Walz-Vance debate: Health care issues in the crossfire

Sen. JD Vance (R-Ohio) and Minnesota Gov. Tim Walz will face off in the first vice presidential debate on Tuesday. 

Health care has featured prominently in the campaign so far, and the debate could be a key opportunity for each side to press the other on their plans – and to attack the records of the candidates at the top of the opposing tickets. 

Vance has thrust ObamaCare back into the national conversation with his explanation of former President Trump’s “concepts of a plan” for health insurance reform, while Walz has continued to make reproductive freedom a central piece of his stump speech. 

Here are some of the main issues we are watching for: 

ObamaCare 

One of the issues getting the most attention ahead of debate is one that Republicans have largely sought to avoid in recent years. 

Subsidies that help about 20 million people afford insurance are set to expire next year, and whether they get renewed will depend on the outcome in November. The subsidies were first put into effect during the height of the coronavirus pandemic as part of the economic recovery law, and later extended in the Inflation Reduction Act.  

Millions of enrollees have come to rely on the enhanced subsidies, and they’ve helped boost health insurance enrollment to record levels. Congressional Democrats introduced legislation in both chambers last week to make the subsidies permanent, something the Harris campaign also supports. 

But Republicans are balking at the $335 billion price tag and argue too many high earners are getting taxpayer-subsidized insurance. They are digging in for a fight, and if they win control of the Senate the odds of passing a permanent extension are extremely low.  

But while subsidies haven’t broken through, the health law’s protections for pre-existing conditions seem more likely to be debated on Tuesday. Vance has floated the idea of going back to the pre-ACA days of “high-risk pools,” where sick people were separated into different, more expensive insurance coverage. 

It’s a position that was a hallmark of GOP proposals to replace ObamaCare during Donald Trump’s presidency, and while the idea sounds wonky, it’s a fight Democrats want to have. Walz will likely try to hammer Vance on the subject.  

Reproductive rights 

Walz’s personal connection to reproductive issues and Vance’s stumbling rhetoric when it comes to childlessness will likely made theseissues a repeated point of contention during the debate. 

The Walz family has been open about their struggles with infertility since the IVF debacle in Alabama earlier this year. Despite campaign materials and prior remarks that implied the couple had used IVF to have children, Gwen Walz clarified in August that they had opted for a less intensive procedure.

Their candor, and Walz being the first governor to codify abortion access after the overturning of Roe v. Wade, has stoked enthusiasm among reproductive rights activist groups, while GOP opponents made a few pointed jabs accusing the Walzes of lying for the sake of political capital. 

Vance’s language regarding people without children, women in particular, has stirred up criticisms of the vice-presidential nominee being prejudiced or insensitive to this demographic.  

Numerous resurfaced clips of Vance in interviews have shown the Ohio senator criticizing people without children as being less invested in the future of the country and contributing to the population being “less mentally stable.” 

When it comes to abortion, Vance has shifted his stance to mirror Trump’s by calling for the issue to be left up to states. In prior remarks, however, Vance has supported the idea of a national ban while also expressing a politically pragmatic approach.  

Speaking on state abortion bans, Vance has said “reasonable exceptions” are necessary due to “political reality,” though he’s waffled on whether he supports exceptions for rape and incest. 

Medical debt 

Walz says his stance on medical debt is informed by how it has affected his family. The Minnesota governor has spoken about how his father’s death left his mother mired in medical debt.

As governor, Walz championed a law that bans medical debt from being reported to credit bureaus, ends the automatic transfer of medical debt to a patient’s spouse and prevents providers from withholding care due to outstanding debt. 

Vice President Harris and Walz have made medical debt a key part of their campaign. Harris has said her administration will work with states to erase medical debt for millions of Americans, but details on how that would be accomplished are thin. 

The Trump-Vance campaign hasn’t mentioned medical debt at all.  

Medical debt relief is a popular policy that’s easy for the public to understand. A June AP/NORC poll showed half of all Americans said it was extremely or very important for the U.S. government to provide debt relief for those who have yet to pay off medical treatments.   

Health care costs 

Health costs routinely top polls as one of the issues people care most about.  

According to Pew Research, 65 percent of all voters say health care is “very important” to their vote in the 2024 presidential election, second to the economy at 81 percent of voters. 

Both Harris and Trump talk about high drug prices, which Walz and Vance will likely try to highlight. Both candidates largely agree the government should rein in drug companies, but Harris as Biden’s vice president has more of a successful record to point to than Trump’s. 

Harris and Walz are campaigning on expanding efforts the Biden administration has already undertaken and touting its successes, such as capping the cost of insulin for Medicare beneficiaries at $35 and saving money from the new Medicare negotiated drug prices.  

Trump has falsely said Harris and Biden are taking credit for his work on insulin pricing, and that he was responsible for the $35 cap. Vance has amplified that claim, and he could try to do it again on Tuesday.  

As governor Walz has a record implementing drug price transparency policies. He also helped launch a prescription drug affordability board in Minnesota that can set limits on what insurers pay. 

But Walz could also face attacks about his and Harris’s past support for a public option health plan and Medicare for All, which conservatives argue would raise insurance costs and reduce Americans’ access to care.