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Warner-Gillespie debate offers look at the politics of health care

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When Sen. Mark R. Warner faces his Republican challenger Ed Gillespie in their first debate today at The Greenbrier resort in West Virginia, the two are likely to clash over the Democrat’s support for the Affordable Care Act, which Gillespie wants to see repealed.

But seven months after entering the race, seven weeks after his nomination as the GOP candidate and three months before the November election, Gillespie, who has repeatedly attacked his opponent for “casting the deciding vote” for the health care law, has yet to roll out his own ideas for policies that would replace the measure.

“I do believe there are reforms that would be helpful,” the former GOP strategist and chairman of the Republican National Committee said in an interview last month. “(But) I haven’t finalized or settled on these in terms of the policy moving forward.”

Asked this week if his campaign would offer specific proposals ahead of the debate, Gillespie spokesman Paul Logan said that he would not be “previewing the policy rollout timeline right now.”

To date, Gillespie has merely hinted at market-oriented solutions for reforming the nation’s health care system, such as equal tax benefits for employers and employees, promotion of medical savings accounts, greater transparency in pricing, “and reforms around medical liability that will make health care more affordable and accessible and will let people keep the doctors and coverage they like without killing jobs,” Logan said.

Politically, Gillespie is better off to not come up with too many alternative plans beyond the blanket statement of repeal, said Stephen J. Farnsworth, a politics professor at the University of Mary Washington.

“Because of the pattern that poor Americans do not participate in elections — particularly in midterm elections — Republicans were able to generate a lot of support from the people most likely to vote on the basis of opposition to the Obama health care bill without having to provide any alternative solution for the tens of millions of uninsured Americans,” Farnsworth said.

“What Gillespie is doing adds up to smart politics. The Republicans have been able to win a number of elections around the country on the basis of public anxiety over Obamacare.”

By dabbling in different policy proposals, Gillespie would also put an easy target on his back, giving Warner a reason to remind voters that the Republican once at least somewhat supported an individual health insurance mandate.

In his book “Winning Right: Campaign Politics and Conservative Policies” from 2006, Gillespie wrote that a rational approach to health insurance reform is “to ensure that every emancipated adult capable of providing for his or her health care do so.”

“One way to accomplish this is to use the tax code to gain compliance. Annual filers would have to attest that they have some form of health coverage or else the ‘standard deduction’ on their income tax would be cut in half,” he wrote.

Another approach, Gillespie continued, would be the creation of tax-free health savings accounts that would be refunded after a certain period for any use.

Farnsworth said Gillespie’s words suggest he once was at least open to the idea of an individual health care mandate as passed by Massachusetts in 2006 under then-Gov. Mitt Romney.

Dubbed Romneycare, the law mandated that nearly every resident of Massachusetts obtain a minimum level of insurance coverage. It also provided free health care insurance for residents earning less than 150 percent of the federal poverty level and mandated that employers with more than 10 full-time employees provide health insurance.

“Republicans were in favor of Romneycare before they were against Obamacare,” Farnsworth said. “There are significant similarities between the two health care provisions, and before Obama was president, Gillespie supported some of the components of Romneycare that became part of Obamacare.”

Michael Tanner, a health care law expert at the libertarian Cato Institute, told PolitiFact Virginia this year that after reading Gillespie’s passage, he had concluded that “absolutely, that’s an individual mandate.”

(PolitiFact Virginia ruled the Democratic Party of Virginia’s statement that Gillespie promoted an individual health care mandate in his book to be Mostly True.)

In the interview last month, Gillespie explained his remarks in “Winning Right.”

“What I said in my book is there are various options out there; people are talking about the alternatives to a government health care system. I listed a number of things that Governor Romney had done in Massachusetts but also laid out other things like health savings accounts and insurance reforms and things like that,” he said.

Gillespie said that on his book tour, he said that some Republicans were open to what Romney had done as governor.

“But I think the better approach is insurance reforms,” he added. “That’s my view, and things like that will be in the bill that I will bring forward as a replacement. The mandates, the taxes and the regulations are among the reasons I fought Obamacare as it was moving through the House and Senate on many shows and panel discussions.”

Democrats also called out Gillespie because his lobbying firm Quinn Gillespie & Associates in 2007 supported the Coalition to Advance Health Care Reform, an organization that favored an individual mandate, among other ideas.

But Gillespie left the firm several weeks later to take on a new position in the White House as adviser for President George W. Bush.

Since the Affordable Care Act passed in 2010, Gillespie has pushed against the law or any form of government-regulated health care.

“I believe we should incentivize Americans to get covered, but I don’t think we should have a policy that says, ‘Here is your exchange, here (are) the plans that you can have, here is where you get them.’ That’s an incredibly intrusive marketplace, which limits our choices,” he said.

And Gillespie’s ideas for the millions of Americans who are now covered under the Affordable Care Act, should the law be repealed, are vague.

“(Obamacare has) disrupted an entire marketplace in a very negative manner. We can help a lot of these people to get themselves covered without this kind of disruption,” he said.

Warner spokesman David Turner said all Gillespie has to offer on health care is partisan sound bites, not serious policy solutions.

“He says he would repeal the health care law, but without a serious plan to replace it, he would only take us back to the days when Virginians were denied coverage for pre-existing conditions and women could be charged more than men,” Turner said.

Because the health care unpopularity among many potential midterm voters is going to draw even more attention to his own support of the measure, Warner is unlikely to attack Gillespie on his lack of ideas, Farnsworth said.

“Health care hurts Warner more than Gillespie, so I would anticipate Gillespie talking about it more than Warner,” he said. “For Gillespie it’s a net plus. It energizes the Republican base and it is one of the most effective ways to tie Warner to Obama. But I’m not sure it brings a lot of new people to the table.”

​mschmidt@timesdispatch.com   (804) 649-6537   Twitter: @MSchmidtRTD

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