One year after the failed effort by House and Senate Republicans to repeal Obamacare, no issue has roiled the race for New York’s 19th Congressional District more than the fate of the nation’s healthcare system. In community forums and campaign trail meet-and-greets incumbent Republican John Faso and Democratic challenger Antonio Delgado have outlined starkly different visions of healthcare reform while portraying — or, as both sides claim, misrepresenting — their opponent’s positions as dangerous and misguided.
For Faso, who cast a key vote to move the GOP’s American Healthcare Act out of committee, reform means bipartisan fixes to boost access and affordability in a private health insurance market that he views as essentially sound. The freshman Congressman, who spent 15 years in the state Assembly before pursuing failed bids for state comptroller and governor, talks about keeping popular elements of Obamacare — like protection for preexisting conditions and allowing young adults to remain on their parents healthcare plans until age 26 — while introducing new legislation to subsidize insurers coverage of high-risk patients and bring predictability to pricing.
Delgado favors a broader government role in healthcare, albeit one that stops short of the single-payer/Medicare-for-all model favored by the Democratic Party’s most progressive elements. Instead, Delgado touts a “public option” — an affordable government-run insurance program open to all that would compete with private insurance on the open market. Along with promoting his own vision, Delgado has leveled fierce criticism at what he calls Faso’s votes to undermine his constituents’ healthcare protections and obfuscation of his record on the issue.
“There’s a reason he’s so determined to lie about this issue when it comes to my record and his own,” said Delgado. “Because he understands how important this issue is in this debate, he understands he has been horrible on this issue, and he is determined to figure out how to rewrite the narrative even if it’s in some alternative universe.”
Faso’s healthcare votes
Faso’s record on federal healthcare mandates dates back to early 2017 when Republicans, in control of both houses of Congress and the White House, moved full steam ahead on their long-promised repeal of the Obama-era Affordable Care Act. Faso served as a moderate voice in the contentious effort to bring the far-right Freedom Caucus on board with the “repeal and replace” effort. A secret tape recording of one committee meeting depicts Faso imploring fellow lawmakers not to include a provision defunding Planned Parenthood in the repeal bill. The move was too politically risky, Faso said.
Advocates for the non-profit said that the bill would have a devastating impact in rural and low income areas where Planned Parenthood clinics often served as women’s only access to cancer screening and other health services. Faso voted in the minority against the defunding provision. But when the final bill, which included the defunding amendment, came up, Faso cast the deciding vote which moved it out of committee and onto the House floor. Later, Faso would say that the overall bill was too good overall to allow the Planned Parenthood provision to be a dealbreaker.
Among the sweeteners in the American Healthcare Act was an amendment Faso negotiated with fellow upstate New York lawmaker Chris Collins. The Faso-Collins amendment would have ended New York state’s practice of passing 13 percent of its total Medicaid costs to the counties. Faso claimed that the amendment would save local property taxpayers $358 million annually. Critics, who derided amendment as “The Buffalo Bribe,” warned that it could endanger Medicaid coverage for millions of New Yorkers and shutter nursing homes and other healthcare facilities across the state.
The final version of the American Healthcare Act also included the “MacArthur Amendment,” named for New Jersey congressman Tom MacArthur. The amendment would allow states to seek waivers to key components of Obamacare, including charging older people up to five times more for insurance coverage than younger ones (under Obamacare that ratio was capped at three to one). The amendment, which was designed to appeal to the party’s most conservative elements, would also have allowed states to seek exemption to Obamacare protections for people with pre-existing conditions provided that they fund a “high-risk insurance pool” to offer coverage to people who might otherwise end up frozen out of the insurance market.
The American Healthcare Act eventually died after its Senate counterpart the Better Care Reconciliation Act went down in dramatic fashion with the late senator John McCain’s famous thumbs-down gesture. Delgado has seized on Faso’s yes vote as evidence that the incumbent broke his promise to constituents to fight any threat to protections for preexisting conditions and the imposition of an “age tax” for seniors seeking insurance.
Opponents take the gloves off
“They could have tried any number of things,” said Delgado. “But they said, ‘Nah, we’re just going to use this as an opportunity to take from those who need to pay for a tax break.’”
