Health Care Reform Absent from Democratic Debate

Two hours of policy-heavy dialogue and, unless I missed it, not one of the five Democratic candidates for President uttered the words “Obamacare,” “Affordable Care Act” or “health care reform.” True, Senator Bernie Sanders brought up “Medicare for all” and declared that health care coverage is a right of citizenship. However, there was no mention of his remarks by the other candidates, former Senator Lincoln Chafee, former Secretary of State Hillary Clinton, former Governor Martin O’Malley, and former Senator Jim Webb.

Update: October 14, 2015: Oops. There was a brief discussion of allowing undocumented immigrants eligible for coverage under the ACA. The focus of this segment was immigration and the candidates mention of health care was incidental. I don’t think this undermines the point of this post, but they did mention it. My bad.

Ignoring health care reform is a s pretty amazing development when you think about it. Health care reform was a big part of the Democratic presidential primary campaign in 2008. The passage of the Patient Protection and Affordable Care Act in 2010 turned American politics upside down adding copious amounts of fuel to the Tea Party movement. Yet, in the CNN/Facebook debate from Las Vegas … not a word.

I’m not saying CNN should have made health care reform the primary topic of Tuesday night’s Democratic debate. However, a short simple question soliciting short simple answers would have, I believe, highlighted some differences among the candidates. At the very least it would have contrasted the Democrats running for president from the Republicans seeking the office.

My hoped for question: “What changes to the Affordable Care Act, if any, would you seek if elected President?”

We know Senator Sanders’ response: he’d scrap the Affordable Care Act for a single payer system. Would any of the others join him? Maybe. Would any of them defend the health care reform law as is? Possibly. Quizzing the candidates on legalizing marijuana was of interest to some, no doubt, but, in my mind at least, finding out what they’d change in the ACA is both a more important and fascinating topic.Of course, given the topic of this blog, I am a bit biased.

Jeb Bush Reveals Health Care Reform Plan

Ironically, this is the day former Republican presidential candidate, Governor Jeb Bush, detailed his health care reform proposal. Calling the ACA a “monstrosity,” Governor Bush said the government should help Americans obtain catastrophic coverage (albeit with a preventive care component) to protect them from financial ruin, but not force individuals to buy and businesses to offer comprehensive coverage.He would require carriers to cover insured’s pre-existing conditions for individuals who maintain continuous coverage.

Under Governor Bush’s proposal, individuals without employer coverage would receive tax credits allowing them to buy coverage against “high cost medical events.” Governor Bush also called for raising the contributions limits allowed on health savings accounts.

Significantly, Governor Bush recognizes that the ACA can’t simply be repealed without serious adverse impacts on what he calls “the 17 million Americans entangled in Obamacare.” He calls for a transition plan to help them move from the ACA to the Governor’s system.

Governor Bush’s health care reform plan also calls for restoring state regulation of insurance markets, promotion of health information technology adoption, wellness rewards and innovation in care delivery models. An interesting, and maybe wishful, provision of his proposal is “an app on your smart phone that calls your doctor to your front door, just as it does for a car to come pick you up.”

Maybe Next Time

Health care reform in general and the Affordable Care Act will no doubt be a big part of the general election. Governor Bush has laid out one approach for Republicans. It would be nice to learn a bit more about what Democrats would do. CBS hosts the next one on November 14th. Maybe the issue will come up then.

Is requesting one straightforward health care reform question asking for too much?

 

Health Care Reform the 2016 Where’s Waldo

At this time in 2011, six months before the Iowa caucuses, health care reform was a big deal. Republicans couldn’t see a live microphone without calling for its repeal. And one would think that the official name of what was commonly referred to as “Obamacare” was “the President’s signature issue” in his first term. Flash forward four years and health care reform is now the “Where’s Waldo” issue of 2016: it’s there somewhere, but darn well hidden.

True, every candidate on the GOP wants to repeal the Patient Protection and Affordable Care Act. They are all happy to haul out the old tropes about how the ACA is a job killing, anti-free market, mess and a government overreach. Many will be happy to explain how it’s all unconstitutional.

Meanwhile, every candidate on the Democratic side is defending the ACA, although some more enthusiastically than, well, at least one. Candidate Bernie Sanders has promised to introduce “Medicare for all” legislation (a euphemism for single payer) soon and would seek a single payer solution were he to become president. Yet even on the Democratic side, the topic of the ACA is pretty well hidden in their campaigns.

In fact, a quick survey of campaign web sites shows a remarkable lack of emphasis on health care reform by presidential candidates. On the Democratic side, health care reform doesn’t make the issues list on the campaign web sites of former Governor Martin O’Malley or Senator Bernie Sanders. Defending the Affordable Care Act is the ninth issue addressed by former Secretary of State Hillary Clinton’s web site.

On the Republican side Donald Trump is too busy bullying his opponents and the press to mention any issues other than immigration on his site. Health care reform makes Dr. Ben Carson list of issues, but he devotes just 98 words to the topic — and the only alternative he mentions is his support of health savings accounts. Former Governor Jeb Bush’s site is nearly issues free (there’s a white paper on his tax reform plan in the “news” section, but there is no “issues” tab). I couldn’t find anything about health care reform on the site. Then, I couldn’t find the issue (or any issues) on Carly Fiorina‘s or Senator Ted Cruz‘s sites, either.

Governor Scott Walker announces his intent to repeal Obamacare on his first day in office. And although I couldn’t find it on his web site, to his credit Governor Walker has offered a plan to replace the ACA. Senator Marco Rubio gets around to discussing health care reform on his web site after first mentioning 17 other issues while on Governor John Kasich‘s site it comes in at #3.

Given all that’s going on the world, it’s not surprising health care reform isn’t a driving issue. Which is remarkable. Health care reform arguably gave birth to the Tea Party movement. It cost Democrats the majority in the House in 2010 and helped chip away at their Senate majority until that was lost, too. In short, health care reform moved elections.

Now, not so much. The ACA is a part of America’s landscape now. Too many people are insured under the law to repeal it. Too much physical, digital and process infrastructure has been built out. Too many stakeholders are vested in the ACA continuing and opponents of the reforms have no coherent program to replace it.

This isn’t a bad thing. Because it opens up a real possibility that, once there’s a new President and Congress in 2017, they can accomplish something important: fixing the Affordable Care Act. The law has lots of flaws, but the debate since it’s passage has too often been an all-or-nothing affair: dump it or defend it. Yes, there’s been some tweaking around the edges of the legislation, but not the comprehensive review and modification that’s needed.

Finding Waldo can be hard. Finding a way forward to improve the ACA will be harder still. If little kids can find Waldo, perhaps there’s hope that what passes for adults in Congress can find common ground to improve the ACA. That’s still a long shot, but perhaps a bit more possible now than just a year or two ago.