WASHINGTON — (CNN) Sen. Ted Cruz urged fellow Republicans Tuesday to quickly “honor the promises” the party made over the years to repeal Obamacare.

“2010, 2014, 2016, I believe were a mandate from the voters. We’re tired of the premiums going up. We’re tired of deductibles going up,” Cruz said at a CNN town hall debate with Sen. Bernie Sanders over the future of Obamacare. “Should Congress move swiftly to repeal Obamacare? Absolutely.”

Cruz and Sanders — two senators with diametrically opposed views of government’s role in health care — faced off at the debate moderated by CNN’s Jake Tapper and Dana Bash and featuring questions from an audience consisting of both defenders and critics of the Affordable Care Act.

Cruz’s call on his party to “repeal every word of Obamacare” came as the GOP is grappling with how quickly to repeal the law. The party hasn’t yet reached a consensus on an alternative to the law. President Donald Trump said Sunday that a replacement plan may not be rolled out until next year.

The town hall debate underscored the many challenges surrounding efforts to dismantle the Affordable Care Act — a sweeping health care law that covers some 20 million Americans. The evening began with each lawmaker laying out starkly different views of the controversial law.

“If you are one of 20 million Americans who finally has received health insurance, forget about it — you’re gone,” Sanders warned about repealing Obamacare. “That means when you get sick, you ain’t gonna be able to go to the doctor. And when you end up in the hospital, you’ll be paying those bills for the rest of your life, or maybe you’ll go bankrupt.”

Cruz, a Texas Republican who made his name in national politics by fiercely opposing the health care law, said former President Barack Obama made a series of promises that were broken.
“If you like your doctor, you can keep your doctor,” Cruz said. “Millions discovered that was not true.”

Policy issues

Several policy questions are at the center of the ongoing battle about reforming Obamacare, including the popular provision to protect people with pre-existing conditions and the controversial mandate that nearly all Americans get coverage. Republican lawmakers are also wrestling with how to live up to their promises to make Obamacare more affordable and to reform Medicaid.

The CNN debate highlighted how Republicans and Democrats fundamentally disagree on many of these issues.

One woman in the audience, Neosho Ponder, spoke about her fight against breast cancer and said she was undergoing radiation treatment. Ponder expressed fear that without Obamacare, she wouldn’t be able to afford health insurance.

Cruz insisted that Republican lawmakers support prohibiting insurance companies from canceling coverage for someone just because they are sick. All GOP proposals that have been introduced to replace Obamacare with, Cruz said, “prohibit companies from jacking up the insurance rates because they got sick or injured.”

Sanders was incredulous.

“Ted, I cannot believe what you just said. It’s a direct contradiction of everything you ran for President on,” he said. “What Ted has said is he wants to get rid of all federal mandates. Did you say that a hundred times?”

“I didn’t say it once,” Cruz said. “Virtually all of the Republican legislation that has been filed — that the Democrats have opposed — maintains a continuity of coverage.”

The issue of pre-existing conditions came up again when Maria Shahid Rowe, a woman who is five-months pregnant, said she was worried she wouldn’t be able to get health coverage without Obamacare.

Cruz responded that Democrats are mandating that people get “every coverage on earth — and it sounds really good.”

However, “you should get the policies that meet your needs,” he said.

Sanders shot back that before Obamacare, Shahid Rowe’s pregnancy would have been treated as a pre-existing condition. “What Ted is really telling you is they will not guarantee coverage for you.”

Another woman in the audience, Melissa Borkowski, told Sanders she simply can’t afford the health services she needs. Burkowski recently had an abnormal Pap smear, but said she couldn’t get additional tests because she hasn’t met her out-of-pocket deductible. Her fear: that she may now have undiagnosed cancer.

Sanders, who repeatedly stressed that Obamacare was far from perfect, said it is “totally absurd” that Borkowski has such an “outrageous deductible.”

“If you were in Canada, you know what? You would get the health care that you need,” he said. “The idea that we have policies like that, like the one you describe, is clearly an outrage.”

