Tuesday, March 25, 2014

Anthony Hall: Stefanik’s Weird Health Care Politics

healthcare-reformIn an interview with the Lake George Mirror, as well in interviews with other newspapers and in an op-ed piece published by the Watertown Daily Times in November, Congressional candidate Elise Stefanik stated that she favors the repeal of the Affordable Care Act.

She added that she would replace it with, among other things, measures that allow people to purchase health insurance from out of state insurers, purportedly on the grounds that the costs of health care would thereby drop. But anyone familiar with the Affordable Care Act knows that it does permit people to purchase health insurance across state lines.

Sections 1312, 1331 and 1333 of the ACA  allows states to form compacts through which insurers are allowed to sell policies in any state that is party to the compact. Those provisions were drafted to permit the less populous states to create larger, more sustainable risk pools, especially among low income groups.

No doubt Ms. Stefanik is aware of those provisions, and perhaps dismisses them because the insurance plans must still protect the consumer and meet the ACA’s definitions of adequate coverage.

I suspect that what Ms. Stefanik favors are measures similar to those John McCain advocated during his unsuccessful 2008 presidential campaign and which have been proposed by conservatives in many states in the south and the west.  While they  might allow an unregulated market to flourish, they would also encourage the sale of  fraudulent policies, or, at the very least, policies with high deductibles and minimal coverage.

Many of those state proposals are based on model legislation drafted by the right wing American Legislative Exchange Council.  Rather than a more market-oriented approach to the problem of the uninsured, the proposals are an attempt to reverse the progress made by the Affordable Care Act to cover the uninsured.

The model legislation includes the following provision: “Each Member State… may suspend by legislation the operation of all federal laws, rules, regulations, and orders regarding Health Care that are inconsistent with the laws and regulations adopted by the member state pursuant to this compact.”

States’ efforts to exempt themselves from federal laws date back to John C. Calhoun and his theory of federalism as a mere compact, justifying a state’s nullification of the nation’s laws and secession from the union. We know where that ended: in civil war.

Every policy is based upon an idea, and a bad policy is usually based on a bad idea. It looks to me as though Ms. Stefanik’s prescription for health care reform is one of those.

Illustration courtesy the National Electrical Contractor Association.




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Anthony F. Hall is the editor and publisher of the Lake George Mirror.

Anthony grew up in Warrensburg and after an education that included studying with beat poet Gregory Corso on an island in the Aegean, crewing a schooner in Hawaii, traveling through Greece and Turkey studying Byzantine art and archeology, and a stint at Lehman Brothers, he returned to the Adirondacks and took a job with legendary state senator Ron Stafford.

In 1998, Anthony and his wife Lisa acquired the Lake George Mirror, once part of a chain of weekly newspapers owned by his father Rob Hall.

Established in the 1880s, the Mirror is America’s oldest resort newspaper.

31 Responses

  1. John Sullivan says:


  2. Tony Goodwin says:

    In the ongoing debate regarding health care and health insurance, I remain mystified why the Democrats haven’t emphasized the costs of the significant amount of unpaid care that hospital must provide to the uninsured who can’t pay for the (mostly) emergency room care that they receive. Those costs are borne by those who are insured or who can afford to pay. The inherent unfairness of people receiving care, essentially for free, while the rest of us pay for both our own care and theirs should be the greatest argument for the insurance mandate.

    Of course, the above situation argues for universal single-payer health care, and that may have just been something supporters of the ACA didn’t want to broach. My own take at the time, September 2009, was that the health care debate had become so acrimonious that the wiser course would have been to, as I said in letters to the editor, hit the “reset button” so that any health care bill somehow had at least a modicum of bipartisan support. That would have significantly tempered the current opposition and not made it a “flagship” campaign issue for Republicans.

  3. Buddy Boyd says:

    Sounds like Ms. Stefanik is rehashing the same old Republican talking points. As such, she apparently has no new ideas.

  4. Curt Austin says:

    Conservatives want you to have the freedom to buy a policy from Arkansas.

    Hospitals don’t want you arriving in the ER with an Arkansas insurance card, since it means they won’t get paid. They’d prefer a NY card, since NY doesn’t allow you to buy goofy insurance.

    You will soon find out yourself that getting the Arkansas card was a mistake, but how were you to know? Read the policy? Don’t be absurd. You’ll think “There ought to be a law!” Bingo.

    It’s all very complicated, but I hope this provides a sense of the hazards of interstate insurance sales. My plea: never vote for someone who wants to reduce regulation in the insurance industry. Unless you are very good at parsing nested “Notwithstanding …” clauses.

