In Oklahoma’s tightly contested 5th Congressional District race, both U.S. Rep. Kendra Horn, D-Oklahoma City, and State Sen. Stephanie Bice, R-Oklahoma City, want to expand health coverage and drive down costs, but each differs significantly on the way to get there, beginning with the issue of whether the Affordable Care Act should remain intact.  

Like most Republican lawmakers, Bice opposes the Affordable Care Act, the Obama-era expansion of Medicaid eligibility that included numerous reforms aimed at reigning in costs.

Bice said she would vote to repeal the Affordable Care Act only if pre-existing conditions were still protected. 

But she has also suggested replacing the coverage some low-income Americans now receive through the Affordable Care Act with health savings accounts, which allow pre-taxed dollars to be set aside to pay for out-of-pocket medical expenses. 

“Instead of offering coverage specifically to individuals under this very strict set of guidelines, (give) them a set amount every year through a health savings account, … where they get to choose their doctor, they get to choose what services they are receiving,” Bice told The Frontier during an interview this month. 

A week later, Bice again suggested health savings accounts as a replacement for some receiving coverage through the Affordable Care Act.

State Sen. Stephanie Bice, R-Oklahoma City. BEN FELDER/The Frontier

“Instead of providing insurance, let’s get an individual a health savings account,” Bice said during an interview with The Oklahoman.  

That comment was quickly seized upon by Horn, whose campaign launched a television commercial claiming Bice wanted to take away health insurance from some Oklahomans. 

“That was shocking to me,” Horn said in response to Bice’s proposal during an interview with The Frontier. “To me, that’s disastrous, that leaves more people further behind.”

During a televised debate Tuesday, Horn again criticized Bice for wanting to replace some insurance coverage with health savings accounts. 

“That’s not what I said,” Bice responded before the debate moderator changed topics.

After the debate, Bice’s campaign sent the following statement to The Frontier when asked to clarify her proposal of health savings accounts: 

“Stephanie will work to ensure all Americans have access to better and more affordable health care and that individuals with pre-existing conditions are never denied coverage. She supports allowing health care to be purchased across state lines and for allowing small businesses to pool together to purchase insurance. In Congress, Stephanie has stated her priorities will include lowering out-of-pocket costs for prescription drugs, ending surprise medical bills, increasing health insurance plan options, and encouraging innovation that can lead to life-saving cures and treatments. What Stephanie will not support is the $30 trillion government take-over of health care national Democrats want, because it would endanger Medicare for the seniors who’ve earned it and raise taxes $60,000 on every American.”

Health coverage and medical care is a challenge for many Oklahomans as more than one in four residents lack health insurance, according to the U.S. Census’ Household Pulse Survey.

The entrance to Mercy Hospital in Oklahoma City. BEN FELDER/The Frontier

Oklahoma voters approved Medicaid expansion earlier this year, taking advantage of an option given to states through the Affordable Care Act to expand coverage for low-income residents.

The expansion is mostly paid by the federal government, but Bice said she opposed the expansion vote because it risked the state having to pay the entire amount if the federal government were to end its contribution. 

Bice pointed to her Senate vote this year in support of Gov. Kevin Stitt’s own expansion proposal that included additional requirements on new enrollees and would be funded through a block grant program promoted by President Donald Trump.

While Trump has pushed for states to have more control over Medicaid, Democratic candidate and former vice president Joe Biden has promoted plans to subsidize insurance in states that didn’t expand Medicaid, along with giving everyone a choice to participate in a federal public health coverage option, and lowering Medicare’s age of eligibility from 65 years old to 60. 

Rep. Kendra Horn at a town hall in Bethany on Jan. 11, 2020. BEN FELDER/The Frontier

Horn said she didn’t know enough about Biden’s proposals to offer an opinion, but she reiterated her support for bipartisan solutions, rather than looking for “extreme” answers, such as “Medicare for All.”

During her first term in the House, Horn voted for the Lower Drug Costs Now Act, which caps out-of-pocket prescription drug expenses for patients who have Medicare Part D. Horn also voted this year for the Patient Protection and Affordable Care Enhancement Act that increases the Affordable Care Act’s affordability subsidies.

But Horn said her second term would include a focus on protecting the Affordable Care Act and looking for achievable measures that lower costs and expand access. 

“These protections are really worth fighting for, they have made a difference,” Horn said about the Affordable Care Act. “Consequences of losing those (protections) for too many Oklahomans is really potentially devastating.”

Further reading about the race in Oklahoma’s 5th congressional district:

Horn and Bice make final pitches in nation’s tightest House race

Ground game: In what is expected to be one of the most competitive congressional races this year, Kendra Horn and Stephanie Bice will be seeking votes across a diverse district.