May 20, 2024

From the start of the second Republican presidential primary debate of the 2024 campaign, the seven candidates on stage were boisterous and unruly.

Florida Gov. Ron DeSantis, former South Carolina Gov. Nikki Haley, South Carolina Sen. Tim Scott, entrepreneur Vivek Ramaswamy, former Vice President Mike Pence, former New Jersey Gov. Chris Christie, and North Dakota Gov. Doug Burgum spent most of the evening talking loudly over — and sometimes quite angrily at — one another.

The moderators — Fox News’ Dana Perino, Fox Business’ Stuart Varney, and Univision’s Ilia Calderón — sometimes struggled to referee at the Ronald Reagan Presidential Library & Museum in Simi Valley, California, as the presidential hopefuls clashed on topics ranging from the autoworkers’ strike to foreign policy. At points, health care issues crept into the discussion.

Our PolitiFact partners fact-checked the candidates in real time. You can read their full coverage here.

Candidates sparred over manufacturing and employment, inflation, and federal spending. When it came to the government shutdown threat, Haley promised to change the process, pointing out that Congress had delivered appropriations on schedule only four times in 40 years.

Asked about medical debt, which plagues tens of millions of Americans, she pledged a multipronged effort to protect people from financial ruin when they need care. She spoke of introducing more competition in the health system and putting “the patient in the driver’s seat” while increasing transparency.

“We’re going to have to make every part of the industry open up and show us where the warts are,” she said. She didn’t elaborate on how that could be accomplished.

Pence dodged a question about whether he would make good on his promise, from 2016 and the current campaign, to repeal the Affordable Care Act — also known as Obamacare — which Perino noted seemed more popular now than ever.

“It’s my intention,” the former vice president said, “to make the federal government smaller by returning to the states those resources and programs that are rightfully theirs under the 10th Amendment of the Constitution.” That would include all Obamacare and Health and Human Services funding, he said.

Pence also said he is “sick and tired” of mass shootings and promised, if elected, to advance an expedited federal death penalty “for anyone involved in a mass shooting” so they “meet their fate in months, not years.” The former vice president criticized DeSantis over the sentence handed down to a gunman who attacked Marjory Stoneman Douglas High School in Parkland, Florida, in 2018, calling it “unconscionable” that he’ll “spend the rest of his life behind bars.”

On the issue of health insurance coverage, DeSantis wore his state’s high uninsurance rate as a badge of honor.

“You can do well in the state, but we’re not going to be like California and have massive numbers of people on government programs without work requirements,” he said. Under DeSantis, Florida is one of just 10 states that have declined to take advantage of federal funding available under Obamacare to expand Medicaid, the program that covers low-income Americans.

Throughout the evening, the candidates sometimes invoked Reagan’s name and memory. He wasn’t the only former president not in attendance but often mentioned. Donald Trump, who enjoys a commanding lead in the polls, opted again to steer clear of the debate stage.

“Donald, I know you are watching — you can’t help yourself,” Christie said early on. He said Trump avoided the event because he was “afraid” of “being on the stage” and defending his record.

Trump told Fox News Digital in an interview after the debate that he hadn’t watched it.

Former Arkansas Gov. Asa Hutchinson did not meet the Republican National Committee’s donor and polling thresholds to participate. Former Texas Rep. Will Hurd also did not qualify.

Here are last night’s health-related claims checked by PolitiFact:

Ron DeSantis: 2.6 million Floridians going without health insurance “is a symptom of our overall economic decline.”

When moderator Varney pressed DeSantis on the relatively high number of Floridians without health insurance — Varney said it’s 2.6 million — DeSantis blamed politicians in Washington, D.C.

But the numbers from DeSantis’ own state health department show no correlation between economic conditions and the number of Floridians without health insurance. Despite population growth and economic changes, Florida had about 2.6 million uninsured residents from 2018 through 2021, and about 2.4 million in 2022.

In 2022, Florida’s uninsured rate was 11.2%, higher than the 8% national rate, according to the U.S. Census Bureau.

Vivek Ramaswamy: “Transgenderism, especially in kids, is a mental health disorder.” 

Medical experts disagree. Being transgender and having gender dysphoria — the distress that some people may experience when their sex assigned at birth does not align with their gender identity — is not considered a mental health disorder. Historically, the diagnosis has carried the term “disorder,” but experts no longer view it as a pathology and are working to destigmatize the diagnosis.

Previous terms such as “gender identity disorder” and “transexualism” have evolved into “gender incongruence,” a condition the World Health Organization now considers a condition related to sexual health — not mental health. The American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders,” or DSM-5, contains a diagnosis for “gender dysphoria,” but experts say it remains partly to let insurance companies cover gender-affirming care and let incarcerated people access care.

Mike Pence: Linn-Mar Community School District in Iowa had a policy where “you could get a gender transition plan without notifying your parents.”

This needs more context. The Iowa school district outside Cedar Rapids in 2022 adopted a policy that allowed students to request a “gender support plan.” According to Axios, this plan would outline a student’s preferred name and pronouns as well as which locker rooms or bathroom the student would use, which is associated with a social, rather than a medical, transition.

The student could choose whether the parents were informed, but the plan was not related to medical transition, which, for minors, requires the consent of parental guardians. Schools often don’t inform parents when students signal they are socially transitioning, The Washington Post reported.

Tim Scott: The southwestern U.S. border under President Joe Biden is “unsafe, wide-open, and insecure, leading to the deaths of 70,000 Americans in the last 12 months because of fentanyl.”

Scott’s claim is misleading. Deaths from fentanyl jumped 23% in Biden’s first year in office to more than 70,000. But they have been increasing since 2014 and also rose during the Trump administration.

Although immigration encounters at the southern U.S. border have spiked under Biden’s watch, most of the fentanyl coming into the U.S. from Mexico reportedly comes through legal ports of entry. The vast majority of people sentenced for fentanyl trafficking are U.S. citizens, federal data shows.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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