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Where they stand: Rep. Cathy McMorris Rodgers and Lisa Brown on health care, Medicare and Medicaid

The narrow defeat of a Republican plan to overhaul the nation’s health care system last summer hasn’t lessened the intense attention the issue has attracted not only in Eastern Washington, but in competitive legislative races nationwide.

As the fourth-ranking GOP member in a deeply divided House of Representatives that passed the bill last May, Rep. Cathy McMorris Rodgers has said she and her colleagues didn’t do a good enough job selling the American public on their plan, which she said would increase consumer choice and take government out of the health care process. She was the only lawmaker in Washington state to vote for the law.

Lisa Brown called the plan wrong for the district, citing the opposition of several key health care advocacy groups and the region’s chamber of commerce, as well as estimates from congressional researchers that millions would lose their comprehensive health coverage they received under the Affordable Care Act. But the Democrat has yet to commit to exactly what reform package she would support if elected to Congress this fall.

In interviews last week, the candidates laid out their philosophies on health care, the government’s role in supplying it and their views on the future of the health care programs Medicare and Medicaid. For McMorris Rodgers, who has voted for what congressional analysts have said are dozens of bills that would repeal portions or all of the Affordable Care Act, the government’s role should be limited to assisting those with disabilities and other vulnerable groups.

“I believe everyone should have access, but I don’t believe that the government is the best way to ensure that it happens,” McMorris Rodgers said.

Brown, who voted during her time in the state Legislature to increase eligibility for state-sponsored health coverage for children, repeatedly said a public health option should be provided to everyone by the federal government. But the candidate stopped short of the single-payer system, in which the government would be exclusively responsible for health care costs, that dozens of Democrats in the House of Representatives have endorsed and that polls suggest a majority of Americans from both parties support.

“I don’t think it’s realistic to expect that we’re going to create an entire public system, and then tell everyone they have to give up their current system to go into it,” Brown said. “It’s just too complicated already.”

Brown expressed interest in multiple proposals that would lower the age at which a recipient would be eligible for Medicare, and even some that would permit young, healthy adults to buy into such plans that she said would stabilize the market for older, sicker beneficiaries. But she wasn’t committal, other than saying she would be looking for “bipartisan solutions” in the House of Representatives.

The national GOP and McMorris Rodgers have seized upon this indecisiveness, contending Brown hasn’t answered for the estimated $32 trillion price tag some outside studies have placed on a Medicare-for-all, single-payer system. Its proponents, chief among them Vermont Sen. Bernie Sanders, have disputed that figure and even suggested it would lead to cost savings, but that claim has been disputed by fact-checkers.

Expanding Medicaid, and short-term health plans

The Republican legislation would have reduced federal spending on health care, largely through changes to the way the federal government funds Medicaid. The Centers for Medicaid & Medicare Services, the federal agency that administers the assistance programs, estimated the Republican law would have reduced Medicaid spending by $383 billion over the next 10 years. States had been given the option to expand access to the program, which is jointly funded by federal and state dollars; Washington did so, while Idaho did not (though it’s on the ballot this year). The Republican health care law would have rolled back federal financial support for the expansion and established a new, per capita formula for determining how much federal money states would receive.

McMorris Rodgers said she didn’t approve of the Medicaid expansion, like the one that was permitted under the Affordable Care Act, because she believed it could delay services for the elderly, low-income mothers and the disabled, people the program was originally designed to assist.

“At the same time, today, in Washington state, individuals with disabilities are waiting to get on Medicaid,” the congresswoman said in an interview.

But a study by the Kaiser Family Foundation found that, in 2015 and 2016, there weren’t any people in Washington state waiting specifically for in-home care for seniors and those with disabilities. When Vice President Mike Pence made that claim last year about the state of Ohio, the fact-checking organization PolitiFact rated it false, citing researchers who found no connection between expansion of the program to a greater number of low-income recipients and waiting lists for home and community-based services under the program.

Further, a report published by the conservative-leaning think tank the Foundation for Government Accountability on what it called the “crisis” created by Medicaid waiting lists after the Affordable Care Act’s expansion doesn’t mention Washington state.

“I believe that the best solution is to get more people employed, and then they’ll have other options through their employer for health insurance, that most of the time is much better than Medicaid,” the congresswoman said.

Brown said she supported Medicaid expansion, noting that it was a major feature of the letter penned by Greater Spokane Inc. listing concerns about the Republican health law last year because of its potential effect on the region’s economy.

“It’s the right thing to do for families, because especially for young people, they’re in careers that may not provide health care with employment,” Brown said. “It’s just the right thing to do, and I think it makes economic sense as well.”

