“The law Tim has embraced is fatally flawed and goes way in the direction of government regulation and taxes,” O’Bannon said.
Wendy Klein, an internist and retired Virginia Commonwealth University medical professor, likes the law. So she’s for Kaine, a Democrat.
“Governor Allen would dismantle the Affordable Care Act, and I believe that governor Kaine would try to support it,” she said. “And I support him. It’s that simple.”
But the choice is not a simple one for every Virginian — nor for the candidates themselves, who have some nuance to their positions. Allen wants to help repeal the law while preserving a couple of its most popular provisions; Kaine wants to hang on to the heart of the legislation but fix certain aspects of it. Because the health-care law is so complex, and because it has not been fully implemented, some voters aren’t sure whether they want it to stay or go. That’s true even for those who are immersed in health-care policy in their professional lives.
“I’ve been doing this job for 30 years; I have never had a time in my life when I’ve been less clear about what we should do,” said Katharine Webb, senior vice president for the Virginia Hospital and Healthcare Association.
The Affordable Care Act has been a highly polarizing law, one that conservatives see as outrageous government overreach and liberals consider long-overdue reform. But the tiny slice of the electorate still up for grabs in this deadlocked Senate race may have a more muddled take on the law — most of which won’t roll out until January 2014.
“We’re in this in-between world where neither the full cost of the burdens nor the potential benefits from expanded coverage — neither of those has arrived in full strength,” said Tom Miller, a health-policy expert at the American Enterprise Institute who lives in Northern Virginia. “Everybody gets to impart their worst fears or their best dreams.”
Jennifer Duffy puts herself in the muddled middle, even though she follows the law closely as an analyst for the nonpartisan Cook Political Report and also happens to oversee health benefits at her tiny firm. In that second role, she has been constantly surprised as various provisions of the law have kicked in. Such as when she discovered her company does not qualify for a small-business tax credit because its payroll is too large.
“We’re a company of five people,” she said. “When I told [editor and publisher] Charlie [Cook] that, he was floored.
. . .
I think that there are a decent number of voters who are still very skeptical of this, and don’t fully understand it, and know that there’s sort of more to come, and they’re not sure what to expect.”
Duffy said Virginia’s Senate race is more likely to turn on jobs and the economy than on the health-care law. But what becomes of the law could depend on the Allen-Kaine race, as one of a handful with the potential to shift the chamber’s balance of power. If Republicans take the Senate and the White House, they’ll try to undo the law. A Senator Allen could be, as he often says on the campaign trail, the 51st vote for repeal. A Senator Kaine would not.
As Kaine has stood by the law, Allen has hammered him over his support for it and for the Obama administration more broadly, seeking to portray Kaine and the president as wanton tax-and-spenders. It’s a strategy that Republicans have pushed in races nationwide, but one that resonates in this one especially because of Kaine’s prominent role in promoting the legislation when he was Democratic National Committee chairman, Duffy said.
“It’s a little more personal here than it is in most states,” Duffy said.
Both candidates risk alienating swing voters with their stances, either because the voters may like some provisions of the law or because they fear that the country cannot afford it. So Kaine and Allen have carved out a little wiggle room. Kaine says he would change what he admits is a flawed law. To find cost savings, he says he would push for more coordinated use of electronic medical records, and give the government power to buy Medicare drugs in bulk.
Allen says he would support legislation to replicate a couple of the law’s more popular provisions: allowing parents to keep children on their polices up to age 26; prohibiting insurers from denying coverage to people with preexisting conditions. He also supports expansion of health-savings accounts.
But the devil is in the mind-boggling details that made the Affordable Care Act a whopping 2,000 pages. The experts wonder whether the savings that Kaine touts can be realized. Or whether Allen’s health-savings accounts, typically paired with high-deductible insurance plans, work for people who aren’t wealthy and healthy. Or whether insurers can afford to cover preexisting conditions if Congress scraps the rest of the law, which spreads out the risk and cost by requiring that healthy people buy coverage.
“It just shows you hard incredibly hard it is to fix this issue,” Duffy said. “They can start from scratch, they can leave the 26-year-olds, the preexisting conditions, and they still have major problems to sort out.”
Which is why someone like Webb, the hospital association executive, is on the fence about a stark choice.
“I’m probably okay with repeal [of the law] and replace, but I want it replaced,” she said. “Above all else, health care needs reform. Very smart people can disagree about how it can be reformed.”