Health care was once a weapon of Republicans. Around KC, it’s now the Democrats’ turn

Oct. 24--If the myriad mailers didn't make it clear, the big blue bus parked near the Country Club Plaza should have: Health care is dominating the race between Republican U.S. Rep. Kevin Yoder and Democrat Sharice Davids -- and other tight contests around Kansas City.

Speaking outside the bus Monday on Davids' behalf was former Kansas Gov. Kathleen Sebelius, who hasn't been in politics or government for almost five years, but is a key voice for Democrats this year because of her role in implementing the Affordable Care Act, commonly called Obamacare.

Sebelius, former secretary of health and human services, was speaking as part of a nationwide tour by the group Protect Our Care, dedicated to preserving the ACA and highlighting the Republican attempts to repeal the law and its mandate that insurance companies cover pre-existing conditions.

"We have to make sure that never again do insurance companies get to pick and choose who gets coverage and who doesn't," Sebelius said.

Health care has been a featured issue in every election since the ACA passed in 2010. Previous elections saw Republicans denouncing Obamacare for raising premiums and Medicaid costs.

Now Democrats, in a dramatic switch from years past, would like to make the upcoming election all about Obamacare. They are attacking Republican attempts to repeal it by repeatedly citing one of its most popular features: the provision for pre-existing conditions.

Meanwhile, Republicans are trying to shift the conversation to some Democrats' proposals to overhaul the current health system and replace it with a single-payer "Medicare-for-all" plan, which Yoder says would "destroy" the best parts of American health care.

Amid that backdrop the Davids-Yoder race for Kansas' 3rd District and other contests that will decide which party controls Congress have become filled with health care-related mailers and TV spots that contain kernels of truth wrapped in exaggeration.

Yoder did vote dozens of times to repeal Obamacare.

But he says he supports extending protections for pre-existing conditions, and the U.S. House's last doomed attempt at full Obamacare repeal would have still required insurers to offer policies to everyone, while allowing companies to temporarily increase premiums for people who let their coverage lapse.

Meanwhile, Yoder and his allies are blasting Davids for supporting a single-payer system, saying it would force people off private insurance plans and lead to long waits for care.

"We think this would destroy what Americans love about their health care system," Yoder told The Star. "We're at a crossroads. This election, both in my district and across the country, will decide whether we're forced into a European system or a Canadian system or maintain the system we have."

That's also a stretch.

Davids has said that she's open to single-payer as a long-term policy goal, but has repeatedly said that it's not a realistic proposal while Republicans control the White House.

In a phone interview she said Congress shouldn't "wholesale exclude any of the ideas that are out there" for expanding coverage. But in the short term she said she's focused on things that are more likely to get bipartisan support, like allowing Medicare to negotiate drug prices and getting generics to market faster.

"It doesn't matter if you're a Democrat or a Republican," Davids said. "When it gets down to it, all of us need health care, all of us need to be able to afford our prescriptions drugs, all of us need to be able to afford and understand what we're paying for when we're accessing health care."

Yoder also said lowering prescription drug costs is a priority, pointing to his vote for a "gag clause" bill that ensures pharmacists are allowed to tell customers when they could pay less by paying cash.

Yoder said the health care policies he wants to pursue revolve around increasing competition, increasing price transparency and decreasing administrative costs. They include longtime Republican standbys, like limiting medical malpractice liability and reducing insurance restrictions so it's easier for companies to sell plans across state lines.

Yoder also wants to expand health savings accounts and continue his advocacy for increased medical research funding through the National Institutes of Health.

"We spend a lot of time debating payment systems," Yoder said, "but not enough time understanding how the breakthroughs and life-saving cures are created."

But Democrats keep coming back to Obamacare.

Obamacare again

In Missouri, for example, U.S. Sen. Claire McCaskill has tried to make hay out of the anti-ACA lawsuit filed by her Republican challenger, state Attorney General Josh Hawley.

Like Yoder, Hawley has responded with an ad blitz saying he supports covering pre-existing conditions and challenging McCaskill to do it outside the Obamacare framework.

Meanwhile, Americans for Prosperity, a conservative group pushing to repeal Obamacare, launched a statewide ad campaign against McCaskill this week highlighting less popular parts of the law, like high premiums for older people in the individual market who don't qualify for subsidies.

