The Register Citizen (Torrington, CT)
Truth can be a casualty in debate over health care
The future of health care in America is among the top campaign-season issues nationwide and nowhere is it more in evidence than the congressional races in Connecticut.
The Democrats, Rep. Jim Himes and Rep. Elizabeth Esty’s prospective replacement, Jahana Hayes, are both ahead of their Republican opponents. But the debate over health care has been vigorous nonetheless. Access Health CT, the state’s exchange for individualmarket health insurance plans under the Affordable Care Act — Obamacare — has been a relative success. It enrolled 114,134 in the most recent sign-up period, a 2.3 percent increase over the previous year.
But for those of modest means who earn too much for federal tax credits, premiums on the individual market have been on the rise in recent years even though this year’s average increase of 12.3 percent is substantially lower than last year’s 25.5 percent.
Despite Republican attempts to overturn and undermine it, the Affordable Care Act remains the law of the land. Himes said he would look for tweaks and alternatives such as a public option, which would give healthinsurance shoppers a chance to enroll in Medicare instead of purchasing private policies.
“Our concentration in the next Congress should be on protecting Americans with pre-existing conditions, working to reduce premium increases and ensuring all Americans have access to affordable health care,” Himes said. “That includes seriously examining a public option for cost, feasibility and competitiveness.” Sen. Chris Murphy, DConn., running for his second term this year, also is a supporter of the public option.
Himes’ opponent, Harry Arora, favors creating a risk pool that separates out sicker policyholders from healthier ones. The result, he said, would be to lower rates for the healthy, while focusing subsidies on those most in need. “I’m a believer in more options,” said Arora, an investment manager who emigrated from India 25 years ago and lives in Greenwich. Younger, healthier individuals without insurance could be attracted by strippeddown policies offering fewer benefits than those mandated under Obamacare, he said.
“We believe that we need to offer options, even if they are not perfect options,” he said. “If the choice is a limited policy or no policy, the better choice is the limited one.”
Prior to the Affordable Care Act, Connecticut tried a statefinanced high-risk pool and it did not work, said Ellen Andrews, a health policy expert who runs New Haven-based Connecticut Health Policy Project. “It was outrageously unaffordable,” she said.
The sharp debate on health care offers voters a chance to judge the candidates on substance, not just imagery. However, as a system costing $3.2 trillion, with 294 million insured and 28 million uninsured, the complexity of health care in America is “way beyond a sound bite or bumper sticker,” as Karen Pollitz, health policy expert at the nonpartisan Kaiser Family Foundation, put it.
Nationally as well as locally, both Democrats and Republicans support protections in the Affordable Care Act enabling those with pre-existing conditions to obtain affordable health insurance. "All Republicans support people with pre-existing conditions, and if they don't, they will after I speak to them,” President Donald Trump said last week. “I am in total support.”
Connecticut Republicans say they, too, support protections for those with pre-existing conditions — about 522,000 in the state. Earlier this year, Democratic Gov. Dannel P. Malloy signed legislation stating protection for people with pre-existing conditions would remain in state law in the event it disappears at the federal level.
But health care experts question whether such a guarantee could remain viable if Congress cancels out features of the Affordable Care Act such as subsidies to make insurance affordable. “Once you start pulling on a thread, the whole market unravels,” said Pollitz.
In questioning Republican commitment to pre-existingcondition protection, Himes and other Connecticut Democrats point to last year’s House approval of the American Health Care Act. It was to be the Republican replacement for Obamacare, but it ultimately fell short in the Senate when the late Sen. John McCain, R-Ariz., gave his famous thumb-down “no.”
The bill would have created a waiver for states to allow basing insurance rates on “health status” if a person has not maintained continuous coverage.
The aim was to prevent “adverse selection” — individuals only buying insurance when they get sick, which blows up the risk pool idea of healthy and unhealthy keeping premiums down. The legislation also required states to set up risk pools.
Democrats said the bill would have allowed a back-door way of discriminating against those with pre-existing conditions, who, they say, would face exorbitant insurance rates without specific protections in law.
Republicans included an amendment that would have targeted $8 billion over five years to counteract the potential negative consequences.
Andrews said $8 billion “would not even be close to covering” pre-existing conditions.
A Kaiser Family Foundation study showed that the 35 states with high-risk pools for sicker individuals (including Connecticut) spent $1.2 billion a year for 226,615 people just prior to the implementation of Obamacare.
In the race to replace Esty, Hayes’ support of Medicare-forall, a single-payer system championed by Sen. Bernie Sanders, I-Vt., drew skepticism from Republican Manny Santos in a debate last week. “It’s not the utopia that many are believing it will be,” said Santos, former mayor of Meriden, who added it would be overly expensive and inefficient.
Andrews acknowledged there would be “a lot of moving parts,” but such a system has worked in Canada and Europe. Most health care experts agree federal taxes would rise dramatically in a “Medicare-for-all” single-payer system. But the extra cost might be offset by eliminating state and federal taxes for Medicaid, as well as premiums for employerprovided insurance.
While “Medicarefor-all” may raise taxes, the cost might be offset by nixing Medicaid taxes and employer insurance.