Editor's note: Printed with permission from the Kansas News Service

TOPEKA — The two doctors running for the U.S. Senate in Kansas are offering very different prescriptions for increasing access to affordable health care during the coronavirus pandemic.

Both Republican Roger Marshall and Democrat Barbara Bollier want to make big changes to the nation’s health care system but aren’t on the same page about whether the U.S. should expand government programs that already cover roughly 35% of Americans or rely more on competition in the private sector.

The outcome of the debate, which is playing out in congressional races across the country, will affect millions of Americans — and hundreds of thousands of Kansans — especially those with pre-existing health conditions.

We’ve broken down the candidates’ positions on the behemoth that is “health care” and how to deal with the COVID-19 pandemic into four sections.

The Affordable Care Act

Marshall, a two-term congressman from western Kansas, is leading the GOP’s persistent effort to repeal the Affordable Care Act, which President Barack Obama signed into law in 2010.

“Both parties want to repeal the ACA,” the retired obstetrician from Great Bend said in an interview.

“The Democrat Party wants to replace it with government-controlled health care. I want to replace it with more patient-controlled health care.”

Marshall also believes that less regulation and more transparency about health care costs would increase competition and result in more choices for consumers. In other words, he said: “allowing patients to be consumers again.”

Bollier, a former Republican and retired anesthesiologist from Mission Hills, said conversations with voters have convinced her that “access to affordable health care is the No. 1 issue … especially now that we’re in the middle of a pandemic.”

And contrary to what Marshall claims, Bollier said Democrats want to strengthen the ACA, not repeal it.

She supports Democratic presidential candidate Joe Biden’s proposal to increase government subsidies to make coverage more affordable. She also supports his plan to create a government-run “public option” to compete with the private plans sold on the health care exchange. Something, she said, that would help middle-income Kansans who don’t qualify for subsidies.

“The (coverage) on the exchange isn’t affordable for everyone, so we need to go beyond that,” she said.

When asked how much an expansion would cost, Bollier said she would have to check. But the nonpartisan Committee for a Responsible Federal Budget estimates extending health coverage to about half or a little more of the approximately 30 million people who lack it would cost about $2 trillion over 10 years.

Marshall said that if Bollier is elected, she’d fall in line with liberal Democratic leaders who want to expand to all Americans Medicare, the government health program for people 65 and older.

“I couldn’t have been any more clear from Day One saying I didn’t support Medicare For All,” said Bollier, who calls the proposal “unworkable” and would force people to give up private coverage.

Pre-existing conditions

Republicans in Washington have talked for years about repealing and replacing the Affordable Care Act. Marshall even helped write unsuccessful legislation that would have replaced the health care law, serving as the chair of a Republican task force.

And repeal isn’t the only threat: The U.S. Supreme Court could strike down the law in 2021, as just days after the Nov. 3 election, it will hear a lawsuit led by Republican state attorneys general, including Kansas’ Derek Schmidt.

Critics say the Republicans’ bill, which passed the House in 2017 but died in the Senate, would have resulted in fragmented coverage and excluded people with pre-existing health conditions.

The Kaiser Family Foundation estimates more than 50 million non-elderly adults in the U.S. have conditions that could make them uninsurable if the health care law is repealed, ranging from relatively mild (seasonal allergies and skin disorders) to more serious (diabetes, heart disease and cancer).

But the fear that Republicans’ replacement plan would put coverage for an estimated 465,000 Kansans at risk are overblown, Marshall said.

“My biggest priority is to make sure we take care of pre-existing conditions,” he said. “It’s a sword I’ll die on.”

Marshall is also advocating the re-establishment of “high-risk pools,” which are state-run programs that provide last-resort coverage for people who either can’t get it from their employer or buy an individual policy in the private market.

Marshall believes that using high-risk pools to cover people with pre-existing conditions would lower the cost of insurance for everyone else.

Karen Pollitz with the Kaiser Family Foundation said the U.S. has tried it before and it didn’t work because “almost nobody” who needed a high-risk plan could afford one. She said only 1,500 people were in Kansas’ high-risk pool when it shut down in 2010.

The Republican replacement bill included money to help states form high-risk pools and provide subsidies to make the coverage more affordable. However, the $100 billion in funding was well short of what was needed to hold down the cost of coverage, Pollitz said.

“When you create a program that covers people only when they’re sick,” she said, “you better be prepared to put a couple of trillion dollars behind it.”

Other insurance issues

Both Marshall and Bollier say they favor legislation to address “surprise” bills from medical providers, which are unexpected costs that arise when a provider outside of an approved network assists with treatment.

A bipartisan bill that Marshall co-sponsored in 2019 remains buried in a U.S. House committee. Bollier’s effort to address the issue at the state level suffered a similar fate; she said Republican leaders instructed a committee chairman “not to run the bill.”

Bollier and Marshall differ on another proposal aimed at lowering health care costs. Currently, the federal agency that runs Medicare isn’t allowed to bargain with pharmaceutical companies to lower drug prices for the approximately 44 million people — including 545,000 Kansans — enrolled in the program.

Marshall voted against legislation to permit the Centers for Medicare and Medicaid Services to negotiate prices, a move Bollier criticized.

The coronavirus

The COVID-19 pandemic has intensified the health care debate and triggered a new fight over public health.

During a September debate between the Senate candidates, Marshall said Democratic Gov. Laura Kelly — with Bollier’s support — went too far in trying to stop the spread of the coronavirus by ordering people to stay home and shuttering schools and non-essential businesses.

