Health Positions of Western States’ Congressional Candidates

As Election Day draws near, the Kaiser Daily Health Policy Report this week takes a look at the health care positions of candidates in several U.S. House and Senate races where health care has played a pivotal role. Today's report examines the West region, detailing the candidates' positions on four issues: A Medicare prescription drug benefit; a patients' bill of rights; the uninsured; and abortion. In the Evergreen State, former Rep. Maria Cantwell (D) is hoping to defeat incumbent Sen. Slade Gorton (R), who has held his seat for 18 years. Most polls "show the race in a dead heat," and given the state's traditional Democratic tendencies, "Washington is seen as a key element in the Democratic bid to regain the Senate" (Richardson, Washington Times, 11/1). The candidates' health care positions are outlined below.

• Prescription drugs: Gorton supports a "voluntary prescription drug benefit targeted to those who need it most" through a program that would "give seniors a variety of choices" in drug coverage plans (www.slade2000.com). Gorton has also been touting his introduction of the Prescription Drug Fairness Act (S 2464), which would force pharmaceutical companies to charge the same price in the U.S. as in Canada and Mexico, although the Seattle Times reports that "no one signed onto the bill" (Searcey, Seattle Times, 10/29). Cantwell supports providing a prescription drug benefit directly through Medicare (Searcey, Seattle Times, 10/31);
• Patients' rights: Gorton says he backs a "common-sense federal patients' bill of rights" but "will not support legislation that helps trial lawyers more than patients" (www.slade2000.com). He was one of several senators targeted earlier this year by the American Medical Association, which urged them to reverse their votes against the House-passed Norwood-Dingell bill (H.R. 2723) (Searcey, Seattle Times, 6/28). Cantwell "mimics Al Gore" in her promotion of a strong patients' bill of rights (Mapes, Portland Oregonian, 10/26);
• Abortion: Cantwell supports abortion rights and "earned a 100% rating from abortion-rights supporters while in Congress" (Oregonian, 10/27). Gorton believes that "under most circumstances a woman should be entirely free to make those decisions" but does not support federal funding for the procedure (Ammons, Associated Press, 10/30);
• The uninsured: Neither candidate has said much on this issue during the campaign, though Gorton has voted in favor of tax breaks for the self-employed (www.slade2000.com).

• Prescription drugs: Koster has not endorsed a specific plan for a Medicare prescription drug benefit (Johnson, AP/Columbian, 10/29). However, he has said that low-income people should get some drug-cost relief. Larsen backs providing a prescription drug benefit directly through Medicare (Galvin, Seattle Times, 10/23);
• Patient's rights: Koster says that a "physician, not a bureaucrat, should be responsible for determining if a treatment is medically necessary.... We must hold HMOs accountable for their actions" (www.koster2000.com). According to Larsen, "Physicians and patients -- not insurance companies -- should make decisions regarding a patient's health." Larsen says he supports greater access to specialists and a right to sue HMOs over treatment denials (Washington voter guide);
• Abortion: The two candidates differ sharply on this subject: Larsen has been endorsed by the National Abortion and Reproductive Rights Action League, while Koster has called abortion "our own American holocaust" (Congressional Quarterly/Washington Post, 10/16). Koster supports "all efforts to defund" groups such as Planned Parenthood and the United Nations Population Fund, and calls for "passage of a Human Life Amendment that would protect all unborn children" (Connelly, Seattle Post-Intelligencer, 5/15).

• Prescription drugs: Feinstein supports a voluntary prescription drug benefit funded by the non-Social Security surplus and available to all beneficiaries. Campbell favors adding drug coverage to Medicare for low-income individuals;
• Patients' rights: Feinstein supports a "comprehensive" patients' bill of rights such as the House-passed Norwood-Dingell measure, and calls herself "disappointed" with the version passed by the Senate, which covers only the self-insured. Campbell, who voted against Norwood-Dingell, favors effecting managed care reform by giving physicians and other providers more power to negotiate with managed care organizations by exempting them from antitrust provisions. He notes, "We have to be very cautious about proposals for the government to replace the private health care industry";
• The uninsured: Feinstein supports expansion of Medicaid and CHIP, including allowing families who have disabled children but do not meet income requirements to buy into Medicaid; allowing people with disabilities to purchase Medicaid coverage for expenses not covered by their regular insurance; covering parents of children enrolled in CHIP or Medicaid through higher federal matching payments; and doing more to "reach out to" CHIP-eligible children. Campbell says that the entire Medicaid system "requires reform," backing a plan to use the "huge buying power" of the federal or state governments to "contract with managed care providers on a regional basis for a capitated fee," with eligibility depending on a graduated income scale. Campbell also supports medical savings accounts and tax deductions (California Journal supplement, 10/00);
• Abortion: Both Feinstein and Campbell support abortion rights; Campbell made headlines this summer when he pushed for the GOP to relax the abortion stance in its platform (Associated Press, 7/26).

