North Dakota Republican Senate candidate Kevin Cramer fended off attacks from his Democratic opponent by committing Wednesday to ensuring health insurance coverage for people with pre-existing conditions.
His remarks provided a preview for how Republicans could respond to election-time criticism that they want to gut health insurance protections for sick people, one of the most popular parts of Obamacare.
Democrats believe healthcare will be a winning issue for them in the 2018 midterm elections, thanks to the unpopularity of Republicans’ Obamacare repeal efforts. Endangered Democrats like Cramer’s opponent, Sen. Heidi Heitkamp, are touting their support for pre-existing condition protections whenever they can.
To wit, Heitkamp held her own press call a few hours after Cramer gave his press conference in North Dakota. Heitkamp, running for re-election this fall in a state President Trump won by 36 points in 2016, said Cramer’s support for a lawsuit that would scrap Obamacare undercuts any statements of support for pre-existing conditions.
“You can’t be in court arguing that you are going to try to eliminate pre-existing conditions and say you want to protect pre-existing conditions,” Heitkamp said. “It just does not work.”
Heitkamp was referring to a federal lawsuit from Texas and 19 other states that argued all of Obamacare must be scrapped because of the repeal of the financial penalty for the individual mandate. The first oral arguments for the case are expected to start on Sept. 5.
The Justice Department decided to no longer defend Obamacare in court. DOJ said it supports the lawsuit, but does not believe the entire law should be scrapped — just the protections for people with pre-existing conditions.
The agency’s position has put congressional Republicans in an awkward spot, and opened them up to attacks from Democrats that Republicans want to gut pre-existing condition protections.
Cramer said that Republicans do not want to do that.
“Every Republican proposal that has been advanced has included guaranteed coverage for pre-existing conditions,” he in a joint statement with state officials on Wednesday.
As a member of the House of Representatives, Kramer voted in May 2017 for the American Health Care Act that repealed most of Obamacare. The bill would have maintained Obamacare’s requirement that insurers not deny coverage to patients based on pre-existing conditions.
However, the bill would have did let states waive a protection for people with pre-existing conditions called community rating. Obamacare requires that insurers not charge people with pre-existing conditions higher premiums than healthy people. However, a state could get a waiver from that requirement.
An insurer in states with a community-rating waiver could charge sick people more money if they had a gap in insurance coverage of 63 or more consecutive days.
Without this protection, a sick person would be able to get coverage, but it could be far too expensive.
A report from the research firm Kaiser Family Foundation found that 6.3 million people with pre-existing conditions would face higher premiums under the House bill.
North Dakota has around 316,000 people with pre-existing conditions.
The Senate eventually failed to pass its own Obamacare repeal bill in July 2017 after Sens. John McCain of Arizona, Susan Collins of Maine and Lisa Murkowski of Alaska joined all of the chamber’s Democrats to defeat it.
Kramer said that North Dakota has always had a high-risk pool to care for people with pre-existing conditions priced out of the individual market, which includes Obamacare’s exchanges and is used by people who don’t get insurance through a job or the government.
Under a high-risk pool, a state segregates people with pre-existing conditions into their own insurance pool and helps covers their medical claims.
Numerous healthcare policy experts have said that a high-risk pool could help maintain coverage for people with chronic conditions, but only if there is enough funding. Republicans added $8 billion over five years to the American Health Care Act to give a boost to high-risk pools in states that got the waiver, but critics and Democrats say it wasn’t enough.
Kramer said that a repeal bill touted by Sens. Bill Cassidy, R-La., and Lindsey Graham, R-N.C., would have given North Dakota more money for a high-risk pool.
The bill would take Obamacare’s funding for tax credits and the Medicaid expansion and convert it into block grants for states to use as they see fit. If a state wanted to continue the Medicaid expansion, for example, it would be able to use the funding for that or do something different.
The bill would leave it up to states to decide the protections for people with pre-existing conditions. The legislation eventually collapsed in September due to insufficient support from Republican senators.
The last poll done on the race was back in June by Mason-Dixon polling, which had Cramer up by four percentage points over Heitkamp.
