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

Republican presidential hopeful Nikki Haley will learn the way 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 nicely referred to as one of many Inexpensive 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 Heart. “South Carolina is on the backside of so many issues in rankings in our nation due to plenty of the choices 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 prime federal spending on covid aid and for the variety of individuals 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 remaining debate earlier than the Iowa caucuses, she reiterated her vital stance on gender-affirming care.

“I’ve at all times stated that boys want to enter boys’ loos, ladies want to enter ladies’ loos, that we shouldn’t have any gender transitions earlier than the age of 18,” she stated. “Similar 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 among her early achievements as governor was fixing a $228 million Medicaid deficit.

“Individuals overlook 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 government vice chairman for system innovation at Ballad Well being in Tennessee.

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

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

Inexpensive Care Act

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

However earlier than the group gathered for its first assembly, Haley wrote in an electronic mail to her advisers that the “complete 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 trade,” in response to a report printed by The Put up and Courier.

When that electronic mail was made public, then-Sen. Tom Harkin (D-Iowa) requested a federal investigation to search out out if Haley had predetermined the 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 regulation if elected president, The New York Occasions has reported.

Medicaid

In 2012, when the U.S. Supreme Court docket upheld the constitutionality of the ACA and made Medicaid growth an possibility for each state, Haley declined to increase it in South Carolina. Christian Soura, one among her former cupboard members, estimated in 2019 that “a number of hundred” individuals 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, whilst individuals who reside in nonexpansion states broadly help it, in response to KFF polling.

South Carolina stays one among 10 states that haven’t expanded Medicaid eligibility underneath the ACA, leaving greater than 90,000 residents in a medical health insurance protection hole, in response to 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 primarily based on knowledge from welfare help and the Supplemental Diet Help Program, previously referred to as meals stamps. A 2013 case research discovered that the Specific 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 extensively 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 loss of life charges in South Carolina have lengthy ranked among the many worst within the nation.

Latest 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 Court docket’s Dobbs v. Jackson Ladies’s Well being Group ruling, which allowed state legislatures to outlaw abortion, Haley referred to as the choice a “victory for all times and democracy.”

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

When she signed the regulation, 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 have been recognized with an “anomaly” and would die or if the mom’s life have been threatened. However no exceptions have been made for rape or incest.

In the course of the latest debate in Iowa, Haley referred to 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 obtained my two candy kids sitting in entrance of me, and I had hassle having each of them,” she stated. “Our purpose must be how will we save as many infants as potential and help as many mothers as potential.”

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 are winnable for Republicans, together with growing 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 funds 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 purpose of controlling well being care prices and avoiding duplication of accessible well being care providers.

On the time, Haley referred to as the foundations “intensely political” and stated they allowed “bureaucratic policymakers” to dam well being care suppliers from providing therapy. “We should always permit the market to work fairly than politics,” she stated.

Nonetheless, the state Supreme Court docket dominated in 2014 {that a} funds veto wasn’t ample to get rid of the rules.

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

In the course of 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 to 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 remains to be in impact.

Primarily, hospitals lose cash when uninsured sufferers do not pay their payments. Federal regulation 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 individuals.

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

Haley prompted the South Carolina Legislature to help rural hospitals by growing 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 Put up and Courier in 2014. “We’re permitting stable footing for these hospitals to make the adjustments 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 might have made the vaccine for HPV, the virus that causes almost all circumstances of cervical most cancers, necessary for ladies getting into seventh grade. It was in the end 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 referred to as her help of that invoice a mistake.

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

In the course of the pandemic, Haley, whose sister-in-law died from covid, stated she obtained 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 likely one of the core working packages at KFF – the impartial supply for well being coverage analysis, polling, and journalism.