The furor over covering pre-existing conditions has largely ignored the fact that the ACA is now missing one of the ingredients that insurers say is key to making such coverage work: the individual mandate that Americans carry insurance or pay a financial penalty.

That's the only part of the law Republicans successfully repealed last year, leaving a landscape in which there are no consequences for Americans who game the health care system and wait until they are sick to buy insurance.

The repeal of the individual mandate was part of the Republican tax bill, which Davids called an "irresponsible piece of legislation."

"The mandate was included (in the ACA) because it's part of what helps to ensure the costs across the board are stabilized," Davids said. "I definitely think the mandate, it served a purpose."

McCaskill said bringing back the mandate is "an option," but she believes there are other ways to close the loophole, like allowing insurers to charge higher premiums for people who buy in outside of regular open enrollment periods -- similar to what Yoder and the House Republicans proposed.

McCaskill also suggested creating a "Copper Plan" with higher deductibles but lower premiums than the plans currently sold on the ACA exchange.

"I think there's ways to create incentives to get healthy people in the pool that may fall short of a mandate and there's a lot of them we can talk about," said McCaskill, who co-sponsored the pharmacy gag clause bill.

Even as the debate over Obamacare continues to rage, some left-wing leaders like Bernie Sanders have moved on to single-payer proposals that Republicans often characterize as "socialism."

Most definitions of socialized medicine hew closer to the British-style system in which hospitals are government facilities and doctors and nurses are government employees, similar to the VA system in the U.S. No one is proposing that.

The "Medicare-for-All" bills introduced by Sanders and U.S. Rep. Keith Ellison would be more like the Canadian system, where the health care providers remain private, but all health insurance is consolidated in a single, publicly-funded program.

Davids has previously said she's open to that kind of change, but not wedded to it.

"Of course universal health care coverage is the ultimate goal and 'Medicare for All' is one of the ways it can happen. ... But we need to be focused on things we can do," Davids said after she won the August Democratic primary in a crowded field.

Other countries, like France and Germany, have reached near-universal coverage with multiple payers but "single pricing" -- centralized price setting coupled with mandates that citizens buy insurance.

Other races

Democrats have also proposed other ways to expand coverage through Medicare, without going fully to single payer.

Paul Davis, a former state representative locked in a tight race with Republican newcomer Steve Watkins for Kansas' 2nd Congressional District, said he thinks a quick switch to single payer would be too disruptive ("like turning a cruise ship on a dime"), but he supports allowing people to buy into Medicare at age 55. The minimum age now is 65.

"They're heading there very soon and they're also the heaviest users of health care that are out there on the individual and small group market, so many believe that will help rate reductions occur," Davis said.

Watkins' campaign didn't respond to a request for an interview on his health care priorities. His campaign website says little about the issue, other than that he wants to preserve Medicare for future generations.

Health care has also been a feature, to a lesser extent, in the tight Kansas governor's race.

Democratic state Sen. Laura Kelly favors expanding Medicaid coverage under the ACA, which supporters say would prevent medical bankruptcies for thousands of uninsured Kansans and prevent more rural hospitals from closing.

Her Republican opponent, Kansas Secretary of State Kris Kobach, says expansion would be too expensive for taxpayers. He said he wants to bring down the costs of Kansas Medicaid, or KanCare, by introducing direct primary care, a system in which patients pay their doctors directly rather than through an insurance middle man.

His campaign has offered few details about how he would implement that.

"We will do a pilot program in a county or region of the state first, hopefully within my first year in office," Kobach said in a statement released by the campaign. "I would set up a task force to work through details of how payments would occur."

Independent candidate Greg Orman has said he favors both Medicaid expansion and direct primary care for KanCare.

Kobach said he also wants to introduce work requirements for "able-bodied" people on KanCare.

The current Kansas governor, Republican Jeff Colyer, flirted with that idea last year. But in Kansas, Medicaid is restricted mostly to children, the elderly, pregnant women and people with disabilities. Colyer's administration estimated that the work requirements would only apply to about 10,000 of the program's 400,000 beneficiaries, and lawmakers balked at the cost of enforcing the requirements for so few people.

Includes reporting by The Star's Bryan Lowry.

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