The Republican fight to change the nation's health care system isn't over, U.S. Rep John J. Faso Jr. said Tuesday.
Despite the withdrawal of proposed Obamacare replacement legislation before a vote last month, Faso said there's still a need to change national health care policy, control Medicaid costs and manage the growth of insurance premiums.
"The primary purpose of our proposed change in Medicaid is to control costs," Faso said during a meeting with the Gazette's editorial board. "Our national debt of $19 trillion in 10 years will be $29 trillion, and it will be driven largely by Medicare, Medicaid and payments on the national debt."
Faso, who is part of a group of moderate House Republicans known as the Tuesday Group, has been deeply involved in the Republican effort to replace the Affordable Care Act, the 2010 law widely referred to as Obamacare after President Barack Obama.
"My view has never been to repeal and replace. My view has been to keep what works and fix what doesn't," Faso said.
Faso, R-Kinderhook, was elected last November to represent the 19th Congressional District, the seat previously held by Chris Gibson, R-Kinderhook. The district stretches from the Hudson Valley to Montgomery and Schoharie counties.
While the ACA brought insurance coverage to more people, required coverage of pre-existing conditions and allowed young people to remain covered by their parents' insurance, it has also lead to higher premiums costs, he said. "I've had small businesses tell me their premiums have doubled or tripled, or there are $3,000 and $4,000 deductibles," he said.
Businesses have also resorted to hiring only part-time workers or not hiring to avoid federal insurance mandates, he said. "There are unintended consequences," Faso said. "That's an unintended consequence."
Faso supported the Republicans' American Health Care Act proposal, including its provisions that would have turned the federal Medicaid program — health services coverage for the poor — into a block grant program, in which states are awarded flat sums.
"Medicaid would no longer be an entitlement," Faso said. "It would be subject to the federal appropriation process."
"The idea behind the block grant is to give the states more flexibility in what they can do with money received from the federal government," he said. "It would be a means of providing an incentive for the states to control their costs."
The block grants are one of the ideas critics of the Republican proposal have hit at hardest.
"What he proposes will hurt lots and lots of people," said Elisabeth Benjamin, vice president of health initiatives for the Community Service Society and co-founder of Health Care for All New York.
"In New York state, it seems like we've done a really good job of controlling costs of Medicaid," she said. "What they are proposing would hurt existing patients. What they are doing would cost shift from the federal government to the states."
New York, Faso said, has particularly high costs, in part because the state passes part of its Medicaid bill along to counties. Faso co-sponsored a proposal for the state to take over the county costs — an idea that Gov. Andrew Cuomo has angrily criticized. Following the withdrawal of the AHCA, Faso and other Republicans representing New York in Congress introduced the idea as stand-alone legislation.
Lifting the cost of Medicaid would allow counties to reduce their property tax levies, he said. It was an issue he campaigned on last fall. "What's killing upstate New York is lack of high-paying jobs and high property taxes," he said.
But critics like Benjamin and Cuomo say changing the system would reduce benefits to tens of thousands of people in the 19th Congressional District alone.
“If this bill is passed as is, our federal representatives will be responsible for massive income or sales tax increases or devastating cuts to New York’s health care system," Cuomo said when the proposal surfaced in March.
"It's clearly a clash of values," Benjamin said. "It's that America can do better and have decent affordable health insurance, versus no, our highest and No. 1 priority is a tax cut."
A second provision of the ACHA that remains under consideration — and which Faso supports — is a "stop loss" provision under which the federal government would step in to cover "catastrophic" medical bills, reducing an insurance plan's concerns about covering those costs. "That would lower premiums for everyone," he said.
The Congressional Budget Office is currently reviewing what the impact of the Republican proposals, as amendments to the Affordable Care Act, would cost as opposed to being part of a complete replacement bill.
Faso, 64, was elected in November when he defeated progressive Democrat Zephyr Teachout in a race that drew national attention.
For Faso, it was a return to elected office after having served in the state Assembly from 1987 to 2002, including a stint as minority leader from 1998 to 2002. He ran unsuccessfully for state comptroller in 2002 and governor in 2006.
On other issues
—Faso said he supports the Trump administration's missile strike on Syria in response to the use of chemical weapons, but "if there's something bigger than this kind of one-off, he needs to come to Congress" for authorization.
—The building confrontation with North Korea over its testing of ballistic missiles "is fraught with peril from many different aspects." "We are running out of time and patience with the North Korean regime," he said. "We need to have tougher sanctions on any nation that in any way facilitates their development of ballistic missiles or nuclear weapons. This situation cannot last forever."
Asked about concerns about President Donald Trump's ability to handle such crises, Faso said he has high regard for retired generals James Mattis, who is Trump's defense secretary, and H.R. McMaster, the national security adviser. "These are serious, sober people who are leading our efforts," he said.
Faso said that Gibson, a neighbor in Kinderhook, remains a role model. "I think he's a great model just in terms of trying to constructively get things done," he said. "He had a lot of integrity."