Faso has hit back, calling Delgado’s attacks “outright fabrications.” Faso notes that the MacArthur amendment would only apply to a small slice of consumers seeking individual insurance plans — about 7 percent of the total market. More importantly, Faso said, the amendment would have no impact whatsoever in New York which, in 1992, enacted community rating legislation which forbids insurers from charging people more for insurance based on their age or other risk factors. As an assemblyman, Faso voted against that community rating law, a vote he stands by pointing to the near total collapse of the private insurance market in New York State after it passed.
“At the time there were 750,000 people in the individual insurance market. Fifteen years later there were 30,000.” said Faso. “New York by [barring higher premiums for older buyers] destroyed that entire market.”
Faso called Delgado’s attacks on his healthcare record disingenuous and ill-informed, part of a national attack strategy by Democrats that in Delgado’s case betrayed a lack of knowledge by a first-time candidate relatively new to the district. Faso points out that a Delgado attack ad highlighting his supposed support of an insurance age tax garnered a “mostly false” rating from the independent fact-checking website Politifact New York.
“He’s just rehashing the standard playbook of the national Democrats,” responded Faso. “It’s very superficial and not very illuminating to the real problems we face.”
Where Delgado sees a broken system in need of a dramatic action, Faso chalks up increasing healthcare costs to an aging population and Americans’ ingrained expectations of the best, latest and most advanced medical care. He thinks these issues can be addressed without a dramatic shakeup of the insurance industry. Faso who touts his membership in the House’s bipartisan Problem-Solvers Caucus, ticks off a list of relatively small-scale fixes that he said would make insurance easier to obtain and less costly.
One of those solutions is the creation of government-subsidized reinsurance for health-insurance providers. The scheme, which Faso said enjoys bipartisan support, would essentially insure insurance companies against losses incurred paying medical costs for those who require an exceptionally high level of care.
The plan, Faso said, would cap the amount insurers would have to pay per patient. Anything over that amount would be covered by the government-backed reinsurance program. The program, Faso claims, would bring predictability to premium increases by allowing insurers to better budget for costs.
Faso favors raising the bar on Obamacare’s mandate that employers with 50 or more full-time employees provide healthcare plans. Faso’s plan would raise that number to 500. Faso said that the 50 employee rule had stifled economic development among small businesses by encouraging employers to cut hours and bring on part-time employees rather than full-time staff in order to remain under the cap. Faso also supports expanding school-based dental and mental-health clinics, reforms to medical malpractice laws to drive down providers’ insurance costs, and maintaining some elements of Obamacare.
“Many of my Republican colleagues have the mantra of repeal-and-replace,” Faso said. “That’s never been my position. My position is keep what works and fix what doesn’t.”
Delgado favors a public option
Delgado’s healthcare platform seeks to tread a middle ground between the status quo and Bernie Sanders’ $35 trillion Medicare for All single-payer proposal. Over the course of a tough seven-way primary fight, Delgado was frequently the target of attacks from the left charging that he was insufficiently committed to the prospect of universal government-funded healthcare.
Instead, the former corporate attorney has proposed a government-backed public option insurance program that would exist side by side with the existing private market. The system, he said, would reduce Americans’ reliance on employer-provided health insurance, and relieve small business owners of the need to provide coverage, thus encouraging mobility and innovation in the job market. Delgado added that government-backed insurance programs typically cost far less than private claims to pay and process, bringing additional cost savings.
“These are all benefits of system that still respects the idea that people may want to keep the insurance they have and still be part of the fight for universal healthcare,” said Delgado.
Opponents of a public option warn that a government-backed insurance plan would inevitably drive private insurers from the market. They portray the public option as a Trojan horse, a way station on the road to the Democrats’ ultimate goal of a single-payer system.
It’s a belief shared by Faso. “It would literally make employer-provided insurance illegal and end Medicare as we know it,” said Faso. “And it would double taxes to cover the costs.”
Delgado brushes off the criticism by noting that a public option would just be one more competitor in a free-market system that thrives on competition. He believes a public option could be accomplished in a bipartisan manner that would bring together competing factions in Congress around the idea of expanding coverage.
“I am in the business of trying to figure out and state clearly what I stand for, what I want to achieve and what I feel is achievable,” said Delgado. “What’s achievable, what’s doable, and what I think can have a really big impact on our system is letting folks opt in.”