Cruz lamented that coverage choices have gone down “dramatically” since Obamacare became law. The senator, whose Canadian birthplace became a political controversy during his 2016 presidential run, also added: “Bernie mentions Canada quite a bit. I know quite a bit about Canadian health care. I was born there. You know Bernie, that may be the best argument against your position. Look what it produced.”

Sanders joked as he gestured at Cruz: “Look what the result is.”

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‘Employer mandate’

Another key pillar of Obamacare that came up was the so-called “employer mandate” — the law’s requirement that small businesses employing 50 or more workers to provide healthcare for its employees.

LaRonda Hunter, who owns five hair salons in Texas, said she can’t afford to provide coverage to her employees because of low profit margins and that the Obamacare rule is preventing her from growing her business.

Sanders responded with what he prefaced would be “an answer you will not be happy with.”

“I’m sorry, I think that in America today, everybody should have health care. And if you have more than 50 people, you know what, I think I’m afraid to tell you, but I think you will have to provide health insurance,” Sanders said.

Cruz shot back that Democrats have turned small businesses into a “bad actor.”

“Millions of businesses are being told by Democrats: tough luck,” Sanders said. “It’s one of the most damaging things about Obamacare.”

One more area where the parties diverge is Medicaid. Democrats championed expanding coverage for low-income Americans by expanding Medicaid to more adults. Republicans, on the other hand, want to curtail federal responsibility for the program by capping funding.

At Tuesday night’s debate, Carol Hardaway shared that she has multiple sclerosis, which created challenges in her walking, speech and vision. When the Affordable Care Act passed, Hardaway said, she moved from Texas — a state that has not expanded Medicaid — to Maryland, which has, and was able to receive treatments right away.

Hardaway posed a question to Cruz that Republicans are struggling to answer: Can he guarantee that people like her would continue to be protected?

Cruz referred to Medicaid as a “profoundly troubled program” akin to “rationed care.”

“We should have a system that allows as many people as possible to be on the private health insurance of your choice rather than Medicaid,” Cruz said, noting that wait times under the program has gone up.

But when Tapper asked Hardaway whether Cruz had answered her question, she indicated that he had not.

Drastically different approaches

Cruz and Sanders both ran unsuccessfully for president in 2016 and have their own ideas on reforming the health care system and making coverage more affordable for everyone. Their approaches, however, are drastically different.

Sanders is a proponent of a “single-payer” federal health care system, or as he refers to it: “Medicare for All.” During the presidential campaign, the Vermont senator outlined a government-run program that would offer Americans comprehensive care covering everything from doctors’ visits to hospital stays, to vision, dental and mental health services.

He is a proponent of hiking taxes on the wealthy to pay for his proposed system.

Cruz, meanwhile, has railed against Obamacare for years and has vowed to fully repeal “every word” of the law. The Texas firebrand made his name in national politics in 2013 when he gave a more than 20-hour marathon speech to oppose funding for the Affordable Care Act.

Taking aim at pharmaceutical industry

Despite their contrasting views on health care, there was a rare moment of agreement for the two senators: the pharmaceutical industry. Sanders asked Cruz to partner with him in taking on drug companies — “the greediest of many greedy corporate interests in Washington” — by supporting legislation to have Medicare negotiate prices with the industry.

“I would love for us to work together in going after big Pharma,” Cruz said, though he stressed that it is the U.S. Food and Drug Administration that is enforcing an important ban.

Congressional Republicans are paving the way to repeal significant portions of Obamacare. Senior lawmakers are currently crafting an Obamacare repeal bill that requires just a simple majority of senators for approval.

But the discussions over creating an alternative to the controversial law has exposed tensions within the GOP. Many Republican lawmakers have grown increasingly wary of the political consequences of a quick and sweeping repeal of Obamacare, and some have more openly begun to discuss “repairing” the law and keeping aspects of it that are popular.

That note of caution clashes with impatience among some conservative members of the GOP conference, who fear that anything short of a swift repeal of Obamacare will be unacceptable to their constituents.

Trump, who campaigned on repealing and replacing Obamacare, said over the weekend that rolling out a new healthcare system will likely be a drawn-out process.

“I would like to say by the end of the year at least the rudiments, but we should have something within the year and the following year,” Trump said.

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