Every candidate in the race for Missouri's 3rd Congressional District wants to lower health care costs, but the ways they want Congress to achieve that goal differ wildly.
With less than a month to go in the campaign for Missouri's 3rd District seat, candidates said health care is the most defining issue of the campaign.
St. Louis Democrat Katy Geppert favors expanding access to health care by making Medicare an option U.S. residents can purchase in ways similar to Affordable Care Act health care plans. Five-term incumbent Blaine Luetkemeyer, R-St. Elizabeth, and Libertarian Donald Stolle, of Arnold, support lowering health care costs and making plans more affordable for middle-class Americans.
In May, a Congressional Budget Office report found benchmark premiums on silver plans on ACA exchanges will increase an average of 15 percent next year. A June report by professional services firm PricewaterhouseCoopers found private insurance premiums will likely jump 6 percent next year, a trend consistent with 5.5-5.7 percent increases over the past five years.
Last year's Tax Cuts and Jobs Act repealed the ACA's individual mandate, which forced everyone age 26 and older to buy health insurance or pay a tax penalty. Eliminating the individual mandate will cause ACA premiums to rise 10 percent every year between 2019-23, according to the CBO report. About 3 million people will lose health insurance between 2018-19, as young healthy people leave ACA exchanges and the premiums become more expensive, according to the CBO report.
Geppert empathizes with people facing rising premiums but said Congressional Republicans never gave the Affordable Care Act a chance to work.
"If your premiums are going up, then the Affordable Care Act is not working the way it was supposed to work," Geppert said. "With the individual mandate, that was supposed to offset some of the premium cost."
Luetkemeyer did not respond to repeated calls and emails made to his campaign staff from the News Tribune over the past three weeks.
In May 2017, Luetkemeyer voted for the American Health Care Act, which proposed several changes to the ACA and included provisions allowing insurance companies to price their products in a way that would lower costs for younger customers and offer health plans with higher deductibles and co-payments for people who want less comprehensive insurance. It also would have eliminated the ACA's employer mandate, requiring large employers to offer coverage to their employees.
The American Health Care Act also proposed substantial cuts to federal funding for state Medicaid programs and charging people with pre-existing conditions more for health insurance if states met certain conditions, like by setting up high-risk insurance pools.
Luetkemeyer told the News Tribune in September that the Affordable Care Act was going bankrupt, which is why premiums skyrocketed.
"Health care is an important issue that is probably one of the top 5 issues we're going to work on in 2019," Luetkemeyer said in September. "We need to find a new way to deliver health care in a positive and affordable way."
Luetkemeyer, like Geppert, supports provisions of the ACA allowing young adults to stay on their parents' plans until age 26.
Stolle said in an email that he supports provisions allowing young people to stay on their parents' health care plans until at least age 18. Stolle also favors Medicare coverage for people over age 65.
"Those two groups use the most health care during our lifetime," Stolle said. "Ensuring the future for our children as well as taking care of our elders is just true principles I hold near and dear to my heart."
In September, Stolle expressed opposition for the Affordable Care Act and said major changes need to be made to reduce the price of premiums.
"We need to sit down and have a discussion," he said at the time. "People are just throwing things at the wall and hoping it sticks right now."
Stolle said in an email Oct. 10 that he believes allowing health insurance providers to sell insurance across state lines will reduce health care costs.
Last year, President Donald Trump signed an executive order allowing some consumers to buy health association plans across state lines. The order was intended to reach millions of uninsured people who don't have access to plans through employers or ACA plans because of the high cost of premiums.
In September, Geppert expressed support for a Medicare for All system similar to the one proposed last year by U.S. Sen. Bernie Sanders, I-Vt. Sanders' system would have created a single-payer system under which the government pays all health care expenses.
In response to a question about the study in September, Luetkemeyer questioned the cost of a Medicare for All plan. Luetkemeyer said lawmakers need to be careful how they structure any health care system, whether it be Medicare, Medicaid or any other health insurance program.
Stolle said in September he does not favor a Medicare for All system.
Geppert last month did not say how a Medicare for All system might be funded, but said lawmakers need to be careful about how much taxes may be raised to pay for such a system.
Earlier this month, Geppert said she favors an alternative Medicare for All system to Sanders' plan that could allow more people to buy Medicare on exchanges similar to ACA exchanges.
U.S. Sens. Jeff Merkley, D-Ore., and Chris Murphy, D-Conn., introduced a bill in April that would launch an enhanced version of traditional Medicare available to individual consumers and employers who offer health coverage to employees.
This plan would allow the government to cover primary care, preventive services and chronic care, Geppert said. Private health insurance providers could cover emergency services or costs to treat chronic conditions, she said.
"I don't think (Sanders' plan) is necessarily in terms of reforming the ACA in a fiscally responsible manner and is necessarily going to be the best way to go about it," she said. "When trying to get constituents to understand what we're trying to do, it's all about explaining how to best go about this in a fiscally responsible manner."