(VIDEO INSIDE) Heitkamp: Health care should focus on incentives, not mandates

Heidi Heitkamp

FARGO – Democrat Heidi Heitkamp said Monday that Congress ought to be discussing ways to reduce health care costs while emphasizing personal wellness, instead of continuing to politicize controversial reforms.

In her first visit with The Forum Editorial Board since launching her Senate bid last fall, Heitkamp clarified her position on the 2010 law – now commonly called Obamacare – and she railed against the “demagoguery” of critics who seek to repeal it while offering few solutions.

“You really need to have people – instead of pointing fingers and using health care as a political football – you need to have them sit down at a table and start talking about what the real costs are and how you solve it,” Heitkamp said.

Health care reform has been one of the most dominant issues in North Dakota’s U.S. Senate race, offering a clear contrast between Heitkamp and Republican Rep. Rick Berg.

Berg adamantly favors repealing the controversial law, and his campaign has relentlessly attacked Heitkamp for her evolving support of it.

After Congress passed the health care law in spring 2010, Heitkamp headlined rallies, in which she praised the law. She called the bill “a legacy vote” and urged supporters of the law to “be vigilant” against efforts to repeal it.

Two years later, Heitkamp said this spring – for the first time publicly – that she’s “often said that it’s not a perfect law.”

Heitkamp expanded on those statements Monday, detailing areas she said the law fell short or was altogether flawed.

“I’ve never liked the mandate – in part because of where it came from,” Heitkamp said referring to the mandate’s origins as a proposal offered by a Republican think tank during the health care debate of the 1990s.

“It presupposes people don’t buy health insurance because they don’t want to,” Heitkamp said. “People don’t buy health insurance because they can’t afford it.”

The individual mandate – which requires all Americans to buy health insurance or be subject to a fine – is the law’s critical element. The Supreme Court upheld the mandate last month as a legal tax.

“That was part of how they made the whole thing balance in the end,” Heitkamp said, “but you need to start from the premise that we’re starting from: How do you get people healthier?”

Heitkamp said the penalty for not having health insurance isn’t severe enough to incentivize people to get insurance, so it won’t work to meet the goal of reducing costs.

“It’s not going to add to the ranks of the people insured,” Heitkamp said. “You need to deal with making health care costs more affordable.”

To that end, Heitkamp said the 2010 law should have looked at ways to promote prevention and early intervention of chronic disease.

“We’ve put no onus on individuals to try and begin to address those issues” of wellness, Heitkamp said, adding that she supports health savings accounts, which could encourage people to take responsibility over their own health and care.

“If you ask me, I’d take a look at private incentives to buy health care, which might be more valuable than a mandate,” she said.

Berg and national conservative groups have slammed Heitkamp for refusing to support a total repeal of the law.

Heitkamp said Monday, “the single reason why I would not vote to repeal the Affordable Care Act is the Frontier Amendment.”

The provision – lobbied for by North Dakota’s delegation and other rural states – fixed a decades-long inequity in Medicare reimbursements to states that provided good-quality care at lower costs.

Heitkamp rejected an assertion by Berg and other critics that the Frontier Amendment could be added back as its own separate legislation.

“If we see the Frontier Amendment repealed, we will never get it back – not in this climate,” Heitkamp said.

On the flip side, Heitkamp reiterated her support for more popular parts of the law, many of which her opponent, Berg, also supports: the additional coverage of pre-existing conditions, allowing young adults on their parents’ plan and removing both the million-dollar insurance cap and the donut hole for Medicare.

Additionally, Heitkamp said the state health care exchanges required by the law are “a great idea” to promote competition.

“They create a network of insurance, where people can self-select what works best for them and you can reduce premium costs overall,” Heitkamp said.

She said it was a “tragedy” that state lawmakers voted down a plan to implement North Dakota’s health care exchanges during a special session of the Legislature last fall.

“I believe it was voted down for no other reason than politics,” Heitkamp said. “It was a political decision, because those exchanges were ready to go, they were bipartisan (and) every group – including Blue Cross Blue Shield – supported the formation of state health exchanges, in part because they don’t want a federal health exchange.”

“If you want to avoid a federal takeover of health insurance, you ought to do the state exchanges as a minimum,” she added.

Rick Berg

Berg’s campaign spokesman Chris Van Guilder did not specify the congressman’s position on the health care exchanges, instead he reiterated Berg’s opposition to the law in its entirety.

“President Obama’s massive government takeover of health care that he forced on the American people is not the right approach,” Van Guilder said. “Rick Berg supports the full repeal of Obamacare and then seeking step-by-step reforms to decrease costs, increase access, and ensure health care decisions belong to patients and their doctors – not government bureaucrats and government-run bureaucracies.”

Also during Monday’s visit, Heitkamp responded to a bit of criticism from Berg’s campaign, who’s been hounding the Democrat to answer for a comment she made at a public event in April when she said Obamacare was a “budget-saver.”

For more than three months, Berg’s campaign has tried to call out Heitkamp on her words and the lack of information she provided publicly to back them up.

To explain her “budget-saver” comment to The Forum Editorial Board, Heitkamp cited a Congressional Budget Office report from January 2011 that found repealing the health care reform law would cost $230 billion over 10 years.

“Repealing it actually adds to the deficit,” Heitkamp said, adding that the price tag of the original bill itself is still a budget-saver. “Well, yeah – because it’s paid for.”

In 2011, CBO officials testified before a congressional committee that the net benefit of health care reform would mean a deficit reduction of $210 billion by 2021.

However, Berg’s campaign didn’t buy her explanation.

“Even the most loyal of President Obama’s allies have conceded that the nearly $1.8 trillion health care takeover adds to the deficit,” Van Guilder said. “Continuing to defend Obamacare’s massive price tag and tax increases, in light of the mounting non-partisan evidence that shows hundreds of billions of dollars in exploding deficits and debt, puts Heidi Heitkamp in a class by herself when it comes to promoting President Obama’s failed policies.

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