From the start of the second Republican presidential primary debate of the 2024 campaign, the seven candidates on stage were boisterous and unruly.

Florida Gov. Ron DeSantis, former South Carolina Gov. Nikki Haley, South Carolina Sen. Tim Scott, entrepreneur Vivek Ramaswamy, former Vice President Mike Pence, former New Jersey Gov. Chris Christie, and North Dakota Gov. Doug Burgum spent most of the evening talking loudly over — and sometimes quite angrily at — one another.

The moderators — Fox News’ Dana Perino, Fox Business’ Stuart Varney, and Univision’s Ilia Calderón — sometimes struggled to referee at the Ronald Reagan Presidential Library & Museum in Simi Valley, California, as the presidential hopefuls clashed on topics ranging from the autoworkers’ strike to foreign policy. At points, health care issues crept into the discussion.

Candidates sparred over manufacturing and employment, inflation, and federal spending. When it came to the government shutdown threat, Haley promised to change the process, pointing out that Congress had delivered appropriations on schedule only four times in 40 years.

Asked about medical debt, which plagues tens of millions of Americans, she pledged a multipronged effort to protect people from financial ruin when they need care. She spoke of introducing more competition in the health system and putting “the patient in the driver’s seat” while increasing transparency.

“We’re going to have to make every part of the industry open up and show us where the warts are,” she said. She didn’t elaborate on how that could be accomplished.

Pence dodged a question about whether he would make good on his promise, from 2016 and the current campaign, to repeal the Affordable Care Act — also known as Obamacare — which Perino noted seemed more popular now than ever.

“It’s my intention,” the former vice president said, “to make the federal government smaller by returning to the states those resources and programs that are rightfully theirs under the 10th Amendment of the Constitution.” That would include all Obamacare and Health and Human Services funding, he said.

Pence also said he is “sick and tired” of mass shootings and promised, if elected, to advance an expedited federal death penalty “for anyone involved in a mass shooting” so they “meet their fate in months, not years.” The former vice president criticized DeSantis over the sentence handed down to a gunman who attacked Marjory Stoneman Douglas High School in Parkland, Florida, in 2018, calling it “unconscionable” that he’ll “spend the rest of his life behind bars.”

On the issue of health insurance coverage, DeSantis wore his state’s high uninsurance rate as a badge of honor.

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