McMorris Rodgers said she supported the Trump administration’s move to provide coverage for those people who can’t afford more expensive plans: extending the permissible length of short-term plans that cost less but offer less coverage than plans compliant with the current health care law’s required services. Democrats, including Sens. Patty Murray and Maria Cantwell, have called them “junk plans” and have sought to overturn the executive ruling.

The congresswoman said such plans weren’t intended to be replacements for other long-term plans and offered customers more choice in their health care options.

“There may be a recent graduate, who no longer is on their parent’s health insurance plan. Maybe it’s a person who’s in between jobs, or those who have retired early but haven’t yet signed up for Medicare or missed the enrollment period,” McMorris Rodgers said.

Brown said she opposed the executive ruling, citing a frequent attack she’s made on Republican health care plans: That they endanger coverage for those with pre-existing conditions. Such short-term plans aren’t required to offer that coverage, but some do.

“They don’t have to cover the 10 essential benefits, and essentially it’s rolling back to a system in which people have the illusion of coverage, but in reality they could go bankrupt,” Brown said. Analyses have also shown making the short-term plans more available would increase premiums for everyone buying insurance in the Affordable Care Act’s marketplaces.

Pre-existing conditions and state waivers

The two candidates sparred this week in debates over exactly what the GOP plan would have done to the Affordable Care Act’s guarantee that patients wouldn’t be charged more for insurance based on their medical condition. Brown said the bill exemplified Republican plans to roll back protections for that population, a claim McMorris Rodgers denied while pointing to an analysis of the bill that showed it was narrow in scope, and said those with pre-existing conditions would only be affected if a state sought a waiver from current health care rules and they allowed their coverage to lapse for more than two months.

Brown conceded that it was unlikely Washington state, which has acted in the past to expand public coverage to people of higher income levels including during the Democrat’s time as leader of the Senate, would seek such a waiver. In states that did seek waivers, insurers would be able to offer plans that didn’t include coverage for ambulance rides, emergency room visits and maternity care.

“I believe that Washington state would never go in the direction of waiving those essential health benefits,” Brown said. “But it doesn’t make sense to me that any American should not have access to an ambulance, or lab services, or pediatric services, maternity care. Those 10 benefits are really significant, and having them be determined by what state you live in doesn’t make sense to me.”

McMorris Rodgers defended the waivers, and said she believed the law as written wouldn’t have negatively affected those with pre-existing conditions who maintained their coverage.

“I believe that the federal government should set the baseline of essential health benefits, and that should include protecting those with pre-existing conditions,” McMorris Rodgers said. “But the states need to have the ability to tailor those offerings to the people in their states.”

Even so, there is no guarantee in the bill McMorris Rodgers voted for that would have prevented insurance companies from charging people with pre-existing conditions more than under current law, as fact-checkers and think tanks have noted.

Tax penalties and drug prices

The Republican health bill would have done away with the individual mandate, a tax penalty that was intended to encourage younger, healthier Americans to purchase health care to drive down costs for older, sicker beneficiaries. The GOP later reintroduced it in their tax reform law that passed late last year, and next year for the first time since the Affordable Care Act passed those who opt out of the markets won’t get a tax penalty.

Both candidates said they didn’t believe the individual mandate was necessary. McMorris Rodgers derided it as ineffectual, while Brown said she believed it wouldn’t be necessary in a system that included an affordable public option for all.

“It did not meet its intended goal, with millions choosing to pay the penalty instead,” McMorris Rodgers said. For tax years 2014 and 2015, according to the Congressional Research Service, roughly 15 million tax filers opted to pay the penalty rather than seek coverage.

Brown said she believed offering an affordable public option would entice enough people to buy insurance that a tax penalty wouldn’t be necessary to sustain a federal health insurance program.

“If there was an affordable public option, most people would get it,” Brown said. “I think we could start to build a culture where people just leave their parents’ health care and join the system. I also think a lot of employers would start to shift to it, because it would make their lives less complicated.”

Brown also said she would support a regulatory scheme that would put price restrictions on established prescription drugs. Two years ago, the skyrocketing price of EpiPens, a device used to counteract allergic reactions, drew congressional attention. Only recently did the Food and Drug Administration announce approval for a generic competitor intended to drive down the cost of the drug, which jumped from $50 per dose to more than $500 after a private company bought the rights to the injectors.

“Now, increasingly, the industry is controlled by a few major players. It’s an oligopoly,” Brown said. She likened a needed regulatory scheme to the same way the government regulated the expansion of the electric grid to rural America in the early 20th century, noting that both public utility districts and private providers, such as Avista, have their rates reviewed by regulatory agencies.

