Heitkamp: Health care should focus on incentives, not mandates

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 in the mid-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.

Kristen Daum is a reporter

at The Forum of Fargo-Moorhead, which is owned by Forum Communications Co.

Tags: news, healthcare, politics