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Colorado's U.S. Sen. Cory Gardner speaks before a campaign rally for President Donald Trump and Vice President Mike Pence at the World Arena in Colorado Springs on Feb. 20, 2020. (Mark Reis, Special to The Colorado Sun)

Cory Gardner doesn’t like Obamacare.

Ask the Republican senator from Colorado about how to improve health care and the first response you’re likely to hear is that President Barack Obama’s signature 2010 Affordable Care Act needs to be repealed. It’s “destroying this country,” he once said.

Ask Gardner for his plans to replace the law, however, and his response will probably be more about what he’s against — Democratic proposals for a public health insurance option or “Medicare for All” — than what he’s working toward.

“Democrats want to replace the Affordable Care Act with socialized medicine,” Gardner said in an interview. “I don’t want that.”

But if Gardner and congressional Republicans have a better idea, they haven’t shared it. 

U.S. Sen. Cory Gardner, R-Colorado, at DeGette’s offices in Denver. (Jesse Paul, The Colorado Sun)

President Donald Trump has spoken of coming legislation, but part of the problem has been GOP infighting over how to move forward. That killed the party’s chance to unwind the Affordable Care Act in 2017, as they’d vowed to do for years, when Republicans took control of Congress and the White House. “We haven’t kept our promise,” Gardner said last year. 

Gardner can identify goals for the replacement legislation, but not exactly what it would do. Still, he says, America doesn’t need Obamacare to have a functioning health care system. 

“This is not a zero-sum game,” Gardner said. “It is not the ACA or nothing. We can have, and have been working on, a plan to reduce costs and increase the quality of care. That’s what I will continue to work on.”

Democrats see the lack of a Republican health care plan as a liability for Gardner and are working to make sure voters know about the gap heading into November. They are making health care a top issue in Colorado’s 2020 U.S. Senate race, in which Gardner faces a difficult path to reelection. 

Gardner’s opponent, former Gov. John Hickenlooper, and his Democratic allies are already running ads slamming Gardner over his votes to roll back or undo the Affordable Care Act.

“Cory Gardner said he would be an independent voice for Colorado,” Hickenlooper said in a campaign video. “He said he would protect preexisting conditions. He says a lot of things. Then he goes to Washington.”

They’re also the highlighting the lack of a Republican health care plan.

“Each time the Republicans promised that they would have a better plan, a different plan, a replacement plan —  the Republicans have no health care plan,” said Kathleen Sebelius, who served as Secretary of Health and Human Services in the Obama administration, in a recent interview with The Colorado Sun.

Gardner supports parts of the Affordable Care Act that are most popular — including protections for preexisting conditions — but Democrats attack him by pointing out that any effort to unwind the law would jeopardize those provisions. That’s left the senator in the difficult position of trying to explain how he backs elements of a broader policy that he doesn’t support and has worked to eliminate for years. 

Adding to the difficult politics around the health care law, polling shows Americans increasingly like Obamacare, meaning that calling for its demise may no longer be so advantageous. Some Republicans have even begun shying away from discussions about repealing the policy.

“One thing that Republicans have been doing lately, which is smart, is they are avoiding discussions about the Affordable Care Act and shifting it to individual health care policies that traditionally Republicans haven’t backed, but are very popular,” said Ryan Lynch, a Republican operative in Colorado. 

MORE: Opposition to Obamacare becomes political liability for Cory Gardner and other Republican incumbents

“Bipartisan, commonsense policies”

Gardner’s campaign argues that while the senator doesn’t have an overarching bill outlining a plan to replace Obamacare, he’s championed or is supporting a number of piecemeal health care initiatives that have added up to make an impact. 

The list includes legislation reauthorizing the Children’s Health Insurance Program and helping Colorado secure a federal waiver to launch its reinsurance program, which was created by Democratic state lawmakers. The reinsurance program works in parallel with subsidies from Obamacare and couldn’t exist if the law were repealed

Gardner has also pushed for faster regulatory review of medical devices and price transparency to ensure prescription drug costs don’t balloon.  

