Monday, February 6, 2017

An Hour With John Faso

On February 3, 2017, the Affordable Care Task Force, a subgroup of the Columbia County Democratic Committee, met with Congressman John Faso in his Kinderhook Office to discuss his position on the Affordable Care Act.


Right from the start he was quite clear that he would not vote to defund Planned Parenthood, noting that the organization receives federal reimbursement for ordinary medical care for women and nothing for abortions.


Much of the meeting addressed Congressman Faso's position on the ACA. To reassure the group he said that complete repeal without a substitution was unlikely, that he intends to support having a replacement before taking action, and that Republicans are coming around to this. Given that insurers are already setting their rates for 2018, he expects that the process to complete replacement could take at least two years.


He was asked whether he favored one of two GOP bills that have been proposed and which offer slightly different approaches to replacement:
  • Tom Price's Empower Patients First Act, which repeals all of the ACA and substitutes full privatization,  
  • The more moderate Cassidy-Collins bill, which would allow states to keep the ACA as one of three options. (It should be pointed out, however, that the GOP are set on reducing federal funds for Medicaid, which will prevent many, if not all, state who have opted for the full ACA to be able to fund it on their own.)


Faso seemed to learn toward the second bill.  He stated several times that parts of the ACA should stay, including
  • keeping the pre-existing conditions clause,
  • children up to age 26 years can stay on their parent's insurance, and
  • no lifetime limits.


He also favored certain provisions of both the plans, which would:
  • offer tax credits to individuals who bought insurance,
  • expand health savings accounts,
  • provide a greater variety of health insurance plans,
  • get rid of the individual mandate, which penalizes people who do not buy health insurance.


On the last point, it should be stressed that Congress can eliminate the mandate immediately because it involves funding. Repealing parts of the ACA involving regulation will come later. Eliminating this penalty would benefit healthy young people, but tossing this group out of the insurance pool would dramatically increase the costs to the insurer for high-risk individuals who incur extraordinary medical expense, estimated at $25 billion per annum. To address this problem, Faso supports lowering the price of insurance for young people by changing the ratio of what they pay now compared to older people (3 to 1) to 5 to 1-- called age banding.  This might reduce insurance payments for younger adults but it would also increase them for older groups.


On other potential replacement provisions, Congressman Faso would permit small businesses and associations to join together to provide health plans.  He also supports the idea of buying insurance across state lines, recognizing, however, the challenge of different state standards and lack of shared networks.  For example, why would a Columbia County resident buy insurance in North Dakota, whose network of physicians would be very unlikely to practice in a New York county?  Faso’s idea was to allow people to purchase insurance from insurers in a cluster of adjoining states, which would set similar standards and share physician networks. Such collaboration between states with very different standards, however, is unlikely.


Because Faso represents New Yorkers, who have access to a rich health insurance program under the ACA, he indicated his support for the Collins-Cassidy provision that would allow states, including New York, to keep the ACA as it is.  New York has whole-heartedly adopted all parts of the ACA, importantly Medicaid expansion, which is expensive and provides essential benefits to people above the poverty line and protections for specific groups.  Given Faso's record, it is unlikely that he would fight his peers for the amount of funding needed by states like New York to retain the ACA as is.  


On another issue related to healthcare, Faso is in favor of permitting the importation of non-FDA approved drugs from countries that have pharmaceutical regulations similar to those in the US. He has not taken a position on Medicare negotiating with drug companies.


Toward the end of the meeting, the members of the Task Force stressed how deeply terrified his constituents are of the Trump presidency in general and specifically about how Congress will address his demand to repeal and replace the ACA immediately. They advised Faso that holding live Town Hall meetings, rather than having them online, would be very helpful in directly reassuring his constituencies that moderate Republican voices still existed to help offset Trump's extreme and dangerous policies. Faso expressed his concern for live meetings, with their risk of major disruptions and distorted coverage.


Members of the Task Force concluded that the only modest hope at this point is for Republicans in liberal states, including Congressman Faso, to join Democrats to offset the most egregious policies of our current President, including the total destruction of the Affordable Care Act. If all or even important parts of the ACA are repealed, costs will dramatically increase and we will be propelled back into a Dark Age of Care, where millions of Americans will be harmed and many will die, particularly the poorest and most vulnerable among us.

About the Affordable Care Task Force. The Affordable Care Task Force provides fact-based information on health care issues, and promotes universal health care through events. It also works with other like-minded organizations and individuals to this end. ACTF is a subcommittee of Columbia County Democratic Committee, but its approach is inclusive, and delivers its information on a non-partisan basis. Keep up with ACA information on our Facebook page: https://www.facebook.com/Affordable-Care-Task-Force-1854478264838134/

ACTF members: Carol Peckham, Chair; Cyndy Hall, Keith Kanaga, Pam Kline

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