• Prescription drugs: Rogan backs the GOP plan to provide Medicare prescription drug coverage through private insurers (HR 4680). Schiff supports adding a drug benefit directly to Medicare, and also backs the Prescription Drug Fairness Act (HR 4869), which would allow seniors to purchase drugs at the same prices as offered to HMOs;
• Patients' rights: Rogan, who voted against the House-passed Norwood-Dingell bill, says one of his "top priorities" is "keeping costs down by keeping the cost of litigation as low as possible." However, he has supported legislation to outlaw HMO "gag rules" that prevent physicians from disclosing treatment options and to require that HMOs provide specialist referrals for patients who need "ongoing treatment." Schiff, who supports Norwood-Dingell, says he "authored the California law that guaranteed California patients a speedy independent review of an HMO's decision to deny or delay medically necessary treatment";
• The uninsured: Rogan supports medical savings accounts and providing tax credits to self-employed workers. Schiff supports tax incentives for small businesses to offer health coverage; tax credits for those who buy their own insurance; allowing individuals 55-64 years of age to buy into Medicare; and expanding CHIP coverage to working parents (California Journal supplement, 10/00);
• Abortion: Rogan opposes late-term abortions, supports parental consent and drew fire earlier this year for a comment made to the Capitol Hill newspaper Roll Call in which he noted that since the approval of Roe v. Wade, there have been some 30 million abortions, 12 million on African Americans. Rogan said, "This has been a Holocaust on the African-American community," adding, "The Ku Klux Klan couldn't do a better job on committing genocide on African Americans." However, Rogan said he would not try to undermine Roe v. Wade. Schiff "strongly supports" abortion rights (McGreevy/Merl, Los Angeles Times, 10/11).

• Prescription drugs: Harman supports adding a prescription drug benefit directly to Medicare, in addition to measures to lower drug prices by "enhancing market competition and creating incentives to develop generic drugs" (www.janeharman2000.net). Kuykendall advocates encouraging private insurers to provide partial coverage for prescription drug costs (Breznican, Associated Press, 10/18). He also opposes price controls on drugs;
• Patients' rights: Harman supports the Norwood-Dingell patients' bill of rights. Kuykendall voted against Norwood- Dingell but endorses the right to seek emergency treatment without prior authorization and the right to sue HMOs that don't follow the direction of independent review boards in coverage disputes;
• The uninsured: Harman believes the CHIP program should be expanded to cover more children, as well as the parents of CHIP- eligible children, and would dedicate more state and federal resources toward public hospitals and clinics. Kuykendall proposes a health insurance tax deduction for self-employed people. He also supports "pooling opportunities" for "small businesses to band together to purchase health insurance for their employees" and argues that CHIP and Medicaid funds are "underutilized" (California Journal supplement, 10/00);
• Abortion: Both candidates support abortion rights.

• Prescription drugs: Bernstein supports adding a prescription drug benefit to Medicare, as well as repealing the law prohibiting importation of medicine from abroad (www.bernstein 4senate.com). Ensign proposes a voluntary plan he calls "Senior Security," which would give group-negotiated discounts to seniors who paid $35 annually (www. ensignseniorsecurity.com);
• Patients' rights: Ensign wants to ensure that doctors rather than insurance companies make medical decisions, but he supports "independent appeals" instead of "legal remed[ies]" (www.ensign4n evada.com). Bernstein supports the Norwood-Dingell bill (Bernstein campaign Web site);
• Abortion: Bernstein said he "will always support a woman's right to choose -- always." Ensign opposes abortion, "with exceptions for rape or incest," and opposes all federal funding of abortion (Sonner, AP, 9/1);
• The uninsured: Ensign wants to extend "tax incentives for the purchase of health insurance for families and small businesses" (Ensign campaign Web site). Bernstein supports "extending" CHIP (Bernstein campaign Web site).

• Prescription drugs: Schweitzer has been organizing what he calls "Runs for the Border," bus trips to Canada -- and even one to Mexico -- where senior citizens buy cheaper prescription drugs (www.brianschweitzer.com). He supports making a prescription drug benefit part of Medicare (Schweitzer campaign Web site), and endorsed a Senate bill (S. 1191) to allow reimportation of prescription drugs into the United States. Burns voted for the reimportation bill, but has said he opposes "government price controls on prescription drugs" (Anez, Associated Press, 10/25);
• Patients' rights: Burns promises to "protect patients that are covered by plans that do not have any protections and allow states to continue to regulate insurance as they have done for many years." He said, "Health plans must be held accountable" for "delayed or denied" care. Schweitzer said he supports "the right of patients to seek redress from their HMOs in a court of law" (AARP Web site);
• Abortion: Schweitzer calls himself "pro-choice," and said he believes the government "should not intervene in a woman's right to make health care decisions" (Schweitzer campaign Web site). Burns has voted to ban "partial-birth" abortions and to disallow privately funded abortions by U.S. service members and their families in overseas U.S. military hospitals (issues 2000.org);
• The uninsured: Burns has said -- to great criticism from his opponent -- "that many Montanans choose not to have health insurance" (Booth, Washington Post, 10/31). Schweitzer has publicly disagreed with the incumbent on this charge, calling "the rising number of uninsured Montanans ... a major breakdown" (Schweitzer campaign Web site).