  5. Paul K says:

    I am amazed that this subject is being discussed on this blog, but anyway,i will just sit back and watch this ACA just ruin the health care system in our country, letting our government take it over is just insane, WE THE PEOPLE can do much better.Nancy Pelosi said we had to pass the ACA before WE THE PEOPLE find out what is in it, well we are finding out and it is insanity, Mr. Hall, how blind can you be!!!!

    • Pete Nelson says:


      Apparently you are not familiar with the insurance industry, for which I worked for nearly a decade. If you think “We the People” is enshrined in the workings of your average insurer – which makes ungodly money in a legally rigged game – more than it is in a government of the people, by the people and for the people, then you are suffering from a major crisis in ignorance.

      I’m astounded by how many conservatives, professed “champions” of liberty, stand shoulder to shoulder with large corporations in the name (and name only) of “free enterprise” when those very large corporations have subverted the will of the people beyond anything our founding fathers could have imagined in their worst nightmares. But those truths can be harder to sort out than can be achieved by mere sloganeering and simplistic black-and-white thinking, so apparently it is easier to just go ahead and blame Nancy Pelosi.

      You have to be in the game for a while to know it. The ACA is flawed to be sure. But it is the right kind of idea.

      • Paul K says:

        Pete i have a good health policy, please tell the government to leave it alone, its ALL ABOUT POWER Pete, go ahead and embrace the ACA, like lambs to the slaughter, it is already tanking before our eyes

    • You can’t spoil what’s already rotten.

      • Paul K says:

        rotten! its not perfect,but it is the best, this ACA is such a beat down, so you go out of the country for your health care?

  6. Henry says:

    As much as I would like to see bipartisan solutions that garner lots of support they sadly do not exist in our current political climate. The default Republican position on the ACA was similar to their position on every other major issue–if the Dems move to the right, move the goalposts to the right further. Plus, their bedrock pricipals mean they are adamently opposed to whatever the President supports, no matter what it is, including the conservative healthcare plan passed. Remember, the ACA is actually based on conservative proposals originally pushed by people like the Heritage Foundation and Mitt Romney!

  7. Randy says:

    Not sure why this article is even in the Adirondack Almanac. I like to read the articles as a way of getting away from the constant whine that is becoming part of our politics in this country. That “notwithstanding”, I am now a full-fledged “old guy” complete with Social Security check and Medicare. Both were “disastrous” intrusions on our liberty when they were introduced. Both are working just fine, helping to keep millions of Americans safe and healthy. The ACA is by no means perfect, but should be viewed as a work in progress. It will provide the basis for better health care for all of us in the future. Those who complain about government intrusions on their lives should refuse any assistance during times of disaster, should not travel on roads, should not go to school, should not take any medicines or buy and food at the supermarket, etc, etc, etc. Call me old-fashioned (as in the Theodore Roosevelt school of reforms) but I believe government’s purpose is to support and protects its citizens, not the interests of large corporations, including those of the insurance industry.

    • Paul K says:

      i pay taxes, so when a crises arrives!!!, i wonder if the White House is insured by those evil insurance companies.

  8. John L says:

    For the Author: You called the American Legislative Exchange Council Right Wing. Why didn’t you mention the EXTREME left wing that rammed through the ACA with not one opposition party vote. That’s never been done before on legislation of this magnitude.
    For Tony: There will be almost as many people that will be uninsured AFTER the ACA as before.
    For Buddy: New ideas will never take the place of Good Ideas.
    For Curt: Never vote for someone who wants the Government to take over ANY private sector function, EXPECIALLY one that impacts your personal health and well-being.
    For Paul K: Amen to you Paul. Trusting the people who said ‘You have to pass this bill to find out what’s in it” is MADNESS. BTW, Paul, what are you doing in the midst of all these government ‘sheep’. Hang in there pal.
    For Pete: Is there any subject on this website that you don’t have some sage, know it all, ‘life experience’ comment about.
    For Everyone: I hope I’m wrong, but 5 years from now (or maybe 2), I don’t think anyone will be writing in touting the ACA.

    • Pete Nelson says:

      John L:

      I’m flattered you’re paying attention. I worked for an insurance company for nine years. What can I say? I know how they work.

      Like any corporation their goal is profit and growth. There’s nothing inherently wrong with that. The problem is that this market is a rigged money maker. They have a bank of mathematicians that work every day to ensure they cannot lose. They manage their profits by deciding how much money to put into reserves, which are not counted as assets. These reserves are typically amounts that would boggle your mind.

      Imagine that the top five insurance companies decided to be altruistic and help the national economy by donating half – not all, half – of their reserves to federal deficit reduction. Their contribution – just five companies, mind you – would eliminate the entire national deficit.

