Republican hopefuls for Indiana’s U.S .Senate seat are placing the Affordable Care Act in the center of this May’s primary. But, the candidates agree more often than not, and some of their plans are met with skepticism from public healthcare experts.
Leading up to the U.S. Senate primary, ads for U.S.Republican Representatives Marlin Stutzman and Todd Young place a lot of focus on the same issue: repealing the Affordable Care Act, also known as Obamacare.
Both Stutzman and Young have voiced opposition since Congress approved the law.
And they both have plans to replace it for the nearly 200,000 Hoosiers that have health insurance through the Affordable Care Act, and the nearly 400,000 that use the state’s program, HIP 2.0 – which is funded by the federal law.
Stutzman & Young: Repeal ACA, Establish Alternative
To start, both Republican primary candidates propose something Young calls a federal health insurance marketplace.
“So that Hoosiers can shop for a health insurance plan that they might find best meets their needs but happens to be located out of Arizona or Florida,” Young says.
For his part, Stutzman says the federal government’s role should be to break down barriers and allow for greater competition.
“My belief is if the customers and consumers and patients have the best choices and the most flexibility and freedom in the marketplace, that companies will also be successful if they go work hard,” Stutzman says.
But a number of public health experts find flaws with that plan.
I’m interested that this argument is still going on after 30 years.
Indiana University public health professor Beth Meyerson says the problem with this idea is that it doesn’t seem to work.
“We’ve seen states already vote with their feet on these ideas and they’re not coming forward,” Myerson says. “So I’m interested that this argument is still going on after 30 years.”
Meyerson says six states have passed legislation in the last decade to allow for “across state lines” coverage, and not a single insurer has taken advantage.
The biggest issue, Myerson says, is what’s called “network development.”
“These insurers could not develop a network of providers to, in fact, be the care on the ground for the people that would buy their insurance product.”
So a Hoosier could buy insurance out of Arizona, but without any local provider to take that insurance, the patient’s cost wouldn’t be any lower.
More Federal Money, Fewer Strings
The two candidates also want to see federal money flow to the states for health care, but with far fewer strings attached.
For Young, that would come in the form of what’s called “block grants” – big chunks of federal tax dollars given to the states without many stipulations. Stutzman calls that “a good start” but doesn’t necessarily want to stop there.
“We’ll find more efficiencies, we’ll find more accountability and ultimately I think that those dollars should be paid directly to the state rather than having to be transferred through the federal government,” Stutzman says.
But not everyone agrees that giving states more autonomy to develop health care policies will equal better results. Meyerson points to Indiana’s poor health rankings as compared to the rest of the nation.
I think our record’s pretty crappy, so not sure that any more control is…going to be what will elevate the health of Hoosiers.
“I think our record’s pretty crappy so not sure that any more control is going to solve … going to be what will elevate the health of Hoosiers.”
But Stutzman says more local control is the answer.
“They will have a better understand of the needs – what waivers should be granted and what waivers shouldn’t be granted; what services need to be provided, what services should not.”
On some other details, Young and Stutzman don’t necessarily overlap.
Young says people or groups should be allowed to pool together to buy insurance. It’s something he says will force insurance companies to be more competitive.
“But if they’re competing only within a given state and negotiating with individuals or entities that are much smaller than them, then it’s difficult to get a good bargain,” Young says.
That’s while Stutzman seeks to make coverage more portable. He says people should be able to take their insurance from one job to another.
Fundamentally, while they might differ on some little details, the two Republicans’ overarching message going into their primary competition is this: the federal government should remove itself from the health care process as much as possible.