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Health Care Is A Hot Topic In The U.S. Senate Race In Missouri

DAVID GREENE, HOST:

In an election season that has been all about division, voters from across the political spectrum do share at least one top priority. They want affordable health care. In Missouri, Senate campaigns have boiled the debate down to a key sticking point - pre-existing conditions. From member station KCUR, Alex Smith reports.

ALEX SMITH, BYLINE: Before 2014, insurance companies could deny coverage to customers who've had anything from diabetes to depression. The vast majority of voters, including most Republicans, say they want to protect pre-existing condition coverage. That's why in his bid for U.S. Senate, Missouri Republican Josh Hawley is running ads like this.

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JOSH HAWLEY: Earlier this year, we learned our oldest has a rare chronic disease. Pre-existing condition - we know what that's like.

SMITH: But as Missouri's attorney general, Hawley joined 19 other Republican-led states in a lawsuit that claims the Affordable Care Act, which made pre-existing condition coverage mandatory, is unconstitutional. Incumbent Senator Claire McCaskill, who's a Democrat, says Hawley can't say he's for protecting pre-existing condition coverage and participate in the lawsuit.

(SOUNDBITE OF ARCHIVED RECORDING)

CLAIRE MCCASKILL: If that lawsuit is successful, it leaves a whole lot of people and potentially millions of Missourians in a position that they can no longer access coverage.

SMITH: Hawley has pledged to force insurers to cover pre-existing conditions. He recently spoke about his plan in Platte County, Mo.

(SOUNDBITE OF ARCHIVED RECORDING)

HAWLEY: It's an insurance guarantee and insurance access guarantee that says that folks with pre-existing conditions can buy insurance plans just like everybody else, on the same terms as everybody else.

SMITH: Under his plan, the federal government would reimburse insurance companies for each person's medical costs that go over $10,000 a year. Hawley doesn't say how this would be paid for.

DAVID SLUSKY: That would make the world better than it was before the ACA, but it wouldn't fix many of the other problems the ACA fixed.

SMITH: University of Kansas economist David Slusky says Hawley's plan could be a major setback for many in Missouri. The federal government subsidizes insurance here for nearly 200,000 people. Those subsidies would disappear if the law went away, making insurance unaffordable for many.

SLUSKY: Insurance in its - on its own doesn't make you healthy. You have to be able to use it. It has to cover the condition you have. And you have to be able to afford the medical bills on the other side of it.

SMITH: The health care law also requires insurers to pay for things like maternity care, drug rehab or checkups, and ending it could allow insurance companies to bring back lifetime limits, meaning an insurer could stop paying after someone's medical costs exceeded, say, a million dollars. Despite the health law's benefits, skepticism abounds in Missouri, and that worries supporters.

CHEYENNE MAUZY: Amara (ph)? Amara, stay inside.

SMITH: At her home in Springfield, Mo., Cheyenne Mauzy rounds up her three young children for dinner. Two years ago, her now-10-year-old son Landon was diagnosed with a rare, potentially deadly blood disorder. While the experience made her a health care advocate, her neighbors remain skeptical.

MAUZY: They don't think it's gone far enough or they think that it has these problems that they didn't expect, and so they think, well, anything that anybody's doing has to be better than what we've got now.

SMITH: Mauzy says she's been a mostly independent voter, although health care has pushed her toward Democrats. She acknowledges there are plenty of problems with the federal health care law. But for her part, she's baffled by the idea of ditching it.

MAUZY: I would never dream that the answer there is taking away some of the most popular things that the Affordable Care Act did and saying, let's start over.

SMITH: Just who Missouri voters decide they trust on health care could decide how the polls sway on November 6. For NPR News, I'm Alex Smith in Kansas City.

(SOUNDBITE OF STIL AND BENSE'S "HOMETOWN (ORIGINAL MIX)") Transcript provided by NPR, Copyright NPR.