      A single company – the largest one in my home state – could give up one percent of its reserves and restore all the financial losses in the state’s education system over the last twenty years… I mean it would be a game changer. Of course that’s not going to happen, now is it? This despite the fact that a 1% drop in reserves can potentially occur any day there’s a bad market, no big deal.

      No companies in the world have the financial muscle of insurance companies.

      Conservatives seem to love that capitol-intensive stuff, don’t they? I guess they like to pretend that they can be that rich and self-centered some day. Good luck with that.

  9. Paul says:

    Here is what we can expect from Washington for two years after the midterm election.

    Congress votes on party lines to repeal the ACA. The president vetoes it.

    Congress votes on party lines to repeal the ACA. The president vetoes it.

    Congress votes on party lines to repeal the ACA. The president vetoes it.

    and so on and so on….

  10. Our health care system is fundamentally broken. The ACA may tweak around the edges but won’t fix it in any meaningful way. The GOP’s “ideas” may tweak around the edges but won’t fix it in any meaningful way. Medicare for All is the only way to fix the system in any meaningful way.

    Even before the ACA, THE MAJORITY (53%) of money in the health care system was public money. Your tax money is ALREADY funding the health care system. It’s just doing so in the most inefficient (except for insurance conglomerates’ balance sheets) way imaginable. Single payer, with its proven record of significantly lower overhead, is the only way to address this. Matt Funicello recognizes this. Stefanik and Woolf will keep their heads buried in the sand.

  11. Tony Hall says:

    To Paul K and Randy, who wonder why this commentary has been posted on Adirondack Almanack. I’ll let John Warren speak for himself about his editorial decisions, but I would add that we’re not merely residents of the Adirondacks, we’re citizens, and therefore have a responsibility to be engaged not only in our local communities but in our region. As the editor of a local paper, I devote much more space to local issues than I do to regional issues, but we now have a race among candidates seeking to represent us in Congress, so they should expect to be scrutinized. The Adirondack Daily Enterprise and NCPR, among others, treat these candidates and issues with the seriousness they deserve, and every local medium should do likewise in the communities they represent. I know they’re not the most popular stories – I’ve been told, “The Lake George Mirror is not The New York Times,” something which, believe it or not, I’m aware of – but they still deserve our attention. We shouldn’t assume that a candidate’s positions are as simplistic as Paul says; we should at least give candidates the benefit of the doubt and allow them to make their cases. And if the candidates’ positions are as dogmatic and simplistic as Paul suggests, the candidate should be called on it. We’re not idiots. Local media can provide a local perspective on issues that, however national they may be, directly affect our communities and our lives here.

  12. Steve Hall says:

    ACA is far from perfect, and it would have been much better, in my opinion, to go with a single payer solution. Having said that, it seems to me that opponents of ACA were quite satisfied with our healthcare system, when its chief hallmark was that it cost American citizens, on average, more than twice as much as the health care systems of any other western country, which leads to the second point. Opponents of ACA continually confuse two important factors about Health Care in America, namely American medical technology and secialists, which are generally speaking second to none, with its delivery of these services to the afflicted, which, according to the World Health Organization, is ranked 35th, in the western world.

    What about comparing the American and Canadian systems? In addition to the Wildlife Refuge, we run a vacation rental business, and half of our clients are Canadian. I have yet to meet one who would prefer our system to theirs. Opponents of ACA continually provide anecdotal arguments, such as “why do so many Canadians come to the US for special procedures?”, but while they’ll provide individual examples, they never provide any numbers, because they would be counter-productive to their arguments, not least because it tends to be only wealthy Canadians for whom the cost of the procedure is not a guiding factor. By the way, thanks to American medical technology, wealthy citizens of many European and mid eastern countries also come to the U.S., because they can afford the very doctors and procedures, which you probably can not.

    Opponents of ACA also claim that higher Canadian taxes trump any savings in state sponsored health care, but as with so many arguments involving comparing two systems from different country, the charge is over-simplified to make a point, and for the vast majority of Canadians not true. Google it and see.

    Some folks commenting here cite the famous out of context quote, about having to pass the bill to see what’s in it, as though the length of the bill was intended to discourage actually reading it. In point of fact, just as so many bills are largely authored by lobbyists for the special interests they serve, most Congressional bills go unread by your congressman, because they are ALL “too long”, and while this is certainly worthy of discussion, it is not unique to ACA, which is indeed one of the ten “wordiest” bills in Congressional history, but try reading “no child left behind” or any of the defense bills, which are in the same general ballpark, partly because pork barrel politics is alive and well, despite all the promises from Washington.

    Finally, everyone freaks out about the mandated policies, which are set up to prevent you and I from having to pay for the uninsured guy who shows up at the emergency room, and skips on the bill.