McMorris Rodgers said the government’s focus should be on ensuring the timely introduction of generic drugs to compete with established brands by pharmaceutical companies.

“We’ll bring down costs by increasing competition and ensuring transparency,” McMorris Rodgers said. “I’m pleased that this administration is accelerating the approval process for generics.”

The U.S. Department of Health and Human Services announced in January that, in 2017, the Food and Drug Administration approved more than 1,000 generic drug applications, more than any other year in history.

The pharmaceutical industry is one of the largest sources of campaign financial contributions, according to the campaign financial watchdog organization the Center for Responsive Politics. Of the $1.9 million in political action committee funding McMorris Rodgers has received directly in this election cycle, $127,500 has come from the political arm of pharmaceutical companies. That includes maximum contributions from Abbvie, a Chicago-based biotech firm responsible for the rheumatoid arthritis drug Humira, and Bristol-Myers Squibb, the New York-based manufacturer of several cancer, diabetes and cardiovascular drugs, including Eliquis and Plavix.

Brown has pledged not to directly take corporate PAC money. However, she has accepted political contributions from other political PACs that have taken cash from pharmaceutical companies, including Abbvie and Amgen, the California-based manufacturer of several name brand prescriptions, including the arthritis drug Enbrel.

Care for veterans

The future of around-the-clock emergency services at the Mann-Grandstaff Veterans Affairs Medical Center is of keen interest to Nine Mile Falls resident Ron Taylor.

Last October, the 84-year-old U.S. Army veteran experienced an episode of “excruciating pain and vomiting.” The problem? It was after 6 p.m., and he couldn’t receive his care at the VA.

“The bill was $13,000,” Taylor said in a phone interview last week.

Taylor anticipated trouble with his VA medical care and had enrolled in Medicare, which covered 80 percent of the bill. But he was still on the hook for roughly $2,600, a bill that wouldn’t need to be paid if the VA were open when he needed them.

McMorris Rodgers said Congress had worked to provide the funding needed to reopen the emergency room at the VA in Spokane, sending to President Donald Trump a nearly $200 billion medical spending package that is the largest in the agency’s history.

“I’ve already voted for the funding,” McMorris Rodgers said. “It’s a matter of the Spokane VA moving forward. They have told me that their goal is to have it open in the first part of 2019, 24/7.”

Brown has criticized McMorris Rodgers for not using her position of leadership to press harder for the return of nonstop emergency services in political advertisements. She said she supports partnerships with the region’s medical schools to staff the center, an idea the congresswoman has also supported in conjunction with Rep. Phil Roe, the chairman of the House’s committee on Veterans Affairs who represents a district in eastern Tennessee that already has a partnership between its medical school and veterans health care center.

“She has talked about doing that, but you know what, it’s not about what you say, it’s about how you accomplish it,” Brown said. She also took credit for “introducing the concept” to the congresswoman during her time as chancellor of WSU Spokane.

The congresswoman disputed that in an interview.

“There’s actually a delegation going down later on this month, business and community leaders later this month to Johnson City (Tennessee),” McMorris Rodgers said, referring to Roe’s district. “The leaders in Johnson City that created this model, that is a partnership between the medical schools, and the VA, and the community.”

Both candidates said they believed the VA could fix its problems from within, rather than pushing for a privatization of services as had been feared by some veterans advocate groups. In May, McMorris Rodgers voted for the Mission Act, an overwhelmingly bipartisan bill that increased options for veterans seeking care outside the VA that lawmakers said wasn’t part of a push toward privatization of services.

“I believe it should be the choice of the veteran,” McMorris Rodgers said. “If the veteran wants to go to the VA, the VA should always be there for the veteran.”

Brown said she also supported the outside option, and has continued to raise the specter of privatization in campaign communications. She said that’s what’s driving discord in the leadership of the federal agency right now.

“I think there’s a lot of confusion around its leadership, correct? The Secretary (David) Shulkin, who was fired, basically said that it was over the controversy of those who want to seek to privatize veterans’ health care,” Brown said, referring to reports around the time of Shulkin’s dismissal that it was due to disagreements about the future of the administration. “I don’t think that clear signals have been coming from the administration on strengthening the VA.”

But McMorris Rodgers pushed back on claims that this Congress was interested in privatizing services, pointing to the historically unprecedented public investment in the program.

“If anyone’s trying to privatize the VA, they’re doing a very poor job,” McMorris Rodgers said.

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