Delegation Sees Varied Paths to Health Care Reform

By Frank X. Mullen

Health care reform is sure to be a major issue in the 2020 presidential campaign, with nearly every Democratic candidate endorsing a type of “Medicare-for-all” and the Trump administration promising that a “great” replacement for Obamacare will be unveiled – but only after the election.

The members of the Nevada delegation have been cautious about jumping on the single-paper bandwagon or calling for another complete overhaul of health care, a segment that makes up about 20 percent of the nation’s economy. Although some Silver State lawmakers say a single-payer plan should be on the table, most want to tinker with what’s now in place.

Sen. Catherine Cortez Masto, for example, has said that instantly replacing the status quo with a Medicare-for-all system wouldn’t be “plausible” because so many workers get health insurance from their employers. Still, she has backed a public option that would run alongside the traditional insurance company system so that Americans could incrementally migrate to the type of universal system available in most other developed nations.

“And what (the public option) looks like, you can call it whatever you want, but we’ve got to take incremental steps along the way and bring everybody along,” Masto told reporters in a group interview last year.  She says she also favors a plan that would allow some individuals to “buy in” to Medicare. The Nevada Legislature passed a similar bill two years ago, but it was vetoed by Gov. Brian Sandoval and the measure wasn’t reintroduced this legislative session.

In a guest editorial in the Las Vegas Sun in August, Rep. Dina Titus blamed many of Obamacare’s problems – such as soaring premiums for people who don’t qualify for government subsidies – on the GOP’s relentless actions to undermine and disrupt the system. She says the ACA must be protected, but she supports Medicare-for-all as the ultimate solution to the country’s health care woes.

“I support Medicare for All, a plan to give all Americans free primary care and prevention services, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, and dental and vision services,” Titus writes. “Wecan make this plan a reality by revisiting our tax structure in a way that helps families and businesses rather than hurts them, unlike the Republican tax law. And Medicare for All would ultimately save our country trillions of dollars in health care costs while putting universal health coverage in reach.”

Sen. Jacky Rosen supports some sort of buy-in to federal health care systems, but not a full-blown single-payer plan: “…first of all, we have to stabilize what we have,” Rosen said in an interview with VOX during her campaign. “Mend it, not end it. Eighty percent or so of people get their health care through their job. So for that 20 percent or so that need a public option, I honestly think — and we’ve been working on this in the Nevada state legislature — is we need a Medicaid buy-in, a Medicaid public option.”

In general, Nevada’s representatives want to improve, not abolish, the current system.

Rep. Mark Amodei, an opponent of the ACA, says for all Obamacare’s faults, it doesn’t make sense to blow it up and start from scratch. “I do not believe wiping the slate clean and starting over is the answer,” Amodei says on his website. “I believe Congress should focus on the biggest problem areas and fix them. I also believe there are some successful aspects of our current system that we should keep, such as ensuring individuals with pre-existing conditions have access to the care they need, and that young adults have the option to stay on their parent’s health care plan until age 26.”

Rep. Steven Horsford says the nation needs to move toward a single-payer system, but lawmakers should immediately address the high cost of heath care, particularly the rising costs of prescription drugs. He told the Intercept that he sees solutions in getting generic drugs to market faster; making it easier for patients and others to take legal action against drug companies for price fixing and efforts to block generic alternatives; and establishing a federal panel investigate drug pricing.

Rep. Susie Lee has in the past endorsed free, universal health care, but subsequently has taken a step back. In an interview with the Nevada Independent, she noted that it’s not fair to force “people to be in one camp or another on an issue that is clearly, clearly complicated.” She says there are so many proposals, a consensus is needed. “…Let’s find the path we want to go to, bring people together and produce a solution that has an impact on people’s lives,” she says.

Sen. Bernie Sanders estimates the Medicare-for-all bill he sponsored would cost about $1.3 trillion and would result in massive savings in the current administrative costs under an insurance company system. Other estimates for Sander’s plan are markedly higher: Kenneth Thorpe, at Emory University, puts the cost at $2.4 trillion a year; the Urban Institute estimates $2.5 trillion a year; and the Committee for a Responsible Federal Budget projects a cost of $2.8 trillion a year.

Sanders says his bill would be paid for by a 7.5 percent payroll tax on employers and a 4 percent tax from workers. Under the measure, Medicare and Medicaid would be scrapped and replaced with a program that would have more generous benefits. Coverage would be mandatory for everyone.