McCaskill, Akin and Dine on health care

Wednesday, October 31, 2012 | 7:02 p.m. CDT; updated 10:09 a.m. CDT, Thursday, November 1, 2012

Editor's note: This article is one of an eight-part series that examines where U.S. Sen. Claire McCaskill, D-Mo., U.S. Rep. Todd Akin, R-St. Louis, and Libertarian candidate Jonathan Dine stand on some of the issues important to Missouri voters.

Affordable Care Act

Claire McCaskill

McCaskill stands by the Affordable Care Act but is willing to change parts of it. She encourages means testing, including customer feedback, to find solutions to health care coverage problems. 

The senator wants to expand coverage, stop denial of coverage because of pre-existing conditions and let young adults gain health insurance coverage through their parents’ health insurance plans.

McCaskill has voiced her support for continuing to fund Medicare, and she said she will reduce money wasted on fraudulent claims to use for the program. She also suggested raising taxes on earnings of more than $250,000 to help fund Medicare and Social Security. 

Todd Akin

Akin has vowed to either fully repeal or chip away at the Affordable Care Act. He believes the federal government is inserting itself between patients and their doctors, decreasing the quality of benefits. 

He is particularly vehement about repealing the creation of the Independent Payment Advisory Board, which he said would decide who gets insurance. 

Akin wants to entirely privatize the health insurance industry. He wants to allow insurance companies to compete across state lines and allow small businesses to band together to buy insurance. He thinks people should have the right to choose their options.

Libertarian Jonathan Dine

Dine wants to repeal the health care act because he doesn’t agree with the individual mandate. He supports a free market in which companies compete. He believes privatization of the industry would be the most efficient way to keep health care coverage available and affordable. He does, however, want to mandate an end to the practice of denying people insurance because of pre-existing conditions. 

Dine is set apart from his opponents by his emphasis on preventive care. He argues that the top five leading causes of death in the U.S. are related to diet and lifestyle. He said he would use his position to encourage regular exercise and educate people on its benefits. Dine, a personal trainer, said he wants to make gym memberships and personal trainer programs a tax-deductible expense.

What experts said

The Affordable Care Act would create costs in the form of:

  • Federal subsidies for lower-income people to help buy insurance.
  • Expansion of Medicaid eligibility.
  • Tax credits for small businesses providing coverage.

The act would generate revenue through reduction in the growth of Medicare spending and various taxes.

The Congressional Budget Office estimates the insurance provisions of the act could bring a net spending reduction of $84 billion over the 11-year period from 2012 to 2022. Other provisions of the act, in aggregate, reduce budget deficits. 

The budget office estimates that House Bill 6079, which would repeal the Affordable Care Act, could cause an increase of $109 billion in federal budget deficits over the years from 2013 to 2022 because the net savings would be more than offset by spending increases and revenue reductions. 

The Supreme Court’s ruling that expansion of the Medicaid program is a state option could result in an estimated net reduction of $84 billion in the cost of the health care act's insurance coverage provisions because it could reduce the number of people participating in the program, according to the budget office. 

According to, a project of the Annenberg Public Policy Center, the federal government won’t be standing between patients and their doctors under the health care act. The act would set only minimum benefits packages; it does not allow the federal government to determine services and rationing of care. 

MU economics professor Saku Aura said the guarantee of coverage despite pre-existing conditions is pointless unless there is also a mandate to make sure companies cannot use pre-existing conditions as a basis for pricing. 

“Otherwise, an insurance company can offer an individual with pre-existing conditions coverage, but at a high price that is difficult to afford,” Aura said. “The positive aspect of the ACA is that it has many specific details to address health care coverage issues, but the effectiveness of the act is difficult to predict."

Supervising editor is Scott Swafford.

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