Health care is certainly not the top-tier Republican presidential issue that it was when candidates were tripping over themselves to call for repealing Obamacare.

• But Peter, Maya and Victoria scoured some of the top-tier candidates’ (and potential candidates’) records for what they are saying so far, from Medicare cuts to vaccines — starting with the two front runners in the early polls.

Donald Trump

You know Trump's record from his first term, and it's not as if he's suddenly diving into the details of site-neutral payments this time. But he is hammering the point over and over that he is not going to cut Medicare and Social Security.

• "Under no circumstances should Republicans vote to cut a single penny from Medicare or Social Security," Trump said in a video in January. He has also attacked Florida Gov. Ron DeSantis over past votes to reduce Medicare spending.

Yes, but: Trump is not mentioning Medicaid in this refrain, which would have seen cuts in the ACA repeal bill he supported as president.

COVID-19: The handling of the pandemic is an area where DeSantis could seek to get to Trump's right by investigating COVID vaccines.

• Trump spokesman Steven Cheung defended the Trump administration's Operation Warp Speed, while noting that it helped develop therapeutics too, not just vaccines.
• "Operation Warp Speed was a once-in-a-lifetime initiative that gave people the option of utilizing therapeutics if they wished to do so," he told NBC in December.
• Trump told CPAC in March that if elected, he would again withdraw from the World Health Organization.

Abortion: Trump of course appointed three of the justices who voted to overturn Roe v. Wade last year. But he has not been trumpeting the abortion issue since then.

• Trump's spokesman told the Washington Post this month that the issue should be decided "at the state level."

Ron DeSantis

DeSantis has tackled quite a bit of high-profile health topics already in the few short months comprising his second term as governor.

Medicare: Trump has already hit DeSantis on Medicare, claiming in a recent ad that the Florida governor supports cuts to the program.

• While he was a member of Congress, DeSantis voted for Republican Study Committee budget proposals that would have reduced future spending in the Medicare program and raised the Medicare retirement age.

COVID and "medical freedom": DeSantis has leaned hard into how Florida reopened quickly after a temporary shutdown during the early part of the COVID pandemic, highlighting how his response differed from Trump's.

• He even recently held an event in March where he highlighted how it had been three years since the two-week "Stop the Spread" campaign and emphasized that the U.S. should "never let it happen again."
• In addition to his investigations, he's also pushed for freedom from "medical authoritarianism" around COVID vaccines.

Drug pricing: He released a drug pricing proposal in January that focuses primarily on cracking down on PBMs by prohibiting spread pricing and clawbacks, as well as requiring more transparency measures.

• This comes after the governor already signed an executive order targeting the middlemen last year.
• "We must bring transparency to the system so that Floridians can save money on their drugs. We need reform of the PBMs," DeSantis said in a press conference earlier this year.

Abortion: DeSantis quietly signed a six-week abortion ban into law two weeks ago. The law won't go into effect until the Florida Supreme Court rules. But if it stands, Florida, previously an abortion haven, will join other southern states in severely restricting access.

Transgender medical care: DeSantis has used the power of state agencies and medical boards to restrict access to gender affirming medical care for both adults and children.

• His administration has implemented rules that prohibit health providers from providing gender-affirming care to youth under age 18 and blocking transgender Florida residents from using Medicaid to pay for gender-affirming care.

The rest of the field isn't exactly cranking out the position papers either. But we found they're dipping their toes into the water on health care — and some, at least, have records to learn from.

Nikki Haley

The former governor and UN ambassador announced her presidential campaign in February. Since then, she's made some news with her health care stances.

Entitlement reforms: In March, Haley proposed altering entitlement benefits for younger generations who have not yet started to use the programs.

• Haley has said entitlement changes should limit benefits for wealthy Americans and include an expansion of Medicare Advantage, according to news reports. She also supports raising the retirement age.

Mental competency tests: Haley said when announcing her candidacy earlier this year that politicians over age 75 should have to take mental competency tests.

• Haley later told Politico this would involve a brief screening from a medical provider to measure the person's cognitive abilities.

