Michigan: John James thinks "tort reform" is the key to covering pre-existing conditions, and other head-scratchers about his wanting to repeal the ACA

 

This morning, U.S. Senator Gary Peters (D-MI) and his Republican opponent, John James, were interviewed online by Nolan Finley of the Detroit News and Stephen Henderson of DPTV & WDET. Here's the verbaitm transcripts of each of their healthcare/ACA Q&A sections, Peters first:

HENDERSON: "One of the things which has been made really manifest during the COVID-19 pandemic is the weakness of our healthcare system. We're now coming up on about a decade of life under the Affordable Care Act, which of course expanded access to insurance and made some other changes, but there are still obviously a lot of inefficincies...there are a lot of insufficiencies.

Give us an idea of what you would support in terms of changes to the healthcare system, changes to the Affordable Care Act, to get more people covered at lower costs and make the system work better."

PETERS: "Well, there's no question that the pandemic highlights the need for healthcare, and the fact that everybody in this country, no matter who they are, no matter where they live, should have access to quality, affordable healthcare, particularly in a pandemic. That's why I've been pushing this administration to actually open up enrollment in the state exchanges; to allow people to purchase quality care at an affordable price. You know, that enrollment only opens up once a year at the end of the year. It makes no sense to me to not open it up now when we're in the middle of a pandemic and people are fearful that they don't have that coverage. So that should happen.

But we also need to expand on the Affordable Care Act and the ability for others to be able to sign up. We know now that because of the Affordable Care Act, here in Michigan, over a million people now have access to healthcare that they didn't have before. People with pre-existing conditions have coverage which is always a problem...and to hear folks say that we are going to repeal the Affordable Care Act is unacceptable.

"What we need to do is make sure we strengthen the Affordable Care Act, fix what may not be working right, but strengthen it...for folks who support, for example, legislation that the Trump Administration has right now which would just throw the Affordable Care Act out is just unacceptable, and people who say that 'well, I'll still protect pre-existing conditons' but have no plan...you actually have to have a plan. You can't have just hollow words, shallow talking points, aren't going to deal with the immensity of this problem with healthcare.

"And I'll just mention one aspect...there are a lot of aspects to improve it, but just one aspect is we have to reduce the cost of prescription drugs. Prescription drugs continue to rise at a level that's unacceptable. We need to have more competition. I've actually written legislation and passed legislation to deal with the escalating costs of prescription drugs and make sure that generics, for example, could be more competitive and can bring down the cost. We have to make sure it's affordable, and that's dealing with the cost structure...but just throwing out the Affordable Care Act in its entirety without a plan is irresponsible. Let's make sure we're fixing what's not working the way we like, and strengthen the other areas that are already working for us.

HENDERSON: "So there are a lot of Democrats who say the solution to this is some form of single payer system...Medicare for All is one idea...there are lots of others out there...how far do you think we should go towards that kind of reform?"

PETERS: "Well, I do not support Medicare for All; I'm not on that legislation that is here before us, but I do believe that Medicare is a very efficient way to deliver health services to folks. That's why I support legislation that would allow people to buy into Medicare if they choose to do that, and to do it at an earlier age, starting at age 50. And also I believe that in the Affordable Care Act, part of the Affordable Care Act, as you know Stephen, it's a very wide act that affects all aspects of healthcare from making sure that seniors have lower drug prices to making sure we can keep our children on our healthcare plans until age 26, having clinical services are all part of that...but in the state exchanges, which is a part of it, where people can buy health insurance.

"I believe that one of the options for people in that state exchange, when they can pick from a variety of private companies, that Medicare should be one of those options in that state exchange. So certainly the opportunity for people to use Medicare is important...and I think we see how that works. And as that moves forward, we can reassess that situation and then take other steps. But right now, let's look at how we increase access to Medicare for folks through the Affordable Care Act."

I admit to being a bit surprised that Peters spent so much of his first response calling for a HC.gov SEP. I strongly supported doing this back in March/April, of course, and I still wish they'd do so...but at this point it's mid-September and the 2021 Open Enrollment Period starts November 1st anyway. Someone enrolling in an ACA exchange plan today (9/16) would only have coverage for 3 months (10/1 - 12/31) while starting with their full deductible cost, so while it'd still be a good idea, it doesn't have nearly the same impact that it would have earlier in the year.

I'm very glad he noted that in Michigan specifically, "over a million people now have access to healthcare that they didn't have before"...he's referring to both 260,000 Michiganders who enrolled in ACA exchange plans and the 791,000 who are enrolled in Medicaid via ACA expansion. It's important to note, by the way, that this number is 253,000 people, or 47%, higher than it was in March, just before the COVID-19 pandemic hit full-on and the state shutdown went into effect. Without the ACA, those 253,000 Michiganders would have been utterly screwed.

