‘Build on what’s working.’ KC area Democrats opt for measured approach on health care

Expect to hear a lot about health care in 2020 from Democratic congressional candidates in Kansas and Missouri, but don't expect them to have the same message as their party's most progressive presidential contenders.

Democrats captured a House majority in 2018 with a message focused on health care. In 2020, the party looks to retain those seats and continue its expansion into once solidly-Republican suburban districts now trending blue.

But the Midwestern moderates running for Congress are keeping their distance from Democratic presidential contenders who want to do away with private health insurance and replace it with Medicare-for-All or some other single-payer system.

"I would like us to build on what's working," said state Sen. Barbara Bollier, a Mission Hills lawmaker who switched parties last year and is hoping to the first Kansas Democrat to win a Senate race since 1932.

Even before her party switch, Bollier, a retired physician, was one of the Kansas Legislature's most outspoken supporters of Medicaid expansion under the Affordable Care Act, which could provide health coverage for roughly 150,000 Kansans.

In a recent interview, she called health care the No. 1 issue concerning Kansans in 2020, but made clear she does not support Medicare-for-All legislation because it would remove people from their private insurance plans.

"Why would we remove people?" Bollier said.

MEDICARE FOR ALL, OR ALL WHO WANT IT?

Two top contenders for the Democratic nomination, Vermont Sen. Bernie Sanders and Massachusetts Sen. Elizabeth Warren, have put forward ambitious plans to enact Medicare-for-All. They would effectively replace the private health insurance industry.

Warren has softened her stance slightly, saying in recent weeks that there would be a transitional period when participation in the program would be optional under her plan.

Former Vice President Joe Biden, who leads in most national polls, has warned about the costs of these plans and instead favors a public option, an idea briefly pursued by President Barack Obama.

Former South Bend Mayor Pete Buttigieg has raised concerns about the impact to employment if the current insurance industry was replaced and has offered a "Medicare for All who want it" plan as an alternative to Sanders and Warren's policies.

Bollier's fellow Kansas Democrat, freshman Rep. Sharice Davids, also opposes Medicare-for-All legislation as currently written for the same reason.

In 2018, Davids flipped a seat that Republicans had won by double digits in the previous four elections with a message focused on health care. As a candidate, Davids had been open to a single-payer system as a long-term goal, but her campaign focused on more incremental steps, an approach she has continued in Congress.

As a first-term incumbent running for re-election, Davids will have a similar message framed around the array of incremental health care bills passed by the U.S. House this year, including brand-new legislation to lower the cost of prescription drugs.

"When I was running before there wasn't legislation that I had worked on or specific policies, and now the House has been passing bills," Davids said when asked about the role of health care in the 2020 campaign.

‘LET THE SAUSAGE-MAKING HAPPEN'

The bill, approved Dec. 12, would expand the U.S. government's power to negotiate drug prices for Medicare recipients and penalize companies that increase prices above the rate of inflation. The legislation stands little chance of passing in the GOP-held Senate, but it gives Democrats a useful talking point headed into 2020.

Minutes after House Democrats passed the bill, the Democratic Congressional Campaign Committee launched Facebook ads in swing districts across the nation.

An ad in Davids' district applauded her vote in favor of the bill. In Missouri, the DCCC attacked Republican Rep. Ann Wagner, who represents the St. Louis suburbs, for voting against it.

State Sen. Jill Schupp, a St. Louis County Democrat challenging Wagner, slammed her record on health care and noted her vote in May against a House bill intended to shore up protections for those with pre-existing conditions. This followed the Trump administration's decision to give states more leeway in setting requirements for health care exchanges.

But Schupp was reticent when asked about Medicare for All and the type of health care plan she'd like to pass if she wins the seat. She stressed the need for bipartisan consensus.

"When you build relationships and find common ground, you're going find the right way or the better way to build a plan," she said. "There's a lot of sausage making that goes into complex issues like this. And we need to let the sausage-making happen, so that we don't have a plan that then someone turns around and tries to undo."

Bob Salera, spokesman for the National Republican Congressional Committee, said Democrats in swing districts won't be able to run on health care this cycle without a focus on Medicare-for-All, a policy popular with progressives but divisive among the general electorate.

"They know just as well as we know that Medicare for All is toxic in these kind of swing districts, but unfortunately for them this is a presidential year. They don't get to set the agenda. The agenda is going to be set by the Democratic nominee," Salera said.

FIRST QUESTION AT CAMPAIGN EVENTS

A November poll from Quinnipiac University found that 52 percent of voters opposed the policy compared to 36 percent in support. Democratic-leaning respondents were more favorable, with 59 percent supporting Medicare-for-All; 71 percent said they would accept an optional Medicare buy-in program.

Adam Green, co-founder of the Progressive Change Campaign Committee, said Democrats need to make the case for the legislation to voters.

"Medicare-for-All is popular as long as we make the case that it gives people more choice to choose their doctors… and eliminates thousands of dollars in out-of-pocket costs for people," Green said.

"That's a message that sells very well in Kansas or Missouri," Green said.

Green noted that Davids, the incumbent Kansas Democrat, had been more open to the idea of a single-payer system as a candidate before coming out against Medicare-for-All as a member of Congress. Green's group had backed a rival candidate in the primary.

Sean Nicholson, a long-time progressive activist in Missouri, said it shouldn't be surprising that candidates from the Midwest are approaching the health care debate differently than some coastal Democrats.

"It's not fair to expect the solutions that come out of Brooklyn are the same that would come out of Kansas or Missouri," he said. "It's a great big country, and a diversity of thought and a whole lot of ideas are great. And that's how we get to solutions that work for everyone."

Nicholson said the party's internal debate on the issue is healthy.

"I don't think Twitter is real life. There is broad consensus that health care costs way too much and way too many people are really struggling. Democrats are having a robust debate about the details of their policies, and that's important," he said. "But at the end of the day what they are talking about is an America where you can have a baby without crippling debt."

Health care will be a major motivator in 2020 for Democratic-leaning voters in Missouri, where Republican lawmakers have blocked Medicaid expansion for years. Leading supporters have begun collecting signatures to put the issue on the 2020 statewide ballot. If it wins voter approval next fall, it's estimated that approximately 300,000 Missourians would become eligible for Medicaid coverage.

Lindsey Simmons, a Democrat challenging Republican Rep. Vicky Hartzler in central and western Missouri, said the first question she receives at campaign events is usually about health care. She wants to move toward 100 percent coverage, but avoids using the phrase Medicare-for-All when talking to voters because its meaning can vary.

"My concern when talking about Medicare-for-All is that it means so many different things to different people," Simmons said. "When I am talking about my vision for healthcare, I like to dive into the specifics so that people don't get bogged down in ‘Does this mean everyone gets the same healthcare as my grandma? Does that mean Bernie's plan? Does that mean Sen. Warren's plan?'"

Simmons said she does not support any plan that removes people from their current insurance without consent.

"There has to be a flexibility to this. I think we need to make the very best plan we can make and make sure as we're devising this plan and working towards this transition that we include stakeholders that include union members, who have historically sacrificed pay in exchange for better health care," she said.