JEFFERSON CITY — Few issues have generated as much passion and attention as health care over the past few years.
The federal health care law signed in 2010 by President Barack Obama has continued to spark debate and legal challenges as it is being implemented. Many Republicans are campaigning on a vow to repeal it while many Democrats are defending it during the 2012 elections. The U.S. Supreme Court this summer upheld the bulk of the law but did give states discretion in implementing a Medicaid expansion.
The Associated Press posed several questions about health care to Democratic U.S. Sen. Claire McCaskill and her Republican challenger, U.S. Rep. Todd Akin, as the second part in a weekly series examining the candidates' positions on issues that are important to voters in the Nov. 6 election. Answers were not edited for content or length, and some answers more specifically addressed the questions posed by the AP than others.
The AP on the health care law: Your differences on the new federal health care law signed by President Barack Obama have been frequently noted. Claire McCaskill voted for and continues to support the law. Todd Akin voted against and wants to repeal the law. But the law has many parts — from the much-publicized individual insurance mandate to sections requiring coverage of pre-existing conditions and allowing people to remain on their parents' insurance up to age 26. For Akin, can you identify one or two specific provisions that you would like to re-instate if the law is repealed? And for McCaskill, can you identify one or two provisions that you think should be repealed?
AKIN: "I support full repeal of Obamacare because I don't think the federal government should insert itself between doctors and patients. I do think that covering pre-existing conditions makes sense but believe we must fully repeal Obamacare and then replace it with common-sense, patient-centered health care reforms."
McCASKILL: "I supported the Affordable Care Act because the law will help to keep long-term health care costs down, promote preventative care that is so important to keeping folks healthy and, finally, bring insurance companies to heel by banning practices like discriminating because of a preexisting condition. It also is totally comprised of private, not government, insurance plans, which will allow free market solutions as companies compete for business on the exchanges where Missourians will have the choice of shopping for their coverage. That said, landmark reforms like this will always require a few adjustments as they take effect, and I'm certainly open to improving the Affordable Care Act going forward. I've already voted to repeal a provision of the law that placed an unnecessary reporting burden on businesses, and by fixing it, we gave another $22 billion tax cut to small businesses. I know we'll continue to make improvements to the law, and I'm eager to work with colleagues on both sides of the aisle to make sure the Affordable Care Act is achieving the reforms the American health care system truly needed."
The AP on contraception coverage: Should insurance plans be required to cover contraception prescriptions at no additional cost to women?
AKIN: "I have no objection with insurance plans choosing to cover contraceptive services, but I am opposed to the federal government mandating that all insurance plans cover contraceptives. The contraceptive mandate will result in faith groups being required by the government to pay for a service they oppose on moral and religious grounds. The Catholic Church has been vocal with their significant objections to the contraceptive mandate, and I believe that the contraceptive mandate violates the freedom of religion protected by the First Amendment."
McCASKILL: "I strongly believe that churches should be free from intrusion of government and politics. I also believe, just as strongly, that our laws need to respect the rights of women and families to access birth control. For years, Missouri law has done both, by providing a fair and common-sense balance between protecting religious freedom and a woman's individual right to contraception coverage. If an employer objects to immunizing children, he or she shouldn't be able to deny that coverage for their employees — the same standard should apply to women who, in consultation with their faith and their doctor, choose birth control for their medical needs."
The AP on Medicare: The federal health care law cuts $700 billion in Medicare payments to hospitals, medical providers and insurers over a decade in order to extend the life of the Medicare trust fund and expand coverage to working-age adults. A budget plan by Rep. Paul Ryan assumed a similar amount savings from Medicare. Claire McCaskill, you have generally supported Obama's health care law. Todd Akin, you have generally supported Ryan's budget plan. Given that, please explain why this Medicare cut is appropriate or inappropriate?
AKIN: "The central question with Medicare is whether we are going to take common sense steps today to preserve Medicare for current recipients and protect it for future generations. Obamacare cuts Medicare by telling doctors that the government is simply not going to pay as much for their services. Even worse, Obamacare establishes a board of 15 unelected bureaucrats who will be responsible for rationing Medicare services. Both of those steps will hurt the health care that seniors receive from Medicare. I support initiatives that reduce costs by introducing free market principles and letting competition help force costs down while improving services. The savings that I have supported would be reinvested in Medicare to ensure that it remains viable today and in the future while the Obama cuts to Medicare are used to pay for the expenses of Obamacare."
McCASKILL: "This is the biggest whopper of this campaign season, and it's frankly unbelievable to me that Congressman Akin would try to mislead voters about those $700 billion in Medicare savings after voting for them time and time again. He knows that the Ryan Budget used those same savings to give another tax cut to multi-millionaires, instead of paying down the deficit or reinvesting it in Medicare. Independent fact-checking organizations have repeatedly and consistently proved that not one dime was cut from Medicare benefits, rather we used some of the excess profits made at taxpayer expense by Medicare Advantage insurance companies and used those funds to close the doughnut hole and extend the life of the program."
The AP on Medicaid: As a result of a U.S. Supreme Court decision this summer, states cannot lose their entire federal Medicaid payment for refusing to implement a provision of the new federal health care law expanding coverage to working age adults earning up to 133 percent of the federal poverty level. Missouri has not decided whether to raise its eligibility to this level. Should it do so? Why or why not?
AKIN: "I support full repeal of Obamacare."
McCASKILL: "While this is a decision for Jefferson City and not one I can or should make, I think it would be mistake for Missouri officials to turn up their noses at a Medicaid expansion that's paid for by federal tax dollars because they're trying to make a political point. Spending 10 cents on the dollar to make sure that hundreds of thousands of Missourians have access to health care other than the emergency room is going to keep costs down for everybody. Right now, people who show up at the emergency room without health insurance and don't qualify for Medicaid, we are all paying those bills through higher insurance premiums. Missouri does not have to expand its Medicaid population, but it just seems backward to me that our federal taxes would go to help states around the country, but not Missourians. That's a little like cutting off your nose to spite your face."
The AP on other changes to health care programs: Do you support additional fundamental changes to the Medicare or Medicaid programs, such as converting Medicaid to a block grant to states or converting Medicare to a program in which future generations of seniors would receive subsidies of fixed dollar amounts to purchase insurance policies in the private sector? Please explain.
AKIN: "Medicare and Medicaid are going to go broke if we don't fix them soon, which is why I have worked with my colleagues to propose common-sense reforms that will protect Medicare and Medicaid for today's recipients and fix them for future generations. I have supported bills in the past that had common-sense reforms, and I will continue to work toward fixing and protecting Medicare and Medicaid in the Senate."
McCASKILL: "We need to get our fiscal house in order, but doing so on the backs of Missouri's seniors and most vulnerable just isn't the answer. While my opponent has questioned Medicare's constitutionality and sponsored numerous proposals to turn Medicare into a voucher system, I've been working hard to ensure that the safety net that keeps many Missourians healthy and safe from poverty remains intact. Medicare and Medicaid are crucial programs that Missouri seniors and working families will be counting on for years to come. I believe we can lower the deficit and debt, but we should not do it by forcing seniors to arm wrestle private insurance companies or at the expense of these important programs that provide reliable health care for seniors and families."