Obamacare: Issue doesn't fade in race for U.S. rep
Editor's note: A series of stories on congressional race issues continues.
More than 2½ years after it passed, President Barack Obama's health care reform law still sucks up all the air in the room when politicians talk health care.
Known officially as the Patient Protection and Affordable Care Act, the March 2010 law is better known as Obamacare, the derisive name fastened to it by Republicans who vow to repeal it, but a name Obama now embraces.
"Because I do care," the president said during a visit Monday to San Francisco. "I care that folks with pre-existing conditions
can still get insurance. I care that insurance companies don't jerk you around."
Republicans say they care, too, and they want to keep provisions such as pre-existing condition coverage, but House Republicans like U.S. Reps. Lou Barletta and Tom Marino say Obamacare won't work and will cost jobs and hurt Medicare.
In the last two years, they have voted more than 30 times to either repeal the law, take away its funding or do, in Barletta's words, "whatever we could to stop the government takeover (of health care by) Obamacare."
As they run for re-election, Barletta and Marino are joined in their full-throated disdain by fellow Republican Laureen Cummings, a home health nursing agency owner running for the other northeast Pennsylvania congressional seat.
"That needs to be repealed," Cummings said of Obamacare.
The Democrats running for local congressional seats - Phil Scollo against Marino, Gene Stilp against Barletta and Matt Cartwright against Cummings - say repeal is unnecessary. If problems crop up, fix them, they say.
"Instead of Congress voting (30) times to try to repeal it, try to make it the best bill it could possibly be," Scollo said.
What Republicans want to repeal is a bill designed to:
- Expand health care coverage to 32 million uninsured Americans. It would do that partly by setting up state-based exchanges where they could buy health insurance coverage and help the poor pay for coverage with federal subsidies. The law will mandate citizens to have coverage and imposes penalties for those who don't of $695 on individuals and up to $2,085 on families.
Though Republicans railed for two years against the mandate as unconstitutional, the U.S. Supreme Court upheld it in June, saving the law's key provision.
- Eliminate 75 percent of the Medicare prescription drug coverage gap by 2020.
- Provide a tax credit to small employers with no more than 25 employees and average annual wages of less than $50,000 who want to offer coverage.
- Forbid insurance companies from denying coverage for pre-existing conditions to anyone starting in 2014.
- Fine companies with more than 50 employees $2,000 a year per worker if the companies do not provide health insurance.
- Allow parents to keep their children on their health insurance plans until age 26.
- Increase the threshold for deducting medical expenses on tax returns by a third, making deductions less likely.
- Cut $716 billion in subsidies to private Medicare Advantage plans and other health care providers to help pay for the law. Medicare Advantage is Medicare-type coverage offered through private insurers. The chief Medicare actuary once predicted the cut would chase 7.4 million people out of Medicare Advantage plans, though they would remain eligible for traditional Medicare.
When congressional Democrats passed the law, they took the money from Medicare Advantage plans, which were becoming more expensive than traditional Medicare, the opposite of what was supposed to happen.
The Congressional Budget Office, which analyzes costs for Congress, said in March 2011 the law will actually cut the federal budget deficit from 2012 to 2021 by $124 billion, a figure that evokes scoffs from Republicans.
10th Congressional District
In the 10th Congressional District race between Marino and Scollo, Marino said the law is already falling short of expectations because its 10-year estimated cost has almost doubled, $1.6 trillion, compared to the original estimate of $940 billion.
The Congressional Budget Office disputes this, saying its higher estimate - actually $1.76 trillion, issued in March, is based on different years - 2012 to 2022 instead of 2010 to 2019 - and more years, 11 instead of 10.
For 2019, the last year common to both estimates, the estimated cost was of Obamacare was $218 billion in the original estimate and $224 billion in the latest. Marino said he had not heard of the CBO's savings estimate and did not dispute it, but was bothered by paying for it through the $716 billion Medicare cut.
"I think everybody should have health care," he said. "And for those who can't afford it, it's our responsibility to help those."
Marino said he favors keeping the pre-existing condition and age 26 requirements, but Obama's plan unnecessarily expands government's role. He said the law's 15-member "unelected" Independent Payment Advisory Board will decide "what type of illnesses get priority and who gets priority."
The law expressly forbids the board from rationing health care, but requires it to work on ways to slow Medicare's growth.
