Preserve healthcare or upend the system? Democratic congressional candidates differ on approach

The two Democratic candidates for Massachusetts first congressional district agree that health care has become too expensive and hard to access for many low and middle income people. But they don’t agree on how to fix those things.

Richard Neal has been the U.S. representative to Congress for many cities and towns in western Massachusetts - including Springfield, Easthampton, and most of Berkshire County - since 1989. That’s only two years after Whalen - a high school teacher from Belchertown with a PhD in education – was born.

Neal says he’s been around long enough to get things done. Whalen, a political newcomer, says it’s time to do things differently, starting with health care.

Neal’s focus is protecting the Affordable Care Act (A.C.A.), which he voted for during Obama’s presidency.

Neal wants to bring back components of the A.C.A. that Trump and his Republican allies have dismantled. Those include the individual mandate that required everyone to have health insurance. And the tax credits that had made premiums much more affordable.

“Our plan is to make Trump negotiate over this,” Neal said. “If we win the House, I'll be returned to the chairmanship of the Ways and Means Committee. The Affordable Care Act is a priority. Extending those tax credits is a big deal.”

Whalen, meanwhile, wants to overhaul the whole system. Health care premiums, he said, are going up between 20 and 40 percent across the district he wants to represent. And while he also wants the ACA tax credits back, he said that’s not a solution.

“That is a band aid,” he said. “We've seen that the Affordable Care Act is not affordable, and we need to think about viable paths forward that aren't always trying to bail us out of situations. Meanwhile, corporations are benefiting from it.”

Both Whalen and Neal are livid over the millions of people – including hundreds of thousands in Massachusetts – who will lose their Medicaid benefits under the Republican-passed budget bill, which Neal voted against.

But Whalen says shifting to a single-payer system, also called Medicare for All, would make people less vulnerable to political game-playing.

With single payer, the government would pay for and oversee health coverage for everyone, as they do in many European countries. By cutting out private insurance companies, Whalen said, administrative costs go way down.

“We can't afford to have that bloat in our system anymore,” he said. “We need to revitalize and revision this entire system and get corporate greed out of that equation.”

Single payer has never gotten far in Congress. Whalen said he knows this but insists that attitudes are changing, and he would work on convincing other representatives.

“In the meantime, as we get more data and we do that at the federal level, we can create that model here in Massachusetts or regionally and use that as the case study… in a similar way that we did with Romneycare became Obamacare,” Whalen said.

Richard Neal does not support a single payer system - and one reason, he said, is that many people, including some in large unions, are OK with their current insurance.

“What about people who don't want to give up what they have?” Neal said.

Neal did support what’s called a public option during the Obamacare negotiations. It would have allowed people to sign up for a government-sponsored insurance plan, which would compete with private insurance plans.

“I think the public option would resolve a lot of what the advocates are saying,” Neal said. “And I have voted accordingly.”

Whalen and others, however, claim there’s another reason Neal doesn’t want to upend the current system, and that’s because, according to campaign records, donations from the health care industry account for the second largest category in Neal’s campaign fund. Out of $2 million in recent donations reported to the federal election commission, about $270,000 came from health insurers, pharmaceutical companies, hospital trade groups, and other health-related companies.

Whalen, who has raised about $300,000, gets no corporate donations.

But Neal said his votes are not guided by his donors, which he pointed out also include unions, albeit at a much lower amount. And he said the hospitals that support him are major employers in the region.

“They've never lobbied me on being for single payer or against single payer. They want to make sure that Medicare and Medicaid are restored,” Neal said. “I think that that's a pretty weak argument that somebody would have that all of a sudden there's this conspiracy that the hospitals want this or they want that.”

When asked to comment on donations by health insurance companies, Neal said people should not be worried.

“Because I pointed out that my history has been pretty clear as it relates to expanding opportunities for people in health care. How about the … child health initiative?” Neal said. “I mean, I think that the career is there. If you're going to put it under a magnifying glass, that's fine and fair. But I also think it has to have a corresponding emphasis on the realities of economics.”

Alongside their differences, Neal and Whalen both say they want more government investment in health care - especially for rural hospitals.

Additionally Neal said, as people live longer, families need help paying for long-term care.

Whalen says the mental health system is dangerously under-resourced, and fixing it is very personal, since his own brother died by suicide.

But both candidates acknowledge all their health care goals will be much harder to achieve if Democrats don’t take back power in Congress.

Whoever wins the Massachusetts Democratic primary on September 1 will face two independent candidates. There is no Republican challenger.