Q and A with Senator Ron Wyden, D-Oregon

As the ranking Democratic member on the U.S. Senate Finance Committee, do you expect Obamacare to be repealed this year? Do you support the repeal of Obamacare?

 

The Republican plan for repealing health care reform seems to change every hour. A replacement plan worth the paper it's written on remains hidden from public view. I'll fight any attempt to return to the dark days of yesteryear when health care was reserved for the healthy and wealthy.

 

In an interview on MSNBC's Dylan Ratigan show in 2009 you criticized Obamacare for "lacking choice and competition" and cost containment measures. You then voted for Obamacare. In retrospect, with health care premiums rising by as much as 10 times the rate of inflation this year, were you right about your criticisms of the landmark health care legislation?

 

Even the most ardent supporter of the Affordable Care Act would say there are things that could be improved. The law has benefited millions of Americans, but there are some who could be helped by further changes. I offered my own set of ideas during the health reform debate, and I would like to see Congress get back in the business of working on a bipartisan basis to improve health care for all Americans. That said, all the recent ideas I've seen from the other side would do nothing to bring down health care costs, particularly for older Americans dealing with chronic illnesses -- the group of uninsured Americans suffering most in the days befoore the ACA was law -- and now are among those benefiting most from tthe ACA. I should also point out that premiums in the individual market are below what they would have been without the ACA.

 

In 2007, you and Sen. Robert Bennett proposed the "Healthy Americans Act." At the time, you told BrainstormNW magazine, "Delinking health insurance and employment is clearly the biggest idea. My view about employer-based health coverage is that we could survive it in the 1940s before there was a global economy, but you cannot today have your businesses spot the competition 18-20 points a day when they open their doors." Obamacare did not delink health insurance from employment. Was this the measure's biggest flaw? Will the end result of the repeal or remodeling of Obamacare be closer to what you and Sen. Bennett originally proposed?

 

As part of establishing that health care would no longer be for the healthy and wealthy, the ACA ensured that affordable, accessible health insurance would be available to all Americans -- not just those whose emmployers offered it. The exchanges were a place people who didn't have this option could turn. Before the ACA was passed, the bill I developed would've fundamentally changed the employer-based system as we know it, while still allowing employers to contribute to their employees' health care. Many people currently get their health care through their employer, so any discussion about changing that system needs to be carefully discussed, and it needs to be bipartisan.

 

In my view, people should have as many available choices about their health care as possible. Getting health insurance through work should be one of those choices -- but if someone thinks they can get a better deeal with a different arrangement, I'd like to see that as an option too. That's why I authored a provision in the Affordable Care Act to allow workers to use money for health care provided by their employer to buy health insurance on the individual market. That provision didn't go into effect, but that is the kind of idea that could make sense.

 

Do you still believe in the "individual mandate"? Will reform efforts going forward include the individual mandate?

 

One of the core principles of insurance, whether it's health insurance, homeowners insurance, or car insurance, is that many people buy into the pool so when something happens -- an unexpected illness, a car accident, and so on -- the pool is large enough to cover the exppense. If someone only bought homeowners insurance after the house caught on fire or health insurance after getting sick, the system simply wouldn't work. For health insurance specifically, if you get sick, you're going to seek out care, whether you have health insurance or not. So in my view, there's a need for people to have some baseline of coverage.

 

In 2010, Paul Ryan gave an interview to Ezra Klein of The Washington Post and said this about the Healthy Americans Act: "If I were a Democrat, it's the bill I'd be on. He's got more mandates than I'd like. But if Ron Wyden and I were in a room, we could hammer out a deal by tomorrow." In 2011, you and Paul Ryan wrote a WSJ op-ed "A Bipartisan Way Forward on Medicare: Allowing plans to compete with traditional Medicare will help lower cost and spur innovation." What is the connection between you and Speaker Ryan in terms of health care reform? Will the hyper-partisan nature of our times restrict the creative partnership the two of you were able to build on health care?

 

Paul Ryan and I are often on totally opposite sides of an issue. But in years past, we've managed to have a productive dialogue on policy. He has new responsibilities as Speaker of the House, and I've been disappointed that he has chosen a "partisanship-first" approach to legislating. I don't think that's a good way to do things. On Medicare, my bottom line is that the program is a promise -- a promise of guaranteed health benefits for seniors when they turn 65. In my estimation, some of the plans on the other side break that promise -- and that's not something I'll be party to. Theree are plenty of areas in Medicare that both sides can work together on including helping people manage the chronic diseases that dominate Medicare spending, and ensuring all seniors can afford the miracle cures that are being created today.

 

You have often said that the fundamental, key compromise in health care reform is that Democrats want universal coverage and Republicans want choice. Does that compromise ground still exist in 2017?

