Beyond the sound bites alleging “Balter’s healthcare plan is extreme” and “Katko voted to end the ACA”, the two candidates in the neck-and-neck race for the 24th Congressional District have different perspectives on two tenets of healthcare: prescription drug pricing and pre-existing conditions.

Both say they want to lower the cost of prescription drugs; both say they want to cover pre-existing conditions, but each sees a different path to getting there.

Affordable Care Act

Dana Balter is an advocate for Medicare for All, and a lot of oxygen in this race has been expended on ensuring voters are familiar with that fact. But if we are to trust what a President Biden would do, politically speaking, Medicare for All is a non-starter. At the same time, it’s important to note that Balter says she is first and foremost a supporter of the existing law, the Affordable Care Act, and if elected, she would fight to maintain and supplement it.

John Katko has had an uneven history with the ACA, also known as Obamacare. While he has voted several times to save the law (because, he has said, there was no immediate replacement for it), he also voted for the 2017 tax bill which ultimately may lead to the ACA’s demise.

Specifically, the Tax Cuts and Jobs Act of 2017 eliminated the individual health insurance mandate under the ACA. Without the mandate, there is wide concern among Democrats and others that the Supreme Court will strike the entire law down as unconstitutional, leaving 20 million Americans without health insurance.

Katko’s replacement for the ACA is a tossed salad of Republican talking points, like “we need to cut down on the cost of out of pocket expenses”, and hard policy ideas like “increase contributions to healthcare saving accounts.”

Drug Prices

Here is how Katko described his plan during a debate on WROC in October:

“Keep the cost of healthcare down; interstate competition; medical malpractice reform; prescription drug price reform and funding high risk individuals in a specialized pool. We also need to cut down on the cost of out of pocket expenses. Increase contributions we can make to healthcare saving accounts; and dramatically increase the deductions we can take for medical expenses that are out of the ordinary.”

As Balter pointed out in the same debate, Katko voted against H.R. 3 in 2019, which, according to bill language, sought “to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees.”

In January, Kako told the Auburn Citizen that he voted against H.R. 3 because it was "highly partisan" and would "stifle innovation and growth."

He told the paper that, instead, he supported a competing bill introduced by Republicans. More from the Auburn Citizen on the Republican bill:

“That legislation, he said, would reduce prescription drug prices by setting out-of-pocket limits for Medicare beneficiaries and achieve price transparency by mandating that drug manufacturers notify consumers to explain price increases of at least 10% in a year or 25% over a three-year period.”

While Balter’s analysis, that “Katko is pulling the wool over our eyes on lowering the costs of prescription drugs” isn’t true, a savvy voter might wonder why Katko’s vaunted bipartisanship didn’t extend to voting for a bill that would “curb the price of prescription drugs and extend more benefits to Medicare beneficiaries”, and that did pass in the House.

Pre-Existing Conditions

Balter’s plan for covering pre-existing conditions would be to restore the ACA under a Biden presidency. If Biden isn’t elected, she doesn’t appear to have a plan beyond supporting Medicare for All, which is even more of a non-starter under a Trump presidency than it would be under a Biden one.

Katko’s response to covering pre-existing conditions is “funding high-risk individuals in a specialized pool”.

“The high-risk pool he’s talking about is what we had before the ACA. If we go to high-risk pools, what happens is, people with complex medical needs get priced out of the market,” Balter told Capital Tonight.

According to a 2017 article in The Actuary Magazine, “With typical premiums at 125 to 200 percent of the standard market rates, pool coverage was not affordable for many individuals.”

When asked about those stats, Katko told Capital Tonight, “You make it affordable. You don’t just discard it. It’s a fact 90% of the costs of healthcare are born by 10% of the people. If you do all the other things with my proposal that you already noted, and took those 10% of the people that are the highest risk, put them into a pool and use cost generators from the Affordable Care Act and any others that we need to do, you can bring insurance down for the high-risk individuals, and then allow the other 90% to buy it on the open market.”

Katko continued:

“Instead of having a government-run monolith like my opponent wants, I think you’re going to get much better healthcare and much better competition and much better deliverables on healthcare for everybody,” he said.

The race in the 24th Congressional District is considered one of the tightest in the nation.