Issue Position: Health Care

Issue Position

Date: Jan. 1, 2018

I believe strongly that basic health care is a fundamental right that should be guaranteed for every American. Similar to our guarantees of a basic education to every child born, health care is an issue that affects us as a nation, and it's a moral issue for me as a daughter of one of the first women to graduate from the University of Kentucky medical school in the 1960s.

The Affordable Care Act (ACA) is far from perfect, but it did enable many Kentuckians, especially those with pre-existing conditions, to acquire affordable health insurance for the first time. As a result, the uninsured rate in Kentucky dropped from over 20% to barely 5%. That's nowhere near "failing," as the Republican Party and President Trump continue to claim.

But the GOP campaigned on the dishonest notion that the ACA was in a "death spiral" and they had something better and cheaper to "replace" it: Trust them.

We all know now, that was a lie.

The House bill that my Republican opponent, Andy Barr, said he would "enthusiastically vote for" would have thrown 23 million Americans off health coverage. Overwhelmingly, doctors, nurses, and healthcare organizations in America have opposed each of the Republican bills this year. Their efforts would especially hurt veterans, where 1 in 10 use Medicaid, and mental health conditions like PTSD would be considered a preexisting condition. The American Medical Association not only opposed the GOP efforts, but went so far as to say it violated their medical standard of "do no harm!"

Ironically, the "repeal and replace" effort is also terrible for jobs. Under Senator McConnell's original Senate bill, Kentucky would have experienced a net loss of 231,400 jobs, all of this so that the wealthiest Americans could have another massive tax cut. The GOP has been unapologetically trying to revert back to a time when people would have to mortgage their homes if they got sick.

That said, we have to be honest that the ACA falls short of the change we really need. My mother was a practicing doctor for 40 years and I continually saw her frustration with the power and control of insurance companies, and with rising costs. We can do better in this country.

I believe firmly that the goal must be universal coverage for all Americans. But we need an honest and meaningful debate over how to get there.

I side firmly with former Kentucky Governor Steve Beshear, the man who implemented the ACA in a manner that made Kentucky the gold standard among states as far as how it's supposed to work. Beshear said recently, "If we were starting from scratch, I would be for single-payer, too…. But we aren't starting from scratch. There are too many stakeholders to be able to sweep them away and begin all over again." In fact, currently proposed single-payer legislation would represent such a sweeping overhaul that it would put our healthcare system into massive upheaval. I do not support such an approach.

Perhaps it's the military officer in me that takes a more pragmatic approach on this issue. Every major piece of legislation in our country has needed fixes along the way: Social Security and Medicare were not created perfect. We have expanded opportunities and overcome challenges in every generation. In each case, Americans didn't quit because we didn't have every answer to start with; instead, we redoubled our efforts, worked together, and found ways around problems and obstacles. That is the American way. We don't simply throw things away that we believe are imperfect. We work over time -- in the words of the Constitution itself -- to make them "more perfect."

So, I remain committed to working in a bipartisan way to fix the problems with the Affordable Care Act, which brought down Kentucky's uninsured rate in a dramatic way. But any fixes must maintain current essential health benefits without allowing states to waive them, not impose any annual or lifetime coverage caps, and must continue the ACA's prohibition against insurers charging higher premiums based on factors such as health status or pre-existing conditions.

The voters expect us to put aside our partisan differences and work together to address rising premiums and deductibles, while maintaining the current guarantees for pre-existing conditions. This is critical. In the military, we don't care whether you're a Democrat or a Republican when it comes to completing our mission. I will bring that same sense of purpose to Congress, when elected.

I favor approaches to bridge some of the single-payer/Obamacare divide, and begin a longer process that may take us in that general direction. Here are some steps we can take:

I support a Medicare buy-in option for those over the age of 55. This is smart public policy.

The health care debate has been especially frightening for middle aged Americans who have not reached Medicare age. Faced with the skyrocketing premiums that the reckless GOP plans would impose, older Americans too often must confront an impossible choice: spending a large chunk of the retirement nest egg to purchase coverage, or go without coverage and pray nothing happens until they reach 65 and can join Medicare.

A Medicare buy-in would provide some peace of mind for the more vulnerable Americans who have some of the greatest, and most expensive, health care needs. And taking some middle aged Americans out of the risk pool would help greatly lower premiums for those under 55.

Meanwhile, with some people still unable to afford coverage, and many more paying too much for the coverage they do have, I believe we must increase competition among existing carriers.

That's why I also support a so-called "public option" to create a government-run health insurance agency that would compete with other private health insurance companies within the country. A major reason for a public option -- beyond the effect of generally lowering premiums since government would not be trying to make a profit -- would be to guarantee that in those counties with just one or two insurers, rates could not be artificially spiked because of lack of competition. Plus, this gives people more choice in the health insurance market. No one would be forced to go with the government-run plan, but it would be there if Americans wished to choose it.

It is worth remembering that both the public option and the Medicare buy-in were initially part of the Affordable Care Act, but were removed because of the threat of a filibuster. To improve Obamacare, we need to return to this original conception.