"But how do you think they can prevent people (from getting coverage)? Through costs," Marino said. "Certain aspects of diseases, particularly where there's no cure for it, they're not going to hesitate to say the cost of treating someone for a disease like this (for) which there's no cure is too expensive so we're not going to do it."
Marino said the reform law also does nothing to limit medical malpractice awards that drive up doctors' malpractice insurance premiums and force them to order costly procedures to protect themselves against lawsuits.
Marino touted his own efforts to reign in costs - pending bills that allow hospitals to more easily but still privately share a patient's medical information and small pharmacies to band together to buy drugs more cheaply.
"Everybody has to come to the table on this," he said. "We can't do it without the insurance agencies, the pharmaceuticals, the doctors, the hospitals, the home health providers, people who are buying it."
Scollo said he understands the nation's health care woes first hand. He and his wife lost their insurance coverage for a while during her fight against cancer because an insurance company refused coverage and later when he couldn't afford premiums while dealing with a prostate problem.
"At the end of the day, it's not really my story, it's people we talk to around the district who are in the same boat," Scollo said.
Scollo said he would have voted for the reform law.
"It's not perfect and I'm not a big fan of the mandate at the end of the day," he said. "I do think it's a stake in the ground," he said. "There's a ton of things (that need tweaking) I'm sure, but I would need to look at it on a line by line basis."
He would be open to Republican ideas such as allowing small businesses to pool employees for coverage to get lower rates and to allow insurance plans to offer coverage across state lines.
"I want to sit down with my colleagues and figure out what the most cost effective way is without having the average person subject to devastation," he said.
11th Congressional District
In the 11th Congressional District (which now encompasses the greater Shamokin-Mount Carmel area) between Barletta and Stilp, Barletta uses many of the same arguments as Marino - the $716 billion cut, the new, higher estimated costs, "the unelected bureaucrats" that will decide coverage.
But he also railed against the law's "21 new taxes, 13,000 new regulations," 800,000 lost jobs and the potential loss of health insurance by three million people.
The CBO estimates between three million and five million people will lose coverage from 2019 to 2022 as employers stop offering coverage because of the new law.
Barletta said he favors medical malpractice reform, small-business coverage pooling and allowing interstate competition for coverage, but opposes the mandate.
"These should be passed in increments" and new ways other than the mandate found to pay for costly provisions such as pre-existing condition coverage, he said.
"I was a small businessman. To get a better employee, you want to give benefits," he said.
Stilp declines to say if he would have voted for the reform law, but says he favors its coverage of pre-existing conditions, age 26 coverage, preventive medicine provisions and better access to care for women.
He wants to focus on ensuring small businesses are not hurt by the law, he said.
"That burden has to be shifted to the much larger corporations," he said.
Stilp said he would focus on implementing the recommendations of the respected Institute of Medicine, which recently estimated the nation's health care system wastes $750 billion a year.
17th Congressional District
In the 17th Congressional District race between Cummings and Cartwright, Cummings also decries the $716 billion cut. She questions whether the nation had such a large problem with uninsured people that it required Obamacare. Many studies showed about 45 million Americans lacked health insurance, but Cummings contended most of them were between 20 and 30 years old and did not want to pay for insurance coverage.
If Democrats had allowed for legitimate debate on the reform law, things would have been different, she said.
"Maybe they could have gotten parents to realize this is an issue and parents could have gone to insurance companies and demanded that their children be left on the insurance," she said. "I think that they would much prefer that to having to deal with a whole government takeover of our health insurance. But this government doesn't have any faith in the American people. I do."
A licensed practical nurse, she railed against regulations such as one that requires nurses, doctors and hospitals to track the temperature in their refrigerators and "throw out good medicine."
"That's why I think my specialty would help in Washington," she said.
Cartwright said he would have voted for the reform law, but he favored creating a public option - government-sponsored coverage that people could buy if they were unsatisfied with private insurance plans.
Critics said that would be government interfering in the free market, but Cartwright contends that would keep insurance companies from overcharging while giving the government purchasing power that produces savings.
Cartwright said he favors the insurance mandate, noting states even require drivers to have car insurance.
Without the health care mandate, too many people are left uninsured. Even with the law, about 30 million people remain uncovered, he said.
"So the challenge is to get 100 percent of people covered," he said. "Uninsured care happens and it's just a question of who pays for it. If you don't cover it, the people paying for it are the providers. It's the doctors, it's the nurses, it's the hospitals."
Cartwright said the law will undoubtedly require tweaking because it's so comprehensive.