In a fractious rerun, GOP rivals Haley and Desantis debate health care. Trump sits it out.

The race to win the quickly approaching Iowa caucuses was the theme running through Wednesday night's Republican presidential debate hosted by CNN at Drake University in Des Moines, Iowa. Front-runner Donald Trump was again absent and only two other candidates made the cut: Florida Gov. Ron DeSantis and former South Carolina Gov. Nikki Haley.

DeSantis and Haley fired a frenzy of attacks at each other's records and positions. The faceoff was moderated by CNN "State of the Union" co-anchors Jake Tapper and Dana Bash.

The two candidates touched on a variety of health care topics. As in previous debates, they each questioned the other's anti-abortion bona fides and reaffirmed their own. They sparred over covid-19 policies as well as whether to push China out of the U.S. supply chain for pharmaceuticals and other health-related products.

Asked whether, as president, they would preserve the Affordable Care Act's Medicaid expansion, both said — after being pressed for clarification — they would like to convert the program to a block grant. That's generally understood to be an approach in which federal funding is capped but state flexibility is increased.

Forty states and the District of Columbia, but not South Carolina or Florida, have expanded Medicaid under the ACA, which is credited with providing insurance coverage to millions more Americans.

Block-granting Medicaid isn't a new idea. The approach has long been favored by Republicans and was advanced by the Trump administration. It's strongly opposed by Democrats.

In terms of health care policy, Haley again promised to add transparency to the U.S. system, emphasize competition, and put patients "in the driver's seat." She also promised tort reform.

DeSantis argued for "health care that’s accessible, that’s affordable, and that’s accountable, and particularly an emphasis on mental health." He also pointed to his Florida experience. "We got accountability for the pharmacy benefit middlemen that are causing your drug prices to go up," he said, and claimed another victory in the war on high drug costs.

The FDA last week approved Florida's plan to import certain medicines from Canada for some state agencies. But the plan faces hurdles, including Canada's government, which has warned it won't allow U.S. imports if they risk causing drug shortages for Canadians.

Meanwhile, primary front-runner Trump again declined an invitation to debate. He instead participated in a Fox News town hall, also in Des Moines.

He claimed responsibility for the Supreme Court's decision to overturn Roe v. Wade: “I did it. And I am proud to have done it," he said.

But in response to a voter who sought assurances he would ban abortion nationwide if he won another presidential term, Trump acknowledged the politics of the issue. He told the voters "you still have to win elections” and that “a lot” of Republicans have been “decimated” as a result of advocating strict abortion bans. He carefully avoided saying what kind of ban, precisely, he would propose if he made it back to the White House.

Trump also revisited some of his favorite controversial covid-related themes. He minimized the role played by Anthony Fauci, who directed the National Institutes of Health's National Institute of Allergy and Infectious Diseases and was a pandemic medical adviser in Trump's administration. Trump called Fauci, who has been a lightning rod among Republican voters, "not a huge factor" in his pandemic policies but said the scientist took on outsize prominence in the Biden White House.

Trump waded into controversy about the virus's origins, outlining his own theory on how it spread from China.

"It came out of Wuhan, the labs," he said. "I think it was done out of incompetence."

"I believe that a scientist went out, said hello to his girlfriend, and that was the end of that. She died, and then people started dying all over the place. But who knows, who knows?” (PolitiFact examined that claim and others from Wednesday night's town hall event.)

Meanwhile, entrepreneur Vivek Ramaswamy did not qualify to participate in the CNN forum. Candidates needed at least 10% support among respondents in three CNN-approved national or Iowa polls to make the debate stage, including one poll of likely Iowa Republican caucusgoers. Former New Jersey Gov. Chris Christie announced on the day of the debate that he was dropping out of the race.

What follows are health care-related fact checks excerpted from PolitiFact's coverage:

Life expectancy and Social Security

DeSantis and Haley sparred over whether to raise the Social Security retirement age.

Haley said life expectancy is longer today, so the age to start collecting Social Security and Medicare benefits, currently 65, should be raised. She said people in or near retirement should be protected from any retirement age increase, while people in their 20s should be told that “we’re going to change the retirement age to reflect life expectancy.”

DeSantis said he wouldn't raise the retirement age, citing an erosion in life expectancy over the past few years.

“The problem now, in the last five years, is life expectancy is going down,” DeSantis said. “So, I don’t see how you can raise the retirement age when our life expectancy is collapsing in this country.” PolitiFact readers asked whether U.S. life expectancy is decreasing. We found that both candidates can point to data that supports their position.

During his town hall, Trump criticized both Haley and DeSantis over their stances on the retirement age, saying they both favor raising the age of Medicare eligibility above 65.

Gender-affirming care

DeSantis: On gender-affirming surgery for minors, “[Haley] said she’s against [it]. That wasn’t what she said this summer. She was asked about it. It’s on video, and she said the law should stay out of it.”

DeSantis is partially correct. Haley has said “the law should stay out of it,” but has also strongly opposed gender-affirming care for minors.

In a June CBS interview, Haley said when determining what care should be available for transgender youth, the “law should stay out of it, and I think parents should handle it.” She followed up by saying, “When that child becomes 18, if they want to make more of a permanent change, they can do that.”

Haley's campaign pointed to a May ABC News appearance during which she said that a minor shouldn't be allowed to have a “gender-changing procedure” and opposed “taxpayer dollars” funding one.

In Wednesday's CNN debate, Haley reiterated, “We shouldn't have any gender transitions before the age of 18.”