It's also interesting that Peters' next point regarding strengthening & expanding the ACA isn't about removing the subsidy cliff or other improvements which I usually write about (though he supports those as well)...its' about reducing prescription drug prices, which is a major part of the H.R.3 bill passed by the House last year and the ACA 2.0 bill (H.R. 1425) passed by the House this year, as well as being a big part of Joe Biden's own healthcare proposal.

He then makes it crystal clear that he does not support a Bernie Sanders-style Medicare for All bill on the table, but does support expanding Medicare availability via an optional buy-in to those over 50 (this is basically his Michigan Senate colleague Debbie Stabenow's "Medicare 50+" bill). He also thinks Medicare should be available as an ACA exchange option alongside the private offerings...in short, he supports a Public Option, as does Biden.

I admit to being a little unclear from his wording here as to whether he thinks the Medicare option should only be available for buy-in by those over 50 or for everyone...if you buy on the exchange, there's no age limit, so this is a little fuzzy. Biden wants to offer Medicare as an option for those age 60 or higher as well, but he distinguishes this from a "Medicare-like" Public Option for those under 60. Again, I'm not sure why you'd need both of those instead of just one, but perhaps the higher-age option would be the fallback position if the main PO fails.

Next up, John James (starting at around 27:30):

HENDERSON: "John, you've been really critical of the Affordable Care Act and called it a monstrosity in one of the ads that's running. But the question is always, what would you do instead? Give me an idea of what a John James approach to health reform would look like."

JAMES: "Well, thank you for that question. That's a classic example of politicians getting in the way and taking things out of context and intent. I said repeal and replace it with something that would work in the real world. Since Obamacare was enacted, there are folks who work at my company who've had their choices reduced and their costs go up. You look at the price of deductibles have increased, and folks who are in high deductible plans are increasingly unable to afford their healthcare and have to ration their care.

"I would support a primary care provision so that people could go at no cost to themselves if you're on a high-deductible plan to be able to get primary care visits throughout the year so that we can stay in better health. There's so much focus on healthcare insurance, not as much focus on health. Nutrition, there's food deserts, around the state; we need to address that. But an overarching theme, my position on it is the same it's always been, is we need to have a market-based, patient-centered approach that must cover pre-existing conditions.

I think that with tort reform and regulatory reform, we can increase transparency in the healthcare industry, we can increase quality, we can increase choice, and we can decrease cost. And now doctors and patients will have the choice and the power not the federal government insurance companies. Sadly, my opponent has said that he believes that Medicare for All is eventually where we will go. I think that's dangerous, I think it reduces choice, I think that's the wrong way to go, and I think it will ultimately bankrupt our children's futures and send our seniors to the back of the line."

HENDERSON: "Well, actually, Senator Peters says he doesn't support Medicare for All in the interview that we've done here. But let me go back to something you said...that we need to cover pre-existing conditions. How would you do that outside a reform package like the Affordable Care Act? What would ensure that pre-existing conditions are covered if you didn't have it?"

JAMES: "Well, I think that by actually legislating and getting that ground-up feedback, you're gonna need the regulatory reform required and the tort reform required to make sure that we can incentivize the people who are making these decisions to care for the people who need it the most. My son has a pre-existing condition and I recognize the need that we have to take care of everyone, especially the most vulnerable. I think that the first start would be to make sure that we do everything we can to listen to the experts and we continue to push for the reforms that we need and get the legislation required."

HENDERSON: "But we had market-based insurance before...and people with pre-existing conditions were not covered. The Affordable Care Act changed that. What makes you think that the market will behave differently?"

JAMES: "Like I said, we need to keep the parts of Obamacare that work and we need to fix the parts that don't, and the part of Obamacare that works is covering pre-existing conditions."

Hoo, boy. Where to begin?

First of all, according to LinkedIn, James Group International has between 51 - 200 employees. Assuming at least 50 of them are full-time, they're required to have their healthcare coverage provided by their employer...namely, John James. James claims that some of his employees say they've "had their choices reduced and their costs go up"...except that those "choices" are determined by the employer, not the employee. If his employees have "fewer choices" that's because JGI was the one who limited them.

As for "their costs going up since Obamacare was enacted"...yes, over a 10 year period costs do tend to go up at least a bit. It's called inflation. James provides zero context or detail about how much their healthcare costs have gone up or what type of coverage he's offering his employees since 2010. Without those details, this is a meaningless gripe.

Next, James says that he'd support "a primary care provision so that people could go at no cost to themselves if you're on a high-deductible plan to be able to get primary care visits throughout the year so that we can stay in better health". This is a wise, admirable goal...which, like protections for those with pre-existing conditions, is already included in the Affordable Care Act. The ACA (Obamacare) includes a long list of primary care provisions that people can utilize at no cost to themselves, with no deductible or co-pay required...including physicals, mammograms, blood/drug screenings and a host of other services.

