The two candidates hoping to represent Arkansas' 2nd Congressional District both say they oppose the type of government takeover of health care that's been promoted by some on the left.
Creating a "single-payer, national health care system because of the 10 years of challenges and problems associated with the [Patient Protection and] Affordable Care Act is not the right direction to go," U.S. Rep. French Hill said.
During the campaign, the Little Rock Republican has repeatedly denounced U.S. Sen. Bernie Sanders, an independent from Vermont, and Sanders' vision of taxpayer-funded, government-run universal health care, warning that Sanders and his allies want to "take health insurance away from people that they get at work."
Hill's Democratic challenger, state Sen. Joyce Elliott of Little Rock, has also criticized the Sanders model.
"I do not support Medicare for All," she said. "That's not the thing that's going to work for us to get everybody covered."
In an interview, Elliott stressed the importance of increasing options for Arkansans, not limiting them.
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"The overall idea is for everybody to have good health care. How we get it is up for discussion and policymaking," she said.
Elliott's position is in line with Democratic presidential nominee former Vice President Joe Biden, who opposes getting rid of private health insurance, his website states.
President Donald Trump opposes a shift to government-controlled health care, as well.
Neither Arkansas candidate has unveiled a precise blueprint for overhauling the system, though Hill points to individual pieces of legislation he has sponsored. One would continue coverage for preexisting conditions, even if the U.S. Supreme Court strikes down the Affordable Care Act, as Republicans have asked.
A second, bipartisan bill seeks to protect patients from surprise out-of-network costs in some instances.
While disagreeing about solutions, the two candidates agree that the existing health care system needs changes.
As lawmakers, Hill and Elliott have backed markedly different health care legislation.
In 2017, shortly after Trump took office, Hill helped pass House legislation repealing the Affordable Care Act, delivering on a longtime Republican promise.
Once the votes were tallied, Hill and other congressmen celebrated at the White House with Trump and other administration officials. "Welcome to the beginning of the end of Obamacare," Vice President Mike Pence told the crowd.
The Republican-backed American Health Care Act, which would have permanently ended the penalties on employers and employees who did not comply, ultimately stalled because of opposition in the U.S. Senate. A watered-down version fell short there, 51-49, after three Republicans opposed it.
In an interview, Hill portrayed the 2017 vote as a missed opportunity.
"The House-passed health care bill had a fully funded preexisting condition [provision] covered with a fund that lowered premiums for people with preexisting conditions, it was better than Obamacare, and lowered premiums for everybody who was penalized by the approach of the mandate in the Affordable Care Act," he said. "To say otherwise is a bold-faced lie."
The legislation would have allowed older consumers to be charged five times what younger people pay. Under Obamacare, they can be charged only three times as much.
Opponents warned that the legislation would also lead to a sharp rise in premiums for those with preexisting conditions, a claim supporters disputed.
The proposal also would have lowered the number of insured Americans by 14 million in 2018, 19 million in 2020 and 23 million in 2026 compared with the law in place at the time, according to independent Congressional Budget Office forecasts. Many of those would've been people opting to bypass coverage altogether, Hill said. He also questioned the accuracy of the estimates.
During the two years his party simultaneously controlled Capitol Hill and occupied the White House, Republicans failed to agree on an alternative to the Affordable Care Act.
"They've been promising for a number of years that we're going to have a replacement," Elliott said. "It would seem to me that if we were going to have a replacement, we would have had one by now."
"Let's just admit the [Affordable Care Act] is not perfect. ... We do need to make it better," she said.
It's time for Republicans and Democrats to work together to improve it, she added.
Rather than scaling back Obamacare, Elliott worked with state lawmakers from both parties to increase access to the program in Arkansas.
She voted in 2013 for Medicaid expansion, initially known as the "private option" and later rebranded as "Arkansas Works."
She has voted three times since then to reauthorize the program, her campaign said.
As of June 30, 277,284 people were enrolled in Arkansas Works. The rate of uninsured in Arkansas, which was 17.5% in 2010, had fallen to 9.1% by 2019, according to U.S. Census Bureau data.
Asked what Hill believes should happen to the 277,284 who are currently enrolled in Arkansas' Medicaid expansion program if the Affordable Care Act is repealed or struck down, campaign chairwoman, Judith Goodson blamed Democrats for any uncertainty, saying the Republican legislation they rejected would have ensured that resources continued to be allocated.
"Regardless of the outcome of the Supreme Court decision, Congress should remain committed to protecting coverage for those with pre-existing conditions, funding for rural hospitals, and flexibility for state Medicaid budgets," Goodson said in a written statement.
Republican efforts to kill the Affordable Care Act, sometimes called Obamacare, the Elliott campaign said, are highly irresponsible.
"It is political malpractice of the highest order to think stripping health care coverage from hundreds of thousands of Arkansans in the middle of a pandemic will work itself out," said campaign spokesman Neil Goodman.
While Elliott has opposed a single-payer system during this election cycle, Hill says her stance was different the last time she ran for Congress.
Asked, before the Affordable Care Act passed, about potential health care approaches, Elliott told reporters in February 2010: "I prefer a single-payer option, but I am not tied to that."
"Joyce Elliott proposed that [single-payer option or] said she preferred that, when Obamacare was debated," Hill said.
While Republicans are emphasizing the first half of Elliott's decade-old sentence, Democrats have highlighted the words that followed.
After saying, "I am not tied to that," Elliott added, "I recognize politics is an art, and I can't just do it by science."