WASHINGTON–Health care reform wasn’t a front-burner issue in the U.S. Senate contest, until Connecticut’s top insurance regulator approved a double-digit premium hike.

Attorney General Richard Blumenthal, the Democratic Senate nominee, blasted the decision, saying Commissioner Thomas Sullivan granted the insurers’ requested increases after a flawed, incomplete review.

Just as quickly, Blumenthal’s Republican opponent, Linda McMahon, circulated a press release tying Blumenthal and the health care reform law to the rate increase.

“Blumenthal-Backed Health Care Law Slams Connecticut With Rate Hikes Up To 47%,” blared the McMahon campaign’s missive.

But even as they try to seek political advantage from the latest health-related headlines, neither candidate has offered detailed views on the controversial health reform law.

Blumenthal has said the health care reform bill passed by Congress earlier this year is a “good first step,” but doesn’t do enough to rein in costs.

McMahon has said the law should be repealed and redone in a more bipartisan way, but she has declined to list exactly which provisions she likes and which she doesn’t.

Neither candidate would agree to be interviewed for this story, citing the crush of their campaign schedules. But a broad-brush outline of their competing views can be gleaned from their campaign websites, previous statements, and other material.

Here’s what we know about their positions:

Consumer protections: The health care law included several provisions to bar insurance companies from denying or dropping coverage. For example, the law prohibits insurers from such as refusing to write policies for children with pre-existing conditions and from canceling policies when patients get sick.

Blumenthal has said these are vital elements that he would fight to preserve.

“This health care reform bill makes sure that no child is denied health care coverage when she is sick and that no worker is dropped from health care coverage simply because he gets sick,” Blumenthal said in the third Senate debate in New London.

McMahon has said some of the mandates in the new law are burdensome.  But she avoided a direct answer when asked if she would vote to revoke the new patient protections, saying they needed to be reviewed for consequences and costs.

“We have to understand the consequences of passing legislation. So we have to understand there is a cost to that,” McMahon said at a press conference last month. “There are a lot of good programs that have been put in place, but can we afford to put them in place?”

Curbing health care costs: Both candidates have said the reform law doesn’t go far enough to truly bring down ballooning health care costs. But the proposals they offer on this contentious question are either not new or not very specific. And they would probably only nibble around the edges of the problem.

Blumenthal says he would take on the “special interests blocking real change” to rein in costs. But his main proposal is to allow Medicare to negotiate drug process, which he says would save $200 billion over 10 years. He has also talked about cutting waste and fraud in Medicare and Medicaid.

McMahon said she would oppose allowing the government to negotiate with the pharmaceutical companies for Medicare’s drug plans.

The only cost-cutting measure she has outlined in detail is medical malpractice reform. She said doctors are forced to practice “defensive medicine,” ordering redundant or unnecessary tests to shield themselves against “abusive lawsuits.”

McMahon said she strongly favors imposing limits on such lawsuits, such as caps on damages awarded to plaintiffs. She points to a Congressional Budget Office estimate that says such tort reform measures could reduce the federal budget deficit by an estimated $54 billion over the next 10 years.

Tort reform has generally been a divisive partisan issue. Democrats usually side with trial lawyers to oppose it, while Republicans side with business interests in support. A spokeswoman for Blumenthal’s campaign, Maura Downes, said Blumenthal believes there’s room for compromise on this issue, but she did not offer specifics about what he might support.

“There’s an opportunity here to seek solutions that find common ground between the doctors and the patient advocates on medical malpractice reform,” Downes said. “Any reform should assure that patients and providers benefit, not simply provide higher profits to insurance companies.”

In any case, both these campaign platforms amount to chump change when it comes to dealing with health costs. For example, Medicare spending alone is projected to be more than $500 billion for 2010, and that figure could climb to more than $1 trillion annually by 2020.

McMahon has also called for allowing small businesses to pool together to get health insurance and letting those policies be sold across state lines. Republicans have long pushed this idea, saying it would allow trade associations, like the National Federation of Independent Business, to offer health insurance to their members and introduce new competition into the marketplace.

But the legislation has never advanced very far in Congress, in part because it would allow insurers to opt out of state patient protection laws, such as well-baby visits and mammogram screenings. Critics say it would also do little to help the uninsured get coverage.

Premium rate increases: Critics of health reform, including McMahon, have blamed the new law for the recent premium rate hikes. They argue that the law’s new mandates are forcing insurance companies to offer more comprehensive benefits, thus resulting in pricier insurance plans.

Proponents of the law say that insurance companies are trying to raise prices as much as they can before new restrictions go into place, including a rule to guard against “excessive” rate hikes.

In the case of the 47 percent increase requested by Anthem for one of its individual market plans, Blumenthal said the insurance commissioner did not look at some basic data, such as whether the policies were profitable or losing money, before granting the hike.

And in an interview with the New Haven Register earlier this month, Blumenthal said the federal government should step in to block excessive rate hikes if state regulators can’t or won’t do so.

The health care overhaul stopped well short of giving the federal government the power to approve or reject insurance increases. Instead, the overhaul gives states additional resources to review rate increase requests and requires insurance companies proposing “unreasonable” increases to file a disclosure form justifying the increase with specific data.

Those disclosure forms can then be analyzed by federal and state officials to determine whether the rate is based on legitimate increases in the cost of medical care or other factors. Federal regulators are still working out detailed rules to enforce that provision.

Although McMahon’s campaign has tried to highlight the recent rate increases as evidence that health reform is not working, she has not said what proposals she would support, if any, to block unreasonable increases. Asked if she supported law’s efforts to ramp up state review and block excessive rate increases, Ed Patru, a spokesman for McMahon, did not directly answer, instead reiterating a criticism of Blumenthal’s support for the reform.

“She rejects this premise that the way we control health costs is to force companies to dramatically expand coverage and expect there will not be a cost for that,” Patru said.

The public option: One of the most contentious elements of the health care debate focused on whether to include a so-called “public option,” a government insurance plan that would compete with private insurance plans. Proponents said including a public plan, similar to Medicare, was the only way to fundamentally reform the health care system, by introducing real choice and competition to bring down costs. Detractors said it was tantamount to a government takeover of health care and would drive private insurers out of the marketplace.

It was not included in the final version of the law, but remains a flashpoint.  And it’s also a good indicator of a candidate’s general philosophy on the government’s role in health care.

In an interview with the Connecticut Post, McMahon said she would oppose any effort to include a public option in health reform.

“I don’t believe that the government would run the public option very well,” said McMahon.

Downes, the Blumenthal spokeswoman, said he favors the idea of a public option. “He would want to review the details of any proposal to determine whether it meets service and cost criteria that should be imposed,” Downes said.

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