He then talks about the need for a "market-based, patient-centered approach". "Patient-centered" is a completely meaningless buzzword. "Market-based" is, as Mr. Henderson points out a few minutes later, exactly what we had before the ACA, and it was a disaster in large part because it didn't include protections for those with pre-existing conditions.

James then goes on about "tort reform" and "regulatory reform" which would somehow "increase transparency" and "increase quality" while "decreasing costs". Republcans have been pushing the "tort reform" chestnut for decades...in the context of healthcare, "tort reform" basically means making it more difficult to sue doctors/hospitals for medical malpractice and/or reducing the amount of the settlements when they do successfully sue. The GOP is convinced that "tort reform" would dramatically cut the cost of healthcare, except that a) tort reform has already been passed in many states (to draconian levels in some cases) and b) it hasn't had more than a negligible impact on healthcare costs.

How on earth "tort reform" would "increase transparency" is beyond me, and it sure as hell wouldn't "increase qualiity" of care...if anything it would reduce quality, since doctors wouldn't be nearly as likely to get held accountable for screwing up.

"Regulatory reform" is also GOP-speak for eliminating regulations. Unless James is talking about adding more regulation (which I somehow doubt), I've no clue how that would "increase transparency" or quality of care either. I suppose it would "increase choice" in the sense that people would be able to choose more junk plans which cover nothing...except he also insists that pre-existing conditions would have to be covered, so...

He then claims that doctors & patients would "have the choice and the power" instead of--and this is verbatim--"the federal government insurance companies". I don't know if he meant "the federal government and the insurance companies" or if he genuinely thinks the federal government is an insurance company, which I guess would be true under Medicare for All, but which isn't the case under the ACA. If he meant the former, then that means he somehow thinks that eliminating government regulations of insurance companies would somehow take power away from insurance companies, which is a very strange type of logic.

He then suggests that Peters supports Bernie-style Medicare for All, even though Peters had just stated, unequivocally, that he does NOT support M4All. James exact words are that Peters "believes M4All is eventually where we'll go", which isn't the same thing as him supporting it at all. "Eventually" could mean 100 years down the road, after all. It has nothing to do with how Peters would vote in the next 10-20 years of his career, and he's been pretty emphatic that no, he doesn't support a pure single payer system at this time.

Henderson corrects him on this, then points out the core cognitive disconnect of James' position: The ACA already fully protects coverage of pre-existing conditions. James wants to keep that part of the ACA while simultaneously stripping away all the other provisions necessary to make that possible... namely, Medicaid expansion for low-income people, the financial subsidies which are necessary to keep premiums affordable for low/middle-income people and so forth. If you remove those core elements of the ACA while keeping just the pre-existing condition requirement, you've removed two of the ACA's 3 legs and it collapses as net premiums skyrocket into the stratosphere for most of the population.

James' response to this is complete word salad:

Well, I think that by actually legislating and getting that ground-up feedback, you're gonna need the regulatory reform required and the tort reform required to make sure that we can incentivize the people who are making these decisions to care for the people who need it the most. My son has a pre-existing condition and I recognize the need that we have to take care of everyone, especially the most vulnerable. I think that the first start would be to make sure that we do everything we can to listen to the experts and we continue to push for the reforms that we need and get the legislation required."

Most of this is completely incomprehensible, and he doesn't indicate which "experts" he thinks "we" should be "listening to".

As far as I can tell, James was given a list of buzz words by the powers that be in the GOP and told to make sure he sprinkles them into his responses whenever possible. He refers to "tort reform" twice even though it has virtually nothing to do with what the question (or the rest of his response) is about. He throws "patient-centric" in there. I'm surprised he didn't dust off the old "selling across state lines" chestnut as well.

Finally, James wraps up with this eye-rolling conclusion:

"Like I said, we need to keep the parts of Obamacare that work and we need to fix the parts that don't, and the part of Obamacare that works is covering pre-existing conditions."

...except that he already said he wants the entire ACA struck down since it's a "monstrosity". He then says that the only part of the ACA which works is "covering pre-existing conditions" which, as I've noted before, would be an utter disaster if taken literally. Medicaid expansion is also a core part of the ACA, and James doesn't seem ot think that it "works" since he wants everything to be "market-based", so I guess all 791,000 Michiganders on Medicaid via ACA expansion (nearly 8% of the population) are completely screwed under his "plan."

As far as I can tell, John James doesn't have the slightest understanding of what he's talking about here. Like much of the GOP, the only lesson he seems to have learned from the blue wave in 2018 is to make sure to utter the phrase "protect pre-existing conditions" a lot, even if the policies he's pushing for would do the exact opposite of that.