ON THE ISSUES

[Editor’s note: This is the first in a three-part series examining the policy differences between the three candidates on the May 25 special-election ballot to fill the vacancy in Montana’s U.S. House seat. Today’s story looks at health care. Upcoming stories examine public lands and foreign policy.]

By SAM WILSON

Daily Inter Lake

Montana voters head to the polls May 25 to cast their ballots for the state’s next U.S. House representative, following the vacancy left by former Rep. Ryan Zinke’s ascendancy to the helm of the Department of the Interior in March.

Montana selects just one of the House’s 435 members, meaning the election typically gets scant attention outside the state. But with Democrats and Republicans both seeking affirmation following the surprise victory of President Donald Trump last November, the race has increasingly attracted a national spotlight and some serious out-of-state money.

And while negative attacks and generalized talking points have dominated a tightening and increasingly expensive race, Democrat Rob Quist and Republican Greg Gianforte have staked out some of their sharpest distinctions over the future of America’s health-care laws.

In interviews conducted last week, the two political newcomers, along with Libertarian candidate Mark Wicks, detailed their positions on the Affordable Care Act, current “repeal-and-replace” proposals offered by congressional Republicans and other aspects of the health-care industry in the United States.

The American Health Care Act, which passed the House earlier this month, is a Republican proposal to repeal and replace former President Barack Obama’s landmark health-care bill, the Affordable Care Act, commonly referred to as “Obamacare.”

Quist has campaigned extensively on a platform of retaining the Affordable Care Act, frequently noting that Montana’s 2015 expansion of Medicaid under the federal law has extended health coverage to more than 70,000 previously uninsured residents.

“I think affordable health care should be a right of all Americans,” Quist said, adding that he would support expanding the act to offer universal coverage to all U.S. residents.

He objected strongly to House Republicans’ latest health-care proposal, saying the American Health Care Act “would be a disaster” in its current form.

Gianforte has joined fellow Republicans calling for replacement of the ACA, which he said is “in a death spiral.”

The Republican, however, said he would not have voted for the American Health Care Act because he lacked sufficient data showing it would meet his criteria of lowering premiums while protecting those with pre-existing conditions and preserving rural access to health care.

“When that initial bill came up, I said, with the [Congressional Budget Office] data it did not show reducing premiums,” he said of the initial version of the bill, which was withdrawn in March without a vote.

House Republicans were criticized for passing a revamped version this month, prior to the non-partisan Congressional Budget Office releasing its estimate of the budget impacts and how many Americans would likely lose coverage as a result. The office’s score of the original bill estimated that 24 million Americans would lose coverage in the next decade as a result.

Gianforte declined to specify whether he would vote for a repeal-and-replace proposal without a CBO estimate, but said that the absence of the score was part of the reason for his stated opposition.

Earlier this month, the Bozeman Republican came under fire after the New York Times reported on a secretly recorded conference call he held with Republican-leaning lobbyists. During the call, Gianforte said, “sounds like we just passed a health care thing, which I’m thankful for, sounds like we’re starting to repeal and replace.”

Opponents were quick to point out that the private comments appeared to be at odds with his public position that he didn’t know enough to weigh in on the bill.

Asked about the discrepancy, he responded, “I am thankful that we’re making progress on repeal-and-replacing, that’s what we need to do.”

Wicks, the Libertarian candidate, said he also opposes the American Health Care Act, but mainly because it doesn’t go far enough: “I’m a repeal guy. I think it needs to go to the states.”

He added, “I don’t think government can fix health care. ... I don’t think it’s even in the Constitution that they have the power to do that. They have a lot of jobs to do that they’re doing very poorly right now.”

However, he added that he could support retaining Medicaid and creating a program that incentivizes private health savings accounts by matching those individual investments with limited tax dollars.

“We’re going to pay for it one way or the other,” Wicks said. “We’re either going to pay for it in taxes or we’re going to pay for it when we walk through the hospital door, through a larger bill.”

While Gianforte called for de-funding Planned Parenthood during a televised debate last month, Quist said he would not vote for such language, which is included in the Republican’s American Health Care Act.

The Democrat also criticized the bill’s provision allowing states to opt out of the ACA mandate that prohibits insurance companies from charging higher premiums due to a patient’s medical history. Those states would have to create high-risk pools for patients with pre-existing conditions — a policy expected to result in significantly higher premiums for those insurance buyers.

“The states do not have the resources to cover a lot of these health-care costs, especially in Montana, where we have such a large state,” Quist said.

Gianforte declined repeatedly to say whether he would vote for a bill that includes the opt-out language, or for a bill that would result in some of Montana’s new Medicaid recipients losing access.

“My guarantee is that we are going to make sure we have affordable health care available for people with pre-existing conditions,” he said when asked whether he would support the opt-out language.

Quist also differed from Gianforte by explicitly stating he would not support health-care legislation projected to reduce the number of insured Montanans.

ALL THREE candidates agreed that health-care policy in the U.S. still needs work.

While he doesn’t support the current Republican proposals, Quist believes the ACA has room for improvement.

“I think what we should have is price transparency with medical providers, where they need to publish and make known what individual costs are,” he said.

He also vowed to work toward ACA reforms by seeking more policy-making input from women and Native Americans.

Gianforte and Wicks both added that they want to see a health-care plan that includes malpractice reform and allows insurance companies to extend coverage across state lines.

And all three candidates said that prescription-drug costs need to be lowered, but they differed on how to get there.

Gianforte believes that could be accomplished through increased transparency of drug prices.

“If we’re going to give a company a monopoly on a drug, it comes with a responsibility for reasonable pricing,” he said.

Quist wants to allow “re-importation” of pharmaceuticals from Canada, where the same drugs are often cheaper than in the U.S.

Wicks, on the other hand, advocated for a mandate that pharmaceutical companies cannot sell drugs internationally for lower prices than they sell them in the U.S.

Reporter Sam Wilson can be reached at 758-4407 or by email at swilson@dailyinterlake.com.