Larry Bucshon is a heart surgeon, a Republican and a congressman. He has had employees who have reached lifetime insurance caps and ended up on Medicaid. He has seen thousands of poor Hoosiers on Medicaid denied access to health care. He paid about $40,000 a year in medical malpractice insurance, a figure that is much lower than in most states. And he is a vociferous critic of the Affordable Care Act, or Obamacare, and has consistently urged its repeal.
Tim Brown is an emergency room doctor, a Republican and as a member of the Indiana House of Representatives, chairs the powerful Ways & Means Committee.
What do these two public servants think of Obamacare and what lies ahead in the next several years?
“We clearly need health care reform," said Bucshon, punctuating it with, "Absolutely."
He backs some aspects of the ACA that allow people with pre-existing conditions to be insured, does away with lifetime caps and allows adult children to stay on their parents' plans through age 26. "Those are things in the ACA that I think everybody agreed on beforehand," Bucshon said. "But at the end of the day, the ACA is not going to accomplish the main goal which is to get the cost down so that everybody can afford health care."
He backs a set of Republican alternatives laid out by the Republican Study Committee and U.S. Rep. Tom Price's HR2300 that include GOP staples such as tort reform and allowing companies to sell insurance across state lines.
"I spent my career trying to make people healthy," Bucshon said. "I was a tertiary care doctor. I've seen the worst of diabetes issues, weight issues. If we can find a way to do better ..."
Bucshon agrees with Gov. Mike Pence on not opting for traditional Medicaid expansion, saying that not only is it "not good insurance," but it actually denies access to people. But he believes that opting out and maintaining any sort of the status quo is not a viable option.
"As a doctor, my goal is for everyone in the country to have access to quality, affordable health care in a reasonable time frame," said Bucshon, who was first elected to Congress in 2010.
"The big issue in health care in my view is how much it costs," Bucshon said. "I mean, you provide insurance for people, but if the overall cost of health care continues to grow at the pace that it has, the insurance is not going to be affordable because the overall cost of health care is still going to be too high, whether it's the government providing health insurance through Medicaid or Medicare, or the private sector."
"One of the areas we don't do a very good job on is preventive care," Bucshon said. "You want to save money in health care in the long run? Prevent people from getting sick in the first place."
"We need to do things that bend the cost curve," Bucshon said. "One of the big things I talk about a lot is price transparency in the health care market. What I would call consumerism, which needs to drive the cost of health care. Consumers need to understand what things cost.”
Brown sees Obamacare as a financial reform. "The federal laws is just changing the financing of health care," said Brown. "There will be a lot more people covered and it is financed it differently. Indiana has taken the position to have consumer driven initiatives. We have seen the evidence where that makes a difference."
What the chairman is keeping an eye on is the insurance exchanges, which have dominated the news over the past month and a half. Brown says the federal and state exchanges will evolve over the coming year, and Indiana should keep an open mind about establishing its own exchange.
"The exchanges will change," Brown said. "Whether they improve or digress will be in eye of beholder. The functioning of the exchanges will be different next year than this year. Indiana has a chance of getting into an exchange business."
As for the troubling health metrics that I’ve outlined over the past two months, Brown said most come about for three reasons: smoking, lack of exercise and being overweight.
"I would say they are not really health care expensive," Brown explained. "They are personal behavior, liberty and choice. To make the biggest dent, we have to tackle the three."
Will Obamacare survive?
Bucshon isn’t sure. "To be totally honest, I really don't know," Bucshon acknowledged. "From a political standpoint, if the health care law starts losing a lot of Democrat support, I think there will be either substantial changes in the law or most of the law will be repealed, other than the things I mentioned, the good things. But honestly, because of what is happening in private sector health insurance and the companies are planning for three and a half years, it's not an easy thing to reverse. That's why I'm saying I really don't know how to fix it."