In Arizona’s 9th Congressional District, a Republican doctor is running against the Democratic former mayor of Phoenix in a race has been dominated by their disagreements over the future of health care.
Steve Ferrara, a doctor who works at the Phoenix VA and the county hospital, wants to adjust the Affordable Care Act by letting states direct Medicaid and moving people with pre-existing conditions into high-risk pools.
Greg Stanton, the former Phoenix mayor, wants to protect the Affordable Care Act and work on lowering prescription drug prices.
Health care has dominated federal races across the country this year, with Democrats touting the virtues of the Affordable Care Act while Republicans making their case to dismantle it, but keep the parts the public likes, including coverage of pre-existing conditions and keeping young adults on their parents’ coverage until age 26.
Ferrara and Stanton have sparred over health care as the issue has emerged as a major plank in this year’s congressional races.
Stanton accuses Ferrara of wanting to repeal the Affordable Care Act. Stanton has also hammered Ferrara on pre-existing conditions, running an ad that says Ferrara would repeal protections that require them to be covered.
But Ferrara counters that he doesn’t want to repeal the ACA commonly referred to as “Obamacare.” And he said his plan would provide coverage for people with pre-existing conditions.
Both said they wanted any changes to the health-care law to be bipartisan, which contrasts with the heated partisan debates common to health-care policy in recent years.
Ferrara’s plan: Medicaid grants, high-risk pools
Ferrara, the former chief medical officer for the Navy, said he sees health care as the most important domestic issue and thinks it’s a “moral imperative” for Congress to get health care done right.
His plan includes three parts: letting states control Medicaid in a block-grant-type program, providing more flexibility on insurance plans and creating high-risk pools for people with pre-existing conditions.
Ferrara’s idea of letting states control Medicaid is similar to the House GOP’s plan for Medicaid block grants floated in the past two years. Basically, states would get a capped amount from the federal government to run their own Medicaid programs as they see fit.
“Similar to education, health care is local,” he said.
James Hodge, a professor of public health law and ethics at Arizona State University, said block grants could lead to people being denied care as states may decide to restrict programs based on policy or finances.
“Often what you see is not more innovation … but actually, more restriction that relates to keeping Medicaid costs under control,” Hodge said.
Now, states have to follow federal rules about access to Medicaid, but block grants would allow states to institute their own rules. Arizona’s GOP-led Legislature and governor are already seeking a waiver from the federal government to allow the state to add work requirements to Medicaid.
Ferrara said the care under Medicaid is already uneven across state lines because some states chose not to expand eligibility for their Medicaid programs as allowed under the ACA.
He thinks local leaders know a lot better what their population needs and would be more directly accountable to constituents on health care.
Ferrara’s plan on pre-existing conditions includes a personal story: His mother had a pre-existing condition and was not able to get affordable insurance. She died of a stroke when he was 20 years old, and the family wiped out its savings to pay off the medical bills.
He wants to create high-risk pools for people with pre-existing conditions. In high-risk pools, states put up money to help cover people with pre-existing conditions who would otherwise not be able to get insurance.
People with pre-existing conditions now receive health care the same way people without them do, creating a large pool of insured people who have varying health needs, thus spreading out costs.
Many states have used high-risk pools before. An analysis by the Kaiser Family Foundation said that experience suggests the pools “have the potential to provide health coverage to a substantial number of people with pre-existing conditions.” But as they have existed so far, they have limited enrollment and excluded coverage in some ways. They also cost some states significant money, the foundation wrote.
Joan Alker, executive director of the Center for Children and Families at Georgetown University, said high-risk pools have historically not worked in many of the states they were tried.
“It’s not going to do the trick. I would definitely not take comfort in his alternative of high-risk pools,” Alker said. “That’s been tried and failed.”
Repealing the ACA?
A door hanger advertisement with Ferrara’s logo and picture on it paid for by the Congressional Leadership Fund, a GOP political action committee, says he wants to “repeal Obamacare.” Ferrara said the ad isn’t from his campaign and doesn’t reflect his position on Obamacare.
A previous version of Ferrara’s campaign website said he wanted to “repeal job-killing regulations including Obamacare,” though that reference has since been removed. Ferrara said he meant repealing some of the regulations, like compliance and paperwork rules, under Obamacare, not the full act.
Ferrara said he doesn’t want to repeal the ACA, but he thinks people should move beyond simple language like repealing and replacing. Health care isn’t simple, and solving existing issues like high costs isn’t as easy as repealing and replacing, he said.
If a vote came up to repeal the ACA without a replacement plan, he would vote no, he said. And if a one-party plan came up for a vote, he would also vote against that, he said.
“I don’t think any party line bill whether its Republican or Democrat is the right way to proceed. … The policy is going to be lacking,” Ferrara said.
But Alker and Hodge, the two health-care experts, said Ferrara’s plan would likely require repealing the ACA because parts of the plan contradict federal health-care law as it stands today.
“Everything he’s talking about in the plan would require a repeal of the Affordable Care Act. It would require it, straight up,” Hodge said.
Ferrara said he looks at health-care law like the tax code or Medicare. You wouldn’t repeal the entire tax code or Medicare law to make changes to it, he said.
“I don’t think we have to do that. I disagree that it would have to be repealed,” he said.
Stanton’s plan: Stay the course
Stanton has a sparser plan than Ferrara, largely because he wants to see the ACA maintained. He notes on his website that health-care costs are too high and wait times for care are too long, though there are no specifics offered for how to decrease either.
Stanton wants to reduce the price of pharmaceutical drugs. He told The Arizona Republic he wants to see a law passed to allow the federal government to negotiate drug prices and allow the importation of drugs from places like Mexico and Canada. He also wants more transparency on drug pricing, he said.
He said some parts of the ACA may not be working and could be fixed, such as the so-called “Cadillac tax,” a tax on employers who offered the highest-quality health plans.
Stanton said he’s “not sure that’s smart policy.”
Stanton also said the ACA needs more money for marketing and health-care navigators to inform people about their coverage and get them signed up.
Hodge, of ASU, said Stanton’s plan, as reflected on his website, “really doesn’t spell out too much here.”
And, while it’s a laudable idea to try to bring down drug prices, Hodge said, it’s a very difficult proposition because insurance companies would fight it.
“He’s got a lot of work to be done to actually get that accomplished,” Hodge said.
Alker, of Georgetown, said allowing importation of drugs and federal negotiation wouldn’t fully solve high drug prices, though it’s “perfectly fine” to put those ideas on the table.
“It’s going to involve some pushback from the drug companies here in the U.S.,” she said of importation.
And in general, like Ferrara, Stanton said health care has become too partisan. He wants to work with the other party to advance bipartisan ideas.
“It’s in my DNA to only care about getting things done,” he said.
Hodge said it would be great to see the two parties come together and reach a consensus on health care. He said he respects the candidates for at least suggesting they could negotiate two-party plans.