well being care suppliers to use for permission from the state earlier than constructing new amenities or buying costly gear, with the objective of controlling well being care prices and avoiding duplication of accessible well being care providers.

On the time, Haley known as the principles “intensely political” and stated they allowed “bureaucratic policymakers” to dam well being care suppliers from providing remedy. “We should always enable the market to work somewhat than politics,” she stated.

Nonetheless, the state Supreme Courtroom dominated in 2014 {that a} price range veto wasn’t ample to get rid of the laws.

The South Carolina Legislature finally repealed the state’s certificates of want guidelines final yr.

Throughout the Jan 10. debate, Haley stated she would get rid of certificates of want throughout the nation. The principles nonetheless exist in about two-thirds of states.

Rural hospitals

Throughout Haley’s second yr within the governor’s workplace, the hospital the place she was born in 1972 closed its doorways. After a failed try and merge with different hospitals within the space, it turned financially unfeasible for that hospital within the rural city of Bamberg to stay open.

In 2013, Haley introduced her administration would reimburse rural hospitals throughout the state for all their uncompensated care prices, amounting to tens of thousands and thousands of {dollars} over her time in workplace. The coverage continues to be in impact.

Primarily, hospitals lose cash when uninsured sufferers do not pay their payments. Federal legislation presents some help. For instance, it requires state Medicaid packages to make “disproportionate share” funds to hospitals that serve giant numbers of low-income and uninsured folks.

However packages like these do not essentially cowl all the losses.

Haley prompted the South Carolina Legislature to help rural hospitals by rising their disproportionate share funds as a result of, with out an infusion of money, a number of of them confronted the identical destiny as Bamberg County Memorial Hospital.

“I actually do not suppose it is a bailout,” Haley informed The Publish and Courier in 2014. “We’re permitting strong footing for these hospitals to make the modifications that they should make.”

However her plan wasn’t fail-safe. Two extra rural hospitals closed throughout Haley’s tenure as governor.

Vaccine mandates

As a member of the state Home of Representatives in 2007, Haley co-sponsored a invoice that may have made the vaccine for HPV, the virus that causes practically all circumstances of cervical most cancers, necessary for ladies getting into seventh grade. It was finally killed by evangelical lobbyists, who’ve traditionally related the HPV vaccine with encouraging underage intercourse, KFF Well being Information reported.

A number of years later, Haley known as her help of that invoice a mistake.

In 2012, Haley vetoed a invoice that may have supplied free, voluntary HPV vaccines to seventh graders in South Carolina.

Throughout the pandemic, Haley, whose sister-in-law died from covid, stated she acquired a covid vaccine, although she has stated she firmly opposes covid vaccine mandates.

This text was reprinted from khn.org, a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF – the impartial supply for well being coverage analysis, polling, and journalism.