Health care a volatile issue

WASHINGTON _ The future of health care in America is among the top campaign-season issues nationwide and nowhere is it more volatile than in the upstate battle pitting Democratic challenger Antonio Delgado against incumbent Republican John Faso.

Faso "can't defend his vote on health care or explain why he voted to gut protections for people with pre-existing conditions," stated a Delgado news release Friday. "So, he just lies."

"Antonio Delgado says a lot of different and conflicting things about health care, but here's what upstate voters know: He is for a government-run takeover of healthcare," said a Faso release, also Friday.

The neck-and-neck race between Faso, a Republican from Kinderhook seeking his second term, and his Democratic challenger, a Schenectady native and Harvard law grad who lives in Rhinebeck, is among the most closely watched in the nation.

With just over two weeks left until Election Day, the health care debate may make a difference in whether Democrats succeed in their push to take control of the House for the first time since 2011.

Of course, a multitude of factors could go into who wins and who loses: Who is more "authentically" upstate? (Delgado moved to Rhinebeck last year after practicing law in New York City; Faso is from Long Island). Faso's past lobbying for payday lenders and his Albany-insider status as Assembly minority leader? Or Delgado's stint pre-attorney as an L.A. rap artist, the subject of a negative GOP political action committee ad?

But 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," said Karen Pollitz, health policy expert at the non-partisan Kaiser Family Foundation.

Nationally, as well as locally, both Democrats and Republicans support protections in the Affordable Care Act _ Obamacare _ 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."

Closer to home, Faso says he too supports protections for those with pre-existing conditions _ over 3 million in New York. "My own wife is a cancer survivor, so I understand the need for it," he said in an interview.

But Delgado and fellow Democrats point to Faso's vote last year for the American Health Care Act, the replacement for Obamacare that passed the House but ultimately fell short in the Senate when the late Sen. John McCain gave it the 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, when individuals only buy insurance when they get sick. Adverse selection impacts the risk pool of healthy and unhealthy. The legislation also required states to set up risk pools for those with high-cost illness.

Delgado and Democrats charge that if enacted, the bill would have allowed a back-door way of discriminating against those with pre-existing conditions.

New York prohibits denied coverage or higher rates under state law, Faso pointed out. And Gov. Andrew Cuomo, a Democratic supporter of Obamacare, would never apply for the waiver, he added.

Faso steadfastly denied Democratic charges that he actually supports doing away with the protections _ which has also been the subject of a Democratic PAC attack ad on Faso. He also denied that Delgado and Democrats generally have seized the high-ground on the issue, and he's playing defense.

"What I acknowledge is my opponent isn't telling the truth about it," he said. "They've put a lot of money into advertising, and some people are going to believe it if they hear it often enough. But it's simply not true."

The Republican bill he supported had an amendment pumping $8 billion over five years into the health care system for those affected by state waivers, Faso said.

But $8 billion over five years would be insufficient, Pollitz said. She pointed to a study she did showing that 35 states with high-risk pools for sicker individuals spent $1.2 billion a year for 226,615 just prior to the implementation of Obamacare.

The Trump administration earlier this year filed a brief in a lawsuit in Texas saying it would not defend the Affordable Care Act's protection of those with pre-existing conditions.

On MSNBC Friday, Senate Minority Leader Charles Schumer said Senate Majority Leader Mitch McConnell's favorable words about the lawsuit (plus support of adjustments for "entitlements," code for Social Security and Medicare) are "a game changer for us."

Although he has made past statements indicating support of "Medicare for all" _ a government run single-payer system proposed by Sen. Bernie Sanders of Vermont _ Delgado now insists he is for a public option, which would allow those under Medicare age to buy into the program as an alternative to private health insurance.

"Adding a public option will help drive down premiums and deductibles and also lower cost burdens for employers while freeing up employees so they are not tied to employers for health insurance," he said in a statement.

Faso and fellow Republicans depict "Medicare for all" as a scary, government-run system that Delgado secretly wants.

"Despite his insistence to the contrary, Antonio Delgado supports a government-run takeover of our health care," said Faso's spokesman Joe Gierut. "He can try his hardest to trick upstate voters, but if a government-run single-payer bill hits the floor of the House of Representatives, you can bet the house he'd vote for it."

Health experts agree federal taxes would rise dramatically in a "Medicare for all" single-payer system. But the extra cost might be offset by elimination of state and federal taxes for Medicaid, as well as premiums for employer-provided insurance.

"For health insurance to work, it needs to be affordable, available and adequate," said Pollitz. "Good insurance is not cheap. It never was, and it never will be."