By Steve Haner

As the state campaign debate rages about health insurance plan which are short term or less comprehensive than the Affordable Care Act, two  on-going national ad campaigns may cross-pollinate the debate.  They are bolstering the Republican position nicely.

The first are the spots with people saying they are worried about the various Medicare for All proposals. They express concerns about a more expensive one-size-fits-all approach. Well, isn’t that exactly what Democrats like Senate candidate Debra Rodman and other others are demanding in Virginia? One size fits all? In several districts they are attacking Republicans who voted to allow lower cost alternatives that didn’t offer all ACA features. 

The second, equally ubiquitous, campaign is from Liberty Mutual Insurance and tells consumers it offers auto insurance with various options, letting you “only pay for what you need.”  Actually, there has always been much coverage flexibility with auto insurance. If consumers want that for auto insurance, why wouldn’t that be an attractive option for health coverage to some? Should auto insurance also have a long list of mandated benefits?

Liberty Mutual has no clue about Virginia politics, but the coalition behind the national anti-Medicare for All campaign has strong Virginia Capitol connections. Many of the same groups were involved in the legislative battles over alternative health insurance plans.  The Partnership for America’s Health Care Future’s “about us” webpage lists 67 logos, seven explicitly Virginian. Some of the national entities, such as HCA Hospitals, PhRMA, and the Blue Cross and Blue Shield Association, also have major operations in Virginia.

The seven Virginia-based entities are: the Virginia Association of Health Plans, Virginia FREE, the Virginia Restaurant Lodging and Travel Association, the Virginia Association of Health Underwriters, the Virginia chapter of the American College of Radiology, the Virginia Orthopedic Society and the Virginia Retail Merchants Association. There are probably more. According to Doug Gray of the Virginia Association of Health Plans, it is “pretty much everybody except the Medical Association” (the major physicians group).

The Democratic complaint, made in some cases against bills with bipartisan votes, is that the various GOP-sponsored efforts to create lower cost, less comprehensive plans let health insurance companies “deny coverage for pre-existing conditions.” That claim now has a “False” rating from Warren Fiske over at PolitiFact.

The charge irritates Gray, as well. His member firms sell the short-term plans in question, and they are not new and do not violate ACA. What is new is they used to be limited to 90 days, but the Trump Administration expanded that to 364 days, with two possible extensions. He agrees with Fiske’s reporting that most people will continue with full ACA plans if they can afford them and people with pre-existing conditions will still be able to get them (if they can pay.)

The Sen. Siobhan Dunnavant bill Rodman attacks was from 2018, but Governor Ralph Northam vetoed similar bills again this year. Most were accompanied by veto explanations similar to this one offered on one of the bills dealing with association health plans:

Association health plans (AHPs) are not required to cover essential health benefits including maternity care and prescription coverage. Additionally, AHPs would be able to set different premium rates based on characteristics like age, gender, job, and preexisting conditions. This bill would undermine current efforts to stabilize the Virginia health insurance marketplace. Virginians who enroll in AHPs may be disproportionately healthy when they enroll leading to higher premiums for Virginians who do not qualify for an AHP and remain in the marketplace.

Gray said the association health plans usually are fully ACA compliant, and the organizers simply want to pool so they can get a better group rate. The Democratic position clearly is that one size (ACA) should fit all.  Here is what the GOP Senate Caucus had to say about the mass vetoes.

The Partnership media campaign against “Medicare for All” was organized well back, reported on by the New York Times and others, and is aimed at federal politics, not state. But more than ever before that line no longer exists in Virginia. Donald Trump’s face appears in Democratic attack ads, and Bernie Sanders, Nancy Pelosi and Alexandria Ocasio-Cortez in Republican counter punches.

None of the Partnership ads mention any candidate or even any Virginia legislation. They check none of the boxes that would make them independent campaign expenditures. It is logical to assume the Partnership effort sees some influence on the Virginia campaigns as a side benefit. Unless somebody makes an explicit link it will be subtle. 

But attitudes can be influenced, or nobody would spend millions on these campaigns. Both the warnings about “one size fits all” government mandates and inducements to “only pay for what you need” are well timed for the health insurance debate in Virginia, with deeper penetration than any of the candidate spots.