Horn, Bice stake out opposition positions on health insurance

Sep. 20--In the state with the 2nd highest rate of uninsured people, U.S. Rep. Kendra Horn and her Republican challenger, state Sen. Stephanie Bice, have staked out opposing positions on health care coverage that track traditional partisan attitudes.

Horn, D-Oklahoma City, supports the Affordable Care Act and backed the Medicaid expansion question that Oklahoma voters approved in June. Bice, of Oklahoma City, wants the Affordable Care Act repealed and opposed expanding Medicaid.

Horn represents the 5th Congressional District, which includes most of Oklahoma County and Pottawatomie and Seminole counties. The election is Nov. 3.

The Trump administration is supporting a legal challenge now before the U.S. Supreme Court that could dismantle the Affordable Care Act, a goal of Republicans since the act's passage in 2010.

Bice, whose support for Trump was a centerpiece of her primary campaign, said in written responses to questions last week, "Obamacare should be repealed and replaced, because it is not sustainable. Obamacare has hurt businesses and job creation and has made health care more expensive for Oklahomans as premiums rise and costs escalate."

Bice said the law's requirement that employers offer health insurance to workers on the job for 30 hours a week was "actually hurting workers who have seen their hours reduced and therefore pay reduced."

She said, "We need targeted fixes to improve our current system that protect the patient-to-doctor relationship, make medical billing more transparent and lower costs."

Echoing the position of Trump and congressional Republicans, Bice said, "I support legislation guaranteeing health insurance coverage for individuals with pre-existing conditions, even if Obamacare is repealed or struck down by the courts."

According to the Department of Health and Human Services, 158,642 Oklahomans selected a health plan for 2020 through the federal exchange under the Affordable Care Act. That number does not include all of the people covered by the plans purchased.

"I think it is critical to protect the Affordable Care Act and the advancements and protections it has afforded ... especially protections for pre-existing conditions to keep people from losing their insurance coverage, as well as the lifetime cap provisions and ensuring the critical services that so many people need are covered," Horn said in an interview last week.

"I think it's really troubling -- especially in the midst of a pandemic -- that the administration is still trying to undermine these provisions that have saved lives and made insurance access possible for so many Oklahomans."

Horn last year bucked some of her party's presidential candidates and came out against a single payer system, sometimes referred to as Medicare for All.

She said last week that many people are happy with their insurance companies and that solving problems in health care like the loss of rural hospitals and high prescription drug costs doesn't require the elimination of private insurance.

Unhealthy rankings

The U.S. Census Bureau released its annual report last week of health insurance coverage in the United States. The report showed Oklahoma still had the second-highest rate of uninsured residents in 2019 -- behind only Texas -- at 14.3%. About 553,000 Oklahomans had no health insurance at any time last year, according to the Census Bureau.

Earlier this month, the Commonwealth Fund, a private organization that promotes health care access and quality, ranked Oklahoma 50th in the nation for its health care system. The factors measured were access, quality, service use and costs of care, health outcomes and income-based disparities.

The fund's study said 22% of Black adults were uninsured in Oklahoma, compared to 15% of white adults. State-based public health spending per resident in Oklahoma was $40, above the $37 U.S. average, the study said.

The expansion of Medicaid, the federal-state insurance program for low-income people, is expected to add more than 200,000 Oklahomans to the rolls when implemented. That would be less than half of the people uninsured in Oklahoma in 2019, according to the Census Bureau report.

Horn spoke out in favor of State Question 802 and said last week that "passage of Medicaid expansion this summer will make a big difference because unfortunately we're still second in the nation for uninsured."

In the 5th District, the Medicaid expansion question was supported overwhelmingly in Oklahoma County, but was defeated in Pottawatomie and Seminole counties.

Bice opposed the state question and said last week her primary objection was that it amended the state constitution, making changes "almost impossible." She said state liquor policy embedded in the constitution "took almost 60 years to change."

Bice said Oklahoma taxpayers would face an "enormous burden" if the federal government stopped paying its 90% share for Medicaid expansion enrollments.

"Also important is that expanding Medicaid does nothing to bring down the cost of health care," she said. "It's simply going to increase taxes on hard working Oklahomans without doing anything to address the real health care concern, which is cost."

Bice voted for a bill this year to raise a hospital fee to help fund the first year of Gov. Kevin Stitt's proposed Medicaid expansion; the increase was expected to generate $134 million. Stitt vetoed the bill and then abandoned his plan after State Question 802 passed.

In 2018, Bice voted for a bill to change state Medicaid qualifications by requiring most recipients between 19 and 64 years old to work or participate in skills training.

Health care bills

Bice, who has been in the state Senate since 2014, said she worked with people in the autism community on legislation requiring insurance coverage for the screening, diagnosis and treatment of autism spectrum disorder (ASD) in people younger than 9.

She said she authored a bill aimed at limiting the use of antipsychotic drugs on nursing home residents.

"Oklahoma was ranked as the worst state in the nation when it came to the use of antipsychotics on nursing home patients with no psychiatric diagnosis," she said. "Under the new law, a prescribing clinician would examine and diagnose the nursing home patient before an antipsychotic could be given."

Horn last year sought a Government Accountability Office report and held a town hall meeting on the high cost of insulin. She also sponsored a provision to cap out-of-pocket prescription drug prices for seniors on Medicare Part D to $2,000 per year, a savings of $3,100 per year.

That provision was included in broader legislation approved by the House to lower drug costs. The Senate has not taken up the bill, which, Horn said, would lower insulin costs by 76% and allow Medicare and Medicaid to negotiate lower drug prices.

Horn said the coronavirus relief bill, known as the CARES Act, approved by Congress in March included "incredibly important" funding for hospitals, medical centers and health care workers and a guarantee of free testing, regardless of insurance.

She pointed to a recent study that showed the average cost of a COVID-19 related hospitalization was $73,000 and said the CARES Act could help cover costs for the uninsured. The bill has also opened more opportunities for telemedicine, she said.

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