The three candidates to represent New York's 21st Congressional District are incumbent U.S. Rep. Elise Stefanik, a Republican who calls Willsboro home; Lynn Kahn of Schroon Lake, running on the Green Party line; and Tedra Cobb, a Democrat from Canton. (Photos provided)

The three candidates on the November ballot in the NY-21 Congressional District race want to expand access to health care and lower costs, but they differ on how large of a role government should have.

Democrat Tedra Cobb and Green Party candidate Lynn Kahn support the “Medicare for All” concept. Republican U.S. Rep. Elise Stefanik, R-Willsboro, opposes a government-run system and is focusing on increasing choice for consumers.

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Tedra Cobb

Cobb said she is open to solutions that achieve the goal of increasing coverage.

“I’ve always talked about the fairness of ensuring that every person has portable and affordable health care,” she said.

Cobb said she is open to the idea of Medicare for All. She said the advantage is that the administrative costs of Medicare are about 2 percent compared with somewhere between 18 percent and 25 percent in the private insurance companies.

Cobb said health insurance coverage in the United States could be some type of hybrid system with expansion of Medicare.

The Medicare for All bill introduced in Congress would fund the program by increasing income taxes on the top 5 percent of income earners, implementing an excise tax on payroll and self-employment income, and implementing taxes on unearned income and stock and bond transactions, according to the www.GovTrack.us website.

A study by the Mercatus Center at George Mason University estimates that the Medicare for All plan would cost $32.6 trillion over 10 years.

However, Cobb said this is misleading because it does not take into account the cost savings that would result if everyone is covered. She said lowering health insurance costs would alleviate the health care burden on local municipalities and school districts.

“Twenty to 25 percent of school budgets now are health care costs — not teachers, not books, not AP [Advanced Placement] courses, but health care,” she said.

Cobb said Stefanik does not understand the impact of people who lack insurance on the health care system.

“They show up at the hospital too late, and their health care costs are more expensive than if we were providing them with preventive care,” she said.

Cobb worried about the loss of protections for people who have pre-existing conditions. She said she has firsthand experience with the issue because she was hired to get the St. Lawrence Health Initiative nonprofit off the ground. The organization had received a $19,000 grant with the overarching goal of increasing access to health care for the uninsured and under-insured, improving nutrition and fitness, and tackling substance abuse.

On her website, Cobb states that her other goals are to ensure federal funding for rural hospitals and clinics, promote preventive care and wellness programs, fund addiction programs and connect nutrition programs with local farm initiatives.

Cobb said that in a country that is as wealthy as the United States, everyone deserves to be covered. Health care is simply a fairness issue, she said.

“We have people who work two and three jobs, and they don’t have health care [coverage]. There’s something wrong,” she said.

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Lynn Kahn

Kahn said she also supports the concept of Medicare for All.

“I believe in universal health care, and this piece of legislation comes the closest to putting in place some of the pieces to get there,” she said.

Kahn also disputed that large tax increases would be needed to pay for expanded health care. During her campaign, she has repeatedly stressed the fraud she believes exists in the federal government. She said she believes there is $300 billion worth of savings in just cutting fraud in Medicare, Medicaid and Social Security disability alone. She also believes the Pentagon budget could be cut.

However, Kahn said she believes the bill underestimates how long it would take to put this system in place.

Kahn said Medicare for All would be a hybrid system with private insurance still available. She said it makes sense to build on the shell of the Affordable Care Act.

In the short term, she said she would support any legislation that aims to reduce the cost of medication. One solution is for the federal government to retain more control over the taxpayer-funded research used to make these drugs.

“We’re paying for the really difficult research that private pharmaceutical companies grab,” she said, adding that those companies are able to charge big prices.

She said the country should allow for re-importation of private drugs from Canada and cap prescription drug costs.

There needs to be quicker marketing of generic alternatives, she said. Kahn said another idea is creating a NASA-like agency for drug production. She said it is a national security issue.

“A thousand dollars a pill is not going to help us if we have a disastrous epidemic, because there are new bacteria and new viruses being released due to global warming,” she said.

Kahn said the North Country is isolated and it is important to improve health networks.

She also supports medical marijuana and alternative medicine. There may be different approaches needed, she said. She suggested peer counseling as a way to combat the suicide rate.

“I believe in the power of veterans helping veterans, of farmers helping farmers,” she said.

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Rep. Elise Stefanik

Stefanik, R-Willsboro, voted to repeal the Affordable Care Act.

“I have been on Obamacare. I have seen it doesn’t work. I have seen how it is expensive in terms of out-of-pocket costs,” she said.

Stefanik does not support a single-payer system.

“Both Vermont and California tried to pursue single-payer, and it financially didn’t work with their state budget,” she said.

Stefanik said she does not support Medicare for All because, she said, it will cost more than a trillion dollars in new taxes. She said she wants broader flexibility for people to purchase health care to fit their needs and the ability for small businesses to pool together to buy health insurance.

She does not support a government-run health care system, and she pointed to the Department of Veterans Affairs as an example.

“Government does not do a good job about providing health care,” she said.

Stefanik said she has a record of supporting bipartisan health care legislation, including a bill that President Barack Obama signed into law to repeal the auto-enrollment mandate, which required employers with more than 200 full-time workers to automatically enroll new employees to an employer-sponsored plan.

Stefanik also has worked to obtain funding for community health centers, reauthorize the Children’s Health Insurance Program and obtain $27 million in funding for rural hospitals.

She also supported bills to repeal the medical device tax, and to extend the Community Health Investment, Modernization and Excellence Act to extend funding for five years. The funding extension benefits organizations such as Hudson Headwaters Health Network, North Country Family Health and Community Health Center of the North Country.

Stefanik is co-sponsoring a bill with a Democratic lawmaker that would increase from one to two the number of primary care visits that are totally covered by insurance.

She also supports associated health plans, which allows small businesses to pool together to purchase health care.

Stefanik pointed to some recently passed bipartisan bills, which would force pharmacists to disclose to customers if there are lower-cost generic options to the medicines they are taking. Also, she said she wants to speed up the FDA drug approval process.

Stefanik said health care will continue to be an issue — regardless of who is elected.

“I think everybody agrees that we have a broken health care system,” Stefanik said.