Editor's note: This is part of a series of stories on issues in the local congressional races, leading up to the election next month. This story focuses on health care. Future stories will look at Social Security, Medicare, federal spending and defense cuts.
More than 2 1/2 years after it passed, President Barack Obama's health care reform law still sucks up all the air in the room when politicians talk health care.
Known officially as the Patient Protection and Affordable Care Act, the March 2010 law is better known as Obamacare, the derisive name fastened to it by Republicans who vow to repeal it, a name Obama now embraces.
"Because I do care," the president said during a visit Monday to San Francisco. "I care that folks with pre-existing conditions can still get insurance. I care that insurance companies don't jerk you around."
Republicans say they care, too, and they want to keep provisions such as pre-existing condition coverage, but House Republicans like U.S. Reps. Lou Barletta and Tom Marino said Obamacare won't work and will cost jobs and hurt Medicare.
In the last two years, they have voted more than 30 times to either repeal the law, take away its funding or do, in Barletta's words, "whatever we could to stop the government takeover (of health care by) Obamacare."
As they run for re-election, Barletta and Marino are joined in their full-throated disdain by fellow Republican Laureen Cummings, a home health nursing agency owner running for the other northeast Pennsylvania congressional seat.
"That needs to be repealed," Cummings said of Obamacare.
The Democrats running for local congressional seats - Phil Scollo against Marino, Gene Stilp against Barletta and Matt Cartwright against Cummings - said repeal is unnecessary. If problems crop up, fix them, they said.
"Instead of Congress voting (30) times to try to repeal it, try to make it the best bill it could possibly be," Scollo said.
What Republicans want to repeal is a bill designed to:
- Expand health care coverage to 32 million uninsured Americans. It would do that partly by setting up state-based exchanges where they could buy health insurance coverage and help the poor pay for coverage with federal subsidies. The law will mandate citizens to have coverage and imposes penalties for those who don't of $695 on individuals and up to $2,085 on families.
Though Republicans railed for two years against the mandate as unconstitutional, the U.S. Supreme Court upheld it in June, saving the law's key provision.
- Eliminate 75 percent of the Medicare prescription drug coverage gap by 2020.
- Provide a tax credit to small employers with no more than 25 employees and average annual wages of less than $50,000 who want to offer coverage.
- Forbid insurance companies from denying coverage for pre-existing conditions to anyone starting in 2014.
- Fine companies with more than 50 employees $2,000 a year per worker if the companies do not provide health insurance.
- Allow parents to keep their children on their health insurance plans until age 26.
- Increase the threshold for deducting medical expenses on tax returns by a third, making deductions less likely.
- Cut $716 billion in subsidies to private Medicare Advantage plans and other health care providers to help pay for the law. Medicare Advantage is Medicare-type coverage offered through private insurers. The chief Medicare actuary once predicted the cut would chase 7.4 million people out of Medicare Advantage plans, though they would remain eligible for traditional Medicare.
When congressional Democrats passed the law, they took the money from Medicare Advantage plans, which were becoming more expensive than traditional Medicare, the opposite of what was supposed to occur.
The Congressional Budget Office, which analyzes costs for Congress, said in March 2011 the law will actually cut the federal budget deficit from 2012 to 2021 by $124 billion, a figure that evokes scoffs from Republicans.
17th Congressional District
In the 17th Congressional District race between Cummings and Cartwright, Cummings also decries the $716 billion cut. She questions whether the nation had such a large problem with uninsured people that it required Obamacare. Many studies showed about 45 million Americans lacked health insurance, but Cummings contended most of them were between 20 and 30 years old and did not want to pay for insurance coverage.
If Democrats had allowed for legitimate debate on the reform law, things would have been different, she said.
"Maybe they could have gotten parents to realize this is an issue and parents could have gone to insurance companies and demanded that their children be left on the insurance," she said. "I think that they would much prefer that to having to deal with a whole government takeover of our health insurance. But this government doesn't have any faith in the American people. I do."
A licensed practical nurse, she railed against regulations such as one that requires nurses, doctors and hospitals to track the temperature in their refrigerators and "throw out good medicine."
"That's why I think my specialty would help in Washington," she said.
Cartwright said he would have voted for the reform law, but he favored creating a public option - government-sponsored coverage that people could buy if they were unsatisfied with private insurance plans.
Critics said that would be government interfering in the free market, but Cartwright contends that would keep insurance companies from overcharging while giving the government purchasing power that produces savings.
Cartwright said he favors the insurance mandate, noting states even require drivers to have car insurance.
Without the health care mandate, too many people are left uninsured. Even with the law, about 30 million people remain uncovered, he said.
"So the challenge is to get 100 percent of people covered," he said. "Uninsured care happens and it's just a question of who pays for it. If you don't cover it, the people paying for it are the providers. It's the doctors, it's the nurses, it's the hospitals."
Cartwright said the law will undoubtedly require tweaking because it's so comprehensive.