WASHINGTON — A chasm is growing within the Democratic party over the most appropriate route to address the country’s struggling health care system.
Some want moderate policies that build on the Affordable Care Act; others are pushing to remake the system entirely by implementing universal health care.
Arizona Democrats are divided, too.
After health care helped Democrats retake the House in 2018, the topic has once again taken center stage in the 2020 Democratic primary and promises to be one of the top policy items voters consider when they head to the polls next year.
Some candidates, particularly U.S. Sens. Elizabeth Warren and Bernie Sanders, are pushing the conversation further left with a “Medicare for All” proposal. They propose creating a national, comprehensive health insurance program that would replace most current coverage sources, including by eliminating private insurance.
But others are pressing for less extreme options. Former Vice President Joe Biden wants to build on the Affordable Care Act by creating a public option, which would create a government-run insurance plan that people could purchase on the health care exchanges.
In the past year, Democrats have submitted various pieces of legislation that would do everything from overhaul the entire system with Medicare for All, to taking more moderate steps that would essentially expand the reach of the Affordable Care Act.
“All the plans are similar in that they aim to address some of the country’s most pressing problems right now, like the fact that 30 million are still uninsured, 44 million are still underinsured and health care costs are rising faster than median income in most states,” said Sara Collins, vice president for health care coverage and access with the Commonwealth Fund, a nonprofit health care research group.
In Arizona, members of the U.S. congressional delegation all seem to share the view that the country’s health care system needs serious reform. But they differ drastically over what that reform should look like.
Republicans point steadfastly at the Affordable Care Act for exacerbating the country’s health care ills and continue to call for its repeal. Arizona Democrats, meanwhile, have shown varying levels of enthusiasm for Medicare for All. Some are wholeheartedly on board. Others have signaled they’re wary or have remained mum on the subject.
Here’s where they stand on health care:
Sen. Kyrsten Sinema (D)
“I am really focused on the solutions that are realistic and pragmatic and that we can get done,” she told reporters last year.
A spokeswoman confirmed that her position on universal coverage has not changed, adding that Sinema supports protecting people with pre-existing conditions, and that she “is working with her colleagues on both sides of the aisle to make health care more affordable so all Arizonans have access to the care they need and deserve.”
Sen. Martha McSally (R)
While a member of the U.S. House, McSally voted to repeal the Affordable Care Act. She has said the health law’s individual markets have failed.
But she has also shown support for one key, and popular, piece of the health law: that it prevents insurers from discriminating against patients with pre-existing conditions. Still, she received a “Mostly False” rating from PolitiFact Arizona for claiming in an ad that she fought to “force insurance companies to cover pre-existing conditions.”
Rep. Tom O’Halleran (D-Sedona)
O’Halleran is considered a centrist Democrat. He has called on the Trump administration to defend the Affordable Care Act in court and protect people with pre-existing conditions, and also supports bringing down the cost of prescription drugs.
Like Sinema, he has not aligned himself with Medicare for All, nor has he signed on to support the other ambitious bills Democrats have put forward so far, like creating a public option. He’s referenced the difficulties in passing significant legislation without support from across the aisle, saying during a town hall that he prefers options to stabilize the insurance market.
Rep. Ann Kirkpatrick (D-Tucson)
Kirkpatrick has thrown herself behind Medicare for All, as well as the public option and expanding subsidies for those buying plans on the exchanges.
“Many have argued that my support for the Affordable Care Act cost me my congressional seat in 2010, however I have and will always stand by that vote,” she said in an emailed statement. “I am committed to supporting proposals that will protect coverage for people with pre-existing conditions, lower prescription drug prices, stop surprise medical bills and make health care overall more affordable and hopefully soon—universal.”
Rep. Raúl Grijalva (D-Tucson)
Like Kirkpatrick, Grijalva, co-chairman of the Congressional Progressive Caucus, supports Medicare for All, and was one of the original co-sponsors of the House’s legislation.
“We need a health care system that works for the people, not one that continues to allow insurance companies to stand between people and their care,” Grijalva said in an emailed statement. “I support policies like Medicare For All because everyone has a fundamental right to quality, affordable health care—and it makes our nation stronger.”
Rep. Paul Gosar (R-Prescott)
Gosar believes that the Affordable Care Act worsened an already struggling health care system. He points to Democrats’ push for universal health care as their own admission that the Affordable Care Act has failed.
In a statement, he called for full transparency on health care billing, more direct pay services that would result in “true market pricing” and the continued protection of people with pre-existing conditions.
Rep. Andy Biggs (R-Gilbert)
Biggs believes that the federal government should be entirely removed “from the unconstitutional role of regulating our nation’s healthcare system,” according to his website. That includes a full repeal of the Affordable Care Act.
Rep. David Schweikert (R-Fountain Hills)
Schweikert’s website says that the Affordable Care Act “has confused an already complex and wasteful healthcare system.”
In an interview this week, he said that Congress is focusing on the wrong issues in health care, though. It should instead work to clear legislative hurdles for advances in pharmaceuticals and health care technology that would reduce cost and increase access across the board, he said.
He thinks debates over the Affordable Care Act and universal health care would become moot if people were able to quickly get their ailments diagnosed and treated, and some of the most expensive chronic diseases were cured. And clearing the way for those innovations to become affordable and accessible is, he said, a bipartisan issue.
“All of a sudden, the debate over the ACA or nationalizing health care in some ways becomes silly because you’re able to do so much more taking care of yourself at such a dramatically less expensive price,” he said.
Rep. Ruben Gallego (D-Phoenix)
Gallego supports Medicare for All. In an emailed statement, he said he wants to stop the Trump administration “from playing politics with people’s health care.
“But we need to do much more,” he continued. “Quality, affordable health care is a fundamental human right, and I am working with my colleagues to push for bold legislative action. Bringing down prescription drug prices, fully funding community health care centers, establishing a public option under the ACA, and passing Medicare for All, are all efforts that will reduce costs, expand coverage, and ultimately move us closer to the kind of health care system the American people deserve.”
Rep. Debbie Lesko (R-Peoria)
Lesko agrees with her Republican colleagues and claims that the Affordable Care Act has been failing for years. In an email, she called the Medicare for All plans that eliminate private insurance “a complete government takeover of our health care system.
“The key to fixing our broken health care system is putting patients back in charge of their health plans, less government involvement and regulations, and protecting those with pre-existing conditions,” she said.
Rep. Greg Stanton (D-Phoenix)
While he was mayor of Phoenix, Stanton side-stepped a resolution sponsored by the local chapter of the Democratic Socialists of America asking the City Council to support Medicare for All. And since he’s joined Congress, Stanton has not signed on to support Medicare for All legislation.
During a town hall at Arizona State University’s Tempe campus, Stanton said he supports the Affordable Care Act, but noted that Medicare for All would have a hard time getting through Congress with a Republican-controlled Senate, according to the university’s newspaper, the State Press.