Additionally, Gardner would like to allow health insurance companies to sell plans across state lines, which he hopes will increase competition and drive down costs. 

The senator also helped Colorado navigate reimbursement problems with its Medicaid program when Hickenlooper was governor by facilitating discussions with the Trump administration on how to resolve them. 

“Sen. Gardner consistently talks about lowering health care costs, strengthening innovation and expanding access for all Coloradans,” said Gardner’s campaign spokesman Jerrod Dobkin in a written statement. “While Gov. Hickenlooper and Democrats push for a one-size-fits-all, government-run approach, Sen. Gardner has focused his efforts on bipartisan, commonsense policies that improve health care for Coloradans.”

Democrats argue that without a comprehensive replacement to the Affordable Care Act, repealing it would be disastrous. 

Meanwhile, the U.S. Supreme Court is slated to rule after the November election on a Republican challenge, backed by the Trump administration, to the constitutionality of the law. Gardner has refused to say if he supports the legal action, which threatens to invalidate Obamacare, but Democrats contend his silence is proof that he’s either ambivalent or supportive of the effort to unwind the policy in the nation’s highest court.  

The Supreme Court Building is the seat of the Supreme Court of the United States. The panel could decide the future of the Affordable Care Act in coming months. (Provided by U.S. Department of State)

Gardner has repeatedly said that the Affordable Care Act is flawed and pointed out the “broken promises” from its Democratic supporters that people would be able to keep their health insurance plans, premium costs would go down and more coverage options would exist.

“That’s the arrogance of government and the arrogance of Obamacare,” he said in a 2015 speech on the Senate floor. “People in the government — bureaucrats, others — think that they know better for the American consumer what the American consumer believes is best for themselves.”

In a recent interview, Gardner said he wants Democrats and Republicans to reach an accord on how to move forward. “I hope we come together with a bipartisan solution,” he said. “If Democrats don’t like the Affordable Care Act, Republicans don’t like the Affordable Care Act, then come together and find a solution that works for the American people.”

Democrats say the Affordable Care Act needs to be expanded because premium costs are too high, particularly for those who seek plans on the individual market in rural areas, like Colorado’s Eastern Plains or Western Slope, where prices can be astronomical. 

Hickenlooper is advocating for the addition of a public health insurance option on top of Obamacare, which he hopes will increase competition and drive down costs. 

Former Colorado Gov. John Hickenlooper speaks to reporters on Thursday, Aug. 22, 2019, the day he announced he was running for U.S. Senate. (Jesse Paul, The Colorado Sun)

“The ACA is not flawless,” Hickenlooper’s campaign website says. “Strengthening the law will enable us to expand coverage affordably using the tools already at our disposal.” 

Critics point out that a public health insurance option would be expensive and they see it as a pathway to a single-payer health care system. Often, the two are conflated.

“He supports socialized medicine,” Gardner said of Hickenlooper. “His path is a path to nationalized health care.” 

Gardner pushes for pre-existing conditions but it comes with some asterisks

When Democrats criticize Gardner on health care, they often focus on the protections for people with preexisting conditions that would disappear if the Affordable Care Act vanished. 

But Gardner has been adamant that he wants to keep those protections in place and even recently unveiled a bill that aims to eliminate any doubt about where he stands. 

“My bill is simple – it guarantees coverage for people who have preexisting medical conditions and ensures that people cannot be charged more because of a preexisting condition,” Gardner said in a statement when the legislation was announced in early August

Health care policy experts, however, say there’s nothing simple about policies protecting preexisting conditions and that a close look at Gardner’s bill shows that it would still allow health insurance companies to deny people coverage. 

MORE: Here’s how Cory Gardner’s bill would and wouldn’t protect people with preexisting conditions

“If an insurer did cover someone with a preexisting condition, they couldn’t exclude coverage for their preexisting condition, they couldn’t charge them more, they couldn’t exclude benefits associated with that preexisting condition,” said Larry Levitt, vice president of the nonpartisan Kaiser Family Foundation, about Gardner’s legislation. “But insurers, under this bill, could just deny coverage.”