“Maybe this works in New York and California,” Marshall said, “but it’s not going to fly in Kansas.”

Bollier criticized Marshall for not taking the virus seriously enough and for attempting to minimize COVID-19 death totals to justify the Trump administration’s uneven response to the pandemic.

“It’s been so disappointing to see a doctor (Marshall) more concerned with his political health than the actual health of the people of Kansas,” Bollier said.

Bollier said Marshall, like President Donald Trump, has “put people at risk” by not wearing a mask as he campaigns. The president came down with the coronavirus in early October, just after the first debate; many White House staff members were infected as well.

Marshall now generally wears a mask, but at events throughout the summer he often didn’t.

“If I walk into rural Kansas with a mask on, people look at me like I’ve got three eyes or something,” Marshall told The Associated Press after a Kansas City-area campaign stop in August.

Marshall has volunteered at clinics and hospitals to help treat COVID-19 patients. Responding to Bollier during the September debate, he said he “respects the virus” but doesn’t believe it should control our lives — particularly now that it can be more effectively treated than early in the pandemic.

“I can see the light at the end of the tunnel,” he said. “We’re winning the war against this invisible enemy.”

In the two weeks following that Sept. 19 debate, the number of COVID-19 deaths in Kansas increased by 20 percent, and the number of cases rose by 11 percent.

(11) comments

freedom fighter

Let be always said that the Democrats and Mrs Bollier do always make the choice for the satanic rite of abortion. You really have to be brave to dispose of the unborn who have no voice .God have mercy on your souls

Aim_High

In the bible, God gives Moses instructions on how to perform an abortion, (Numbers 5:11-31) so I don't think it's a satanic rite, but more just a by-product of jealous Christian men. The bible expresses zero concern for the unborn fetus.

Republicans have also excluded pregnant women from receiving $500 per "child" in the stimulus bill... if they truly believed what they're claiming (life starts at conception), there wouldn't be any problem including these unborn "children" they care so much about receiving their benefit, right?

Republicans are also opposed to free/subsidized birth control & contraceptives, which are well known to prevent unwanted pregnancy and thus abortion. If you took the cost of providing birth control and divided it by the estimated number of abortions it would prevent, you could calculate exactly what an "unborn baby" is worth to the so-called pro-life crowd. I'm guessing it is a lot lower than they would care to admit. Democrats are actually more pro-life than Republicans in my opinion.

cropduster1

I would suggest that there are as many dems. pro life as rep. As for subsidizing birth control. That is a dem. thing. They want to subsidize everything. I would suggest that welfare just makes the children of the recipients think it is a way of life so it happens again and again. Not to say that there isn't a need for subsidizing and freebies but it has gotten out of hand.

Aim_High

If the benefit of teaching teenage girls that welfare and subsidies are "dem.thing" outweighs the cost of an abortion, I can't believe you're as pro-life as you claim. Birth control is cheap, most insurance covers it, there's no reason anyone who can't afford it shouldn't be able to get it for free. The last thing we want is people who cant afford birth control to take on the responsibility of raising a child, or even worse get an abortion, right? Some freebies should really be freebies for the good of all of us.

Hollowed Ground

Roy Moore no doubt impregnated teenage girls in his younger days. I wonder if he paid for their abortions. Or did he say, "God will pay you!"?

Hollowed Ground

Have you ever wondered where Republicans go for their abortions? They can't go to the local clinic lest they be recognized and shamed online. They must wear very good disguises. Or they go out of state, maybe to Canada? Maybe they call the doctor to come to their home. Or they keep a stock of RU-486 in their medicine cabinet while they blather against abortion and contraceptives? That's called "insurance".

freedom fighter

Numbers 5:11-31 Good luck on convincing God that HE codons abortion by those verses. How do you interpret the 5th Commandant?

Aim_High

You didn't even read the verses, did you.....

"Then the Lord said to Moses, “Speak to the Israelites and say to them: ‘If a man’s wife goes astray and is unfaithful to him so that another man has sexual relations with her... etc."

It was God a.k.a. "the Lord" who gave these instructions. It's YOU who doesn't like abortion and you're trying to bend words in the bible to fit YOUR feelings. The 5th commandment "Thou shalt not kill" refers to other humans, not to an unborn fetus. It was written so simply so it wouldn't be misinterpreted... but if you want to make up different things that it COULD mean, maybe it refers to cows. Maybe God is talking about trees? Maybe he was talking about that fetus he told Moses how to get rid of.

Hollowed Ground

Marshall's replacement for Obamacare really can be called patient-controlled health care, as he claims. "Die Quickly" certainly does give patients total control over their health care choices. Patients can choose bankruptcy, eternal debt or death. And they can make those choices with any doctor. Let it never be said Republicans do not allow us to make choices.

cropduster1

I don't know about you. But Obama care sure as hell didn't make my insurance cheaper or better. I've never seen the government run anything that private people or industry couldn't do better and cheaper. UPS vs. USPS would be a good example. But then there's the old saying. I'm from the government and I'm here to heip. If you believe that I've got some seashore property in Arizona I'll sell you.

Hollowed Ground

USPS is vastly less expensive than UPS or FedEx, vastly more convenient and vastly more accessible. I always use it. Packages picked up free at your doorstep. Instant quotes and just about everything and everything you need to do is online. Never a need to drive to the post office any more. Hopefully USPS will soon be free of its voodoo economics burden too. Just about everyone who complains about USPS uses it after they see what the others charge. But now of course, the others are faster because their CEOs have not ordered them to slow down. That will soon pass too.

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