During his short time in the Senate, GOP vice presidential nominee JD Vance has made his opposition to abortion access and transgender health care well known — but all the while the Ohio Republican has been quietly introducing and supporting bills to try to shape America’s public health apparatus.

Vance has been in the Senate for less than two years. He doesn’t serve on any major health care committees of jurisdiction, although he is the fifth of six Republicans on the Senate Special Committee on Aging.

But his health policy interests are wide-ranging. He’s taken an interest in curbing opioid addiction, drawing inspiration from his background as the son of an opioid addict, an experience he wrote about in his autobiography “Hillbilly Elegy.” He’s also expressed interest in limiting health care access for undocumented immigrants and immigrants who came here illegally as children and increasing personal autonomy in health care.

He’s co-sponsored bills aimed at making insulin more affordable; that would overturn the Biden administration’s lab-developed test rule; as well as a resolution calling on a moratorium on gain-of-function research. He has been vocal in calling for monitoring of the health impacts of a toxic train derailment in East Palestine, Ohio, in February 2023.

In September 2023, Vance introduced a Senate bill that would block taxpayer dollars from being used to enforce a mask mandate in non-health care sectors. While that bill didn’t pass, a similar amendment he introduced to the spring 2024 spending bill prohibiting the Department of Transportation from using any federal funds to enforce mask mandates was signed into law.

Upon passage, Vance called the amendment a victory for common sense and declared that “the era of public health panic is over.”

“Mask mandates were an outrageous overstep by the public health establishment. We cannot allow this mistake to be repeated,” Vance said.

Vance has also introduced legislation aimed at preventing taxpayer dollars from going toward health care for “Dreamers,” people brought to the United States illegally as children.

In 2023, he introduced a bill to prevent those protected under the Deferred Action for Childhood Arrivals program, or DACA, from enrolling in the HealthCare.gov exchanges and barring any undocumented immigrant from accessing health care through the exchanges. The legislation was referred to the Senate Finance Committee but never went anywhere.

Vance criticized the Biden administration when it finalized a rule in May allowing DACA recipients to enroll in certain exchange plans.

“Joe Biden’s response to all this is to give your hard-earned money away to illegal immigrants in the form of taxpayer-funded healthcare. This is a slap in the face to every hardworking American who plays by the rules, and it would never happen if Donald Trump were president,” Vance said in a statement.

Reproductive health and transgender health care

When he ran for Senate in 2022, Vance supported a 15-week national abortion ban but said he also believes in exceptions. At the time, he pointed to the case of the 10-year-old Ohio rape victim as an example and said her case probably fell under protecting the life of the mother.

“I think it’s totally reasonable to say you cannot abort a baby, especially for elective reasons, after 15 weeks of gestation,” he said on the debate stage. “No civilized country allows it. I don’t want the United States to be an exception.”

But at other points in his career, he’s argued against exceptions for rape and incest, saying in September 2021 that “two wrongs don’t make a right.”

He campaigned against Ohio’s constitutional amendment guaranteeing a right to an abortion and called its passage a “gut punch” in a post on X. Ohio currently has a ban on abortions after 21 weeks, six days of pregnancy.

Vance is also interested in boosting the nation’s fertility rate and has offered support for proposals to make childbirth free. Last year he introduced a bill, along with three Republican co-sponsors, to prohibit an employer from recovering any health care premium paid by the employer for an employee if the employee fails to return to work because of the birth of a child.

The Ohio Republican is also a staunch opponent of gender-affirming care for minors. He introduced legislation in 2023 to criminalize providing hormones or surgery to transgender minors, punishable by up to 12 years in prison. On this policy issue, Vance is closely aligned with Trump, who has made limiting access to transgender health care a hallmark social issue of his 2024 campaign.

Opioids

On the heels of his success with “Hillbilly Elegy,” Vance opened and ran a nonprofit to combat the opioid epidemic, Our Ohio Renewal, in 2016, but he closed it down at the start of his Senate career.

But the nonprofit failed to raise money or accomplish much. After the nonprofit shuttered, its employees accused Vance of creating the group to launch his political career — not to help Ohio. An Associated Press investigation also questioned the hiring of a physician, Sally Satel, whose writings questioned the role of prescription painkillers in the national opioid crisis and who was affiliated with a think tank linked with Purdue Pharma, the maker of OxyContin.

In the Senate, Vance has introduced one opioid-related piece of legislation, according to a search of CQ archives.

In January, he introduced legislation to allow health plan policyholders to obtain information about controlled substances prescribed to adult children enrolled in a parent’s plan.