Hagan v. Tillis: The health care debate within the debate

As expected health care played a major role in the first debate between Sen. Hagan and Speaker Tillis.

Tillis took two major lines of attack against Sen. Hagan on health care: he chastised Hagan for saying that people could keep the insurance plan they like, and he criticized the policy of setting minimum standards for insurance plans. He also mentioned at the end of the debate that people will pay 11 percent more for insurance next year but that was a strange sidebar claim with no evidence to support it. Insurance policies are not yet posted and have not even completed regulatory review.

On the first point Tillis chose his words carefully. Koch brother groups in North Carolina keep claiming that thousands of people in the state lost their insurance. The Tillis camp apparently realizes that this is a ridiculous assertion. So Tillis said that thousands of people received cancellation notices from their insurance company. This thrust was parried by Hagan when she pointed out that the plans were continued when she and other members of Congress pressured the Obama Administration to keep the policies in place. She also noted that insurers continued selling non-compliant insurance plans to consumers after the Affordable Care Act was signed without adequately explaining that the policies would have to change after 2014.

On the second point Tillis argued that people should be able to purchase any insurance plan they want without regulations on what is covered. The Affordable Care Act imposes some standards on insurance policies. Hagan didn’t spent much time responding to this charge, although she could have noted that his push for mandating that insurance cover Autism treatments directly contradicts his criticism of health reform. The problem with deregulating insurance is twofold. First, health insurance is unique in that people really don’t know what they will need. Consumers tend to buy the least expensive plan available and then get drowned in medical debt when someone in the family gets sick and needs an uncovered treatment. Second, there were some services that no insurance plan covered on the individual market, like pregnancy. For some services, for example many Autism treatments, if you don’t require it then insurers won’t offer it. Making insurance plans comprehensive does increase the price of some policies, which is why subsidies are available to make the plans more affordable.

Hagan counterattacked on health care with three main points: Tillis refused Medicaid expansion, which is having enormous consequences for the state; he opposed the requirement that all insurance plans cover birth control; and he wants to repeal the Affordable Care Act, which will cause a cascade of negative consequences.

Tillis largely ignored the first and third arguments other than saying that the Affordable Care Act will bankrupt the country, although strangely he also acknowledged that it reduces the deficit by “taking” money from Medicare. On birth control Tillis followed an emerging national GOP talking point that we should provide oral contraceptives over-the-counter without a prescription. This was a useful proposal as it made Speaker Tillis sound more sympathetic to the idea of providing birth control. The problem is that it’s beside the point. The question is whether or not he thinks birth control should be a basic feature of a comprehensive health insurance plan. An IUD, after all, is one of the most effective forms of birth control and that’s not going to be sold beside the cold remedies in your local pharmacy.

I’m sure that health care will be a major feature of the next debate. It would be nice to see the candidates stray from their scripts to engage a bit on the topic. For example, Tillis could have asked Sen. Hagan (or “Kay” as he calls her) to elaborate on what changes she would make to the health care law. Hagan could have asked for more specifics on why Tillis opposes Medicaid expansion, especially when so many deeply conservative states are now creating state-specific programs to cover low-income residents. I’m not optimistic that we will get candid opinions in a media age where politicians only seek to avoid gaffes, but we can always hope.


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