Levitt, who served as a health care adviser for former President Bill Clinton, and other experts explained that Gardner’s bill — which is just one sentence long — lacks a guaranteed-issue clause that would require health insurance companies to provide coverage to anyone who applies. 

“That language bars insurers from excluding particular treatments or benefits in a plan,” said Nicholas Bagley, a professor at the University of Michigan’s law school who specializes in health care law, in an email. “That’s what an ‘exclusion’ is. But there’s nothing requiring insurers to sell to all comers. It’s easy to draft a guaranteed issue provision — the ACA’s got one. This isn’t it.”

Gardner’s office rejected the outside analysis of the senator’s bill, though it didn’t cite specific inaccuracies. 

“This bill was drafted to explicitly prohibit insurance companies from denying coverage or charging more for people with pre-existing conditions – and that is what it accomplishes,” said Annalyse Keller, Gardner’s spokeswoman. 

Even if Gardner’s bill did require that health insurance companies provide coverage to people with preexisting conditions, Levitt says that to truly make such a policy work, it can’t stand alone. Specifically, he said, there needs to be either a requirement that people get insured — which Obamacare did with a tax penalty until it was unwound by Republicans — or one that premiums are subsidized, as they are under the Affordable Care Act. 

Without one or both of those mechanisms, premiums would skyrocket as people would wait until they were sick to get coverage, he said. 

“The idea of protecting people with preexisting conditions has become like motherhood and apple pie,” Levitt said. “But the regulations required to make it a reality are somewhat antithetical to a small-government ideology. That’s part of why Republicans have had such difficulty coming up with a replacement for the ACA.”

Where Gardner stands on the rest of Obamacare

Preexisiting conditions coverage is likely the most popular part of the Affordable Care Act, but there are other widely liked provisions that would go away without it.

Those include: 

  • A clause allowing young adults to stay on a parent’s health insurance plan until they turn 26
  • A requirement that coverage includes birth control for women, including intrauterine devices, with no out-of-pocket costs
  • A mandate that insurance companies cover a set of “essential benefits,” including prescription drugs, pregnancy and newborn care, hospitalizations and laboratory services
  • The expansion of Medicaid, which allowed for the coverage of hundreds of thousands more Coloradans under the program

Gardner has said he likes how the Affordable Care Act allows children to stay on their parents insurance plans into adulthood, but he has expressed concerns about the cost of Medicaid expansion and how it affects the program’s long-term sustainability as a safety net. 

On birth control, Gardner has backed the idea of allowing oral contraceptives to be sold over the counter at pharmacies without a prescription to anyone over age 18. In fact, it was one of his major policy platforms that he ran on in 2014, when he was first elected to the Senate. 

But six years later, over-the-counter birth control still hasn’t been approved at the federal level. And Gardner’s opponents point out that his proposal wouldn’t drive down costs and doesn’t apply to long-acting contraceptives, like intrauterine devices. 

The exterior of Children’s Hospital Colorado in Aurora, photographed on Oct. 18, 2019. (John Ingold, The Colorado Sun)

As for the essential benefits, Gardner supports giving consumers more choice when it comes to their health insurance. If they want a short-term plan or wish to pick and choose their coverage, they should have more freedom to do that, his campaign says. 

But the question remains how Gardner and Republicans plan to make their health care proposals law. 

Asked if there has been GOP work on a cohesive plan, Gardner said “there certainly has been.”

“We’ve got a number of ideas that we continue to promote, to support and to work on,” he said. 

But so far, with Election Day fast approaching, Republicans have not introduced a comprehensive plan and the Affordable Care Act’s future remains uncertain. 

Colorado Sun staff writers John Frank and John Ingold contributed to this report.

Jesse Paul is a Denver-based political reporter and editor at The Colorado Sun, covering the state legislature, Congress and local politics. He is the author of The Unaffiliated newsletter and also occasionally fills in on breaking news coverage....