Worth noting: Haley doesn’t have official policy positions up on her campaign website yet, but she does list her "record of results" in previous positions.

• The only mentions of health care on her list include signing anti-abortion legislation into law in South Carolina and rejecting Medicaid expansion as governor.

Tim Scott

The South Carolina senator has formed an exploratory committee for a 2024 presidential run.

Abortion: Scott is anti-abortion, but he’s already stumbled while defining what that means to him. He declined to outright support Sen. Lindsey Graham's proposal for a 15-week federal abortion ban in an interview earlier this month.

• Scott did co-sponsor Graham's pre-Dobbs proposals to ban abortions at 20 weeks, and he reiterated that position this month.

The intrigue: Scott's position as a sitting senator gives us more insight into his current policy views than we have for most other potential GOP candidates.

• So far this year, he's co-sponsored bills to improve outcomes for Medicaid beneficiaries with major depressive disorder, re-regulate health savings accounts and prohibit HHS from giving Title X grants to abortion providers.
• He's also spoken out against CMS' changes to Medicare Advantage plan payment and the use of QALYs in federal programs.

Mike Pence

Former Vice President Mike Pence has taken steps to distance himself from Trump on health care. He says he'll decide whether to run "well before late June."

• Last month, he called for "common sense" reforms to entitlement programs including Medicare — though he didn’t give details on what that could mean.
• A vocal opponent of abortion, he's been quick to say he wants mifepristone off the market.
• When asked for comment on the former VP's health care views, a spokesperson referred Axios to the website of Advancing American Freedom, Pence's conservative policy advocacy group.

The details: The group advocates for promoting competition and transparency in health care, furthering value-based payment and building on the success of Operation Warp Speed.

• AAF also calls for more choice and competition within Medicare and "allowing for easy, voluntary exit" from the program.
• The group pushes for increased flexibility for states in running their Medicaid programs, too.

Asa Hutchinson

Hutchinson comes from a red state, but one that expanded Medicaid under the ACA. His high-profile twist on the program, though, was to seek work requirements, before the program was halted in the courts.

• "We want them to have the health care coverage. We want them and we help them to comply. But we also want to help them to get to work and to show them where the path is so that they can have an income," Hutchinson told NPR in 2019.

Abortion: In 2021, Hutchinson signed a sweeping abortion ban into law. He noted in a statement at the time that, "I would have preferred the legislation to include the exceptions for rape and incest, which has been my consistent view," according to the Associated Press.

Vaccines: Hutchinson also stood out to a certain degree among Republicans by being a vocal advocate for getting the COVID-19 vaccine and going on a tour of his state to encourage people to get the shots.

An ideologically diverse group of think tanks and individual policy experts are launching a coalition Tuesday that will push for site-neutral payments in Medicare and hospital transparency legislation, Victoria reports.

Why it matters: It's not every day you see groups like Americans for Prosperity and experts from the Brookings Institution working together — and it's another step showing that site-neutral payment reform and physician-owned hospital legislation could have momentum this Congress.

Details: The coalition — which doesn't have a name yet — is sending a letter to the House Energy and Commerce and the Education and Workforce committees today urging them to "advance reforms that promote site-neutral payments in Medicare and site of service billing transparency in commercial health insurance."

• The group says the changes would be "an important step to lowering the cost of health care."
• The coalition includes the Koch-led Americans for Prosperity, the center-left Progressive Policy Institute and high-profile health policy scholars like Brookings Institution's Loren Adler and the American Enterprise Institute's Brian Miller. (You can see the full list in the letter.)

What we're watching: Legislation on site-neutral payments and physician-owned hospitals, such as the Patient Access to Higher Quality Healthcare Act, are going to be discussed during Wednesday's Energy and Commerce health transparency hearing.

• As Peter reported last week, there were some objections from Democrats on the nature of some of the bills, which means the hearing may not end up being bipartisan after all.
• Rep. Victoria Spartz also re-introduced several hospital transparency bills last week, some of which focus on these topics.