 

I don't see choice and access to health care coverage as a zero sum game -- in fact, they are both necessary for an affordable, ffunctional health insurance market. As for compromise, I've long said that there is more common ground than meets the eye in Washington, even when it comes to health care. That said, starting off with partisan efforts to roll back the gains made by the Affordable Care Act, instead of constructively working with Democrats, is disappointing. But I'm optimistic that over the next several years there will be areas for the two parties to work together, such as bringing down the cost of prescription drugs, which I know is a big priority for the president.

 

In 2007, you warned both political parties about purely partisan reform saying you "are not going to deal with the health care issue in a strictly partisan way. It is too big. It is too complicated. It is too personal." But, in 2009, the Democrats and Obama administration did deal with health care in a partisan way. Do you regret that? And will Republicans be making the same mistake if they repeal Obamacare on purely party lines?

 

I still believe that. Changing something as complicated as America's health care system takes a lot of hard work, and that's easier when both sides are committed to making progress. But I don't regret putting an end to the days when health insurance was reserved for the healthy and wealthy.

 

Sen. Rand Paul has been in the news this month arguing that Republicans cannot repeal Obamacare without offering a replacement. Rush Limbaugh is warning his listeners about the dangers of delay. What is your advice to Republicans about timing?

 

It doesn't make much sense to me to leap off a cliff without having a plan for how you're going to land. When it comes to people's health care, it's important to be deliberate, thoughtful and compassionate. That's why, when the Affordable Care Act was being written and debated, there were countless hearings, public forums, and other input given before Congress passed anything. I hope Republicans take the same measured approach.

 

Currently, there is a large variation between what public sector employees pay for their health care, compared to private sector employees, particularly small business employees. Should government workers have better guaranteed health care coverage than all Americans?

 

When I wrote the bipartisan Healthy Americans Act, I made clear that every American should have the opportunity to have the same health care as members of Congress. Every American ought to have access to that kind of robust, affordable health care. That's something I've always been committed to, and I'll keep working towards that goal.

 

What percentage of colleagues in your caucus would favor a single-payer, government-run health care system? Was Obamacare supposed to be a stepping stone toward that system? You have been against a single-payer system. Are you still? Why?

 

When people talk about health care in America, it's important to keep in mind that there are really 50 different systems in every state that vary based on the needs of that state. The kind of health care that works for Oregon may not work for Arkansas, or vice versa. That's why during the Affordable Care Act debate I included a provision known as State Innovation Waivers, or section 1332, which allows pioneering states to reform their health care systems in a way that works best for them. If a state decided to pursue a single-payer system, or the public option, that might be a possibility. At the end of the day, state flexibility means letting states make their health care system better, not making it worse for the people who count on it.

 

A decade ago, you described your philosophy for fixing a badly broken federal tax code system: "When you fix the tax code, you give everybody a chance to get ahead, and I really want to emphasize that, because that is the space that brings people together. A lot of people want to talk about soaking the rich, but I want everybody to have a chance to get ahead -- I think marginal rates are a big deal. I don't thhink preferences are a big deal. Ronald Reagan and Bill Bradley came to this together. Ronald Reagan felt that with high marginal rates making an additional movie didn't make any sense. Bill Bradley, as a professional basketball player, saw that the top marginal rate was way too high, and both of them, as incredible as it sounds, subscribed to the idea that you ought to have a tax system that lets everybody get ahead." Do those ideas still define your philosophy toward fixing the federal tax code? If not, what's changed? Will you be able to find common ground on tax reform with the incoming Trump administration?

 

The approach to tax reform I described was the one Congress used successfully in 1986 when it lowered rates and broadened the base by cleaning out special interest tax breaks. And a cornerstone of that reform was treating wages and wealth the same. So the cop or nurse who has their taxes taken out of each paycheck isn't paying a higher rate than a Wall Street financier. In the two years after the 1986 reform, the economy soared, creating millions of new jobs. I still think the 1986 approach is a good model, and it's the approach I've taken with my two bipartisan tax reform bills with Senators Gregg and Coats.

 

Nearly 20 years have passed since President Reagan, and the American public is seeing lawmakers give a lot of lip service but little substance on tax reform.

 

The White House and House Republicans aren't on the same page, and we have yet to see legislation that might make its way to the Senate.

 

Congress needs a bipartisan approach to pursue a simplification of the tax code that works for all Americans, not just those at the very top. And this must be done in a fiscally responsible way. Tax reform can't blow up the deficit and it can't rely on fuzzy math to disguise how much it will burden the American taxpayer. That kind of financial burden will be carried by our children and our children's children -- all so the well-to-do can pay a lower tax rate.
 

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