    Opponents call it unconstitutional and unprecedented, when it is neither. In 1790, a Congress including 20 Founders passed a law requiring that ship owners buy medical insurance for their seamen. Washington signed it into law. In 1792, another law signed by Washington required that all able-bodied men buy a firearm. And, in 1798, a Congress with five framers passed a law requiring that all seamen buy hospital insurance for themselves. Adams signed this legislation.

    I don’t know anyone who believes that the ACA is the best possible system, but as with so many other issues today, our absurdly polarized, “sound byte”, gotcha! poltical discussions seem to start with who supports what, rather than what may be good for our nation as a whole. Or as Groucho Marx used to say, “Whatever it is…. I’m against it!!!”

  13. Peter Brownsey says:

    This political discussion does not belong on the Adirondack Almanack.

  14. John Warren says:

    The Adirondack Almanack has, for nearly ten years now, always run stories about our politics.

    Tony is right when he says “we’re not merely residents of the Adirondacks, we’re citizens, and therefore have a responsibility to be engaged not only in our local communities but in our region”.

    The Adirondacks is not all fluffy bears and gurgling streams – people live here too.

    John Warren
    Founder, Editor

    • Paul K says:

      i understand that, i just thought i would throw it in for fun

    • Peter Brownsey says:

      John, For partisan politics I go to POLITICO or The Huffington Post not The Adirondack Almanack. I live here too.

      • John L says:

        Hmmmm. Politico, Huffpo. They’re a great place to get all sides of an issue. You’re not kidding when you say ‘for partisan politics’ I go to’. I’m surprised you didn’t mention Daily Kos too.

    • Amen. Anyone who thinks access to health care isn’t a major issue in the Adirondacks doesn’t actually live here.

  15. Randy says:

    Fluffy bears and gurgling brooks? The true adirondackers carved homes here and depended on themselves not the government. They would see through all this liberal rhetoric. You take only one part of what a person says so it immediately is out of context. Then let’s “suspect” what that means and try and tie it to something else. We are citizens, and we expect the political sites to produce this slanted coverage and “weird” biased commentary. Let’s throw out the ACA and be “forever wild”.

  16. Charlie S says:

    I am not an Obama fan,let me get that out. I think Obamacare could have been better than what it is.Paul K seems to think the Affordable Care Act (ACA) will ruin the health care system in our country,he says letting our government take it over is just insane.

    So I suppose we keep letting the private people decide on our healthcare hey Paul? And while we’re at it let’s keep privatizing prisons and schools and…what else is left that is not privatized? Let’s privatize the Adirondacks!

    Insanity is doing the same thing over and over and expecting different results.Which cave have you been in Paul? Ruin the healthcare system? Dear me.These are the same people trying to convince us that global warming is a liberal hoax even though 10,000 year-old glaciers are disappearing from the face of the earth; the same people who said “Kill em all” referring to Iraqi men,women and children whose life and limbs were lost due to bombs directed by their puppet savior,terrorist George W. Bush; the same people who would rather see taxpayer dollars go towards a new privately-owned football stadium…
    Yet when it comes to helping out their poor fellow American brothers and sisters….

    Listening to the talking heads from the Tory camp you’ll hear Obama this Obama that,how Obamascare is going to ruin this country and on and on yak,yak,yak… yet what you don’t hear is that none of their brethren tried to help the prez out on this,they fought him every step of the way to make sure the healthcare system in this country did not change as corrupt as it was. It is ‘they’ who are to blame for what we got (or didn’t get) with the new ACA.

    As an aside I know someone who recently came up with colorectal cancer.He was treated and is now going through six months of chemo and if it wasn’t for the ACA he would be having a very hard time economically right now.

  17. Paul says:

    Big programs like this do require tweaking. But I wonder if this program is tweaking itself to death? There is quite a laundry list of changes that have been made since the implementation. There comes a point where you have made so many changes that the fundamental underpinning of the economics will collapse. Also most of these changes have been made for political reasons.

    • Henry says:

      One of the many reasons for the huge complicated mess that is ACA is that it was based on the very conservative idea that we had to somehow preserve all the complicated business relationships (or as many as possible) that were a pre-existing condition, while at the same time covering 40+ million people who didn’t have coverage, and accommodate quirks of 50 different states, the whims of religious conservatives, yada, yada. Single payer or Medicare for all would have been ten times less complicated, covered more for less, and probably worked better too. But, the ACA is what it is, and it is already saving lives, preventing bankruptcies, and helping our fellow citizens, which strengthens all our communities here in the Adirondacks. When your neighbor down the street dies an early death or destroys his families finances because of a medical emergency he also stops buying things in your stores, stops paying his taxes, stops volunteering, etc. It impacts everyone, and is part of self-reliance to support your neighbors and friends.