Prices, not the ACA, are this year’s hot-button campaign issue

Considered one of the most vulnerable incumbents up for re-election in November, Sen. Claire McCaskill is making a big issue out of healthcare.

The Missouri Democrat says the country is at a “breaking point” when it comes to healthcare prices, and she professes to be looking for opportunities to push through the gridlock to address that anxiety.

But unlike the past few election cycles, it’s not all about the Affordable Care Act.

“I don’t know and don’t care how quote-unquote Democrats should be addressing healthcare,” McCaskill said. “I know how I’m going to address healthcare as the most important issue facing Missourians in terms of their anxiety and their worry about their copays, their deductibles and the cost of medicine particularly.” She added that it’s not just an issue for people on the exchanges.

“It’s really, frankly, also for people getting insurance at work,” she said. “It’s for people who are on Medicare. I don’t think enough people (in Washington) realize how worried and stressed people in this country are about this.”

With the ACA’s individual mandate effectively gone and the Trump administration pushing short-term plans, Democrats are blasting Republicans for this year’s wave of insurance rate hikes. Polling is in the Democrats’ favor: 50% approve of the ACA compared with 43% disapproving, according to a Kaiser Family Foundation poll this month.

As Sen. Chris Murphy (D-Conn.) put it, Democrats ought to be “talking about healthcare 50% of the time. We ought to be talking about sabotage 80% of the time.” He noted, however, that decisions about how to unwind the GOP effect on the exchanges probably will have to wait until the Democrats win back both the House and the Senate.

“It could take a while to get to that next step,” Murphy said.

Joseph Antos of the right-leaning American Enterprise Institute predicted that the timeline likely will drag out until the next presidential cycle at least.

For Republicans, the individual market that covers a small slice of America has become a political albatross. Both parties balked at restoring the cost-sharing reduction payments halted by President Donald Trump in October. While Democrats decried Trump’s move, they ultimately accepted it as the majority of state insurance commissioners piled the costs of the payments into silver plans, a maneuver called “silver-loading,” thereby increasing subsidies for lower-income enrollees.

A push by Sens. Lamar Alexander (R-Tenn.) and Susan Collins (R-Maine) to restore these payments and establish a federal reinsurance fund to help bring premiums down fell apart in March as political will failed.

“We’re stuck exactly where we are,” Antos said. “It’s not a question of an unstable market. Insurers know what they should do; insurance commissioners know what they can accept; and here we are. It means more money out of the general federal revenues, but that’s the price of political gridlock.”

Sen. Bill Cassidy (RLa.), who drew up the last Republican attempt to repeal and replace the ACA—a proposal that would have turned over substantial federal regulatory authority to the states along with a capped allotment of funding— also has his sights aimed at cost, specifically through transparency measures.

“I think there is tremendous political will to try to lower healthcare costs,” Cassidy said. “The president’s message about lowering healthcare costs is exactly about that.”

McCaskill and Cassidy both touted a bill they co-sponsored that would forbid carriers and pharmacy benefit managers from adding so-called “gag clauses” to contracts. These contracts block pharmacists from telling plan enrollees whether they would pay less for a drug if they buy it without insurance.

For others, such as Sen. Doug Jones, the freshman Democrat from Alabama, problems like rural access are key. He is homing in on the Medicaid wage index— Alabama has the lowest in the country—and rural broadband expansion so hospitals and doctors can use telehealth to reach patients.

Rep. Cheri Bustos (D-Ill.), who hails from a purple, rural district that went for Trump, didn’t shy away from talking about the ACA—it’s more popular than ever, she said—but current policies are pointing the law in the wrong direction. Even if Democrats take the House, she wants to work on policies that both sides can rally around. “Prescription drugs seem to be the top issue we can work on together,” Bustos said, noting that she wants to push for negotiating prices through Medicare.

“Insurers know what they should do; insurance commissioners know what they can accept; and here we are. It means more money out of the general federal revenues, but that’s the price of political gridlock.”

Joseph Antos American Enterprise Institute