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Health Care

Health care - A Human Right

Health care in America has evolved as a moral decision between two camps: 1) is health care a right and not a business or; 2) is the primary purpose of the health care and insurance industry to create profits for stockholders? Over the past several years we have seen how this disagreement has evolved by reviewing: 1) what our system was like before the Affordable Care Act [ACA] was implemented; 2) results of ACA implementation and; 3) the Republican House Repeal/Replace – American Health Care Act or the Republican Senate version - the Better Care Reconciliation Act, which was created behind closed doors.

Before the Affordable Care Act

Prior to the ACA, access to health care was a privilege. You were fortunate if you were afforded the opportunity for health insurance via your employer. Or, if you were 65 or older, you were lucky to be eligible for Medicare. Additionally, you could purchase health insurance on your own, which typically meant ultra-high premiums or very limited coverage, and dismal preventative care. Alternatively, if you were poor, and met the criteria, you may be covered by Medicaid.

That left 47 million people without access to health insurance or affordable care. It meant many people didn't seek medical attention until they were in crisis mode. The end result was usually a visit to the emergency room at the local hospital because hospitals must provide medical assistance, regardless of a person’s ability to pay. Because people were not getting preventative care, their illnesses would become more severe than necessary. This jeopardized many small, rural hospitals because they were trying to absorb the costs of treating people without medical insurance.  

If you were working, but didn't have insurance, you worried that one accident or illness could throw your family into bankruptcy.  And yes, in this rich and generous nation, people died because they could not afford medical care. Before ACA, we were the only developed nation in the world that did not provide the opportunity for health care to all its citizens. People suffered while health insurance companies reported record profits and paid their CEO’s millions in annual salary.

With the Affordable Care Act

The Affordable Care Act was debated publicly for well over a year and the process allowed for Republican amendments. Congress conducted 79 committee hearings on features of the bill. Since the inception of the ACA, 20+ million previously uninsured citizens are now covered across the country. In our state alone, more than 500,000 Washingtonians benefit from coverage provided through the ACA.

The uninsured rate in our state has been cut in half, and is down to 7.3 percent. People were able to afford the insurance, in part, with tax credits or subsidies. To share costs and create a balance of both healthy and sick people, the ACA includes a mandate that all people must have insurance or pay penalties. The ACA offers benefits to all, even people who already had coverage via their employment.  

Here’s a list of some of the universal benefits included in the ACA:
• Discrimination on pre-existing conditions ended.
• Premium cost equity for women and men.
• No annual or lifetime limits.
• Children up to age 26 covered on parents’ policy (50,000 benefited in Washington).
• Free preventative care.
• All health plans must include 10 basic services.
• Insurers must spend 85 percent of premium on care.

It's not hard to see why the ACA, or Obamacare, has become so popular with people, and a target for insurance companies. Polls indicate 60 percent of Americans now want to keep the ACA. But the ACA is not without problems. For some, the premiums and/or deductibles are too high. And in some areas there are too few insurance companies willing to offer acceptable plans. The Republicans in Congress have been so focused on trying to repeal the ACA, they have refused to allow consideration of amended legislation that would make the ACA better. 

The Republican House Bill – the American Health Care Act (Trumpcare)

The rise in popularity of the ACA may in part be due to people now being able to compare it to what the House Republicans blindly passed in May 2017, called the American Health Care Act (AHCA). It's also known as Trumpcare. The AHCA is exceedingly unpopular. Less than one in three Americans favor the ill-conceived Republican version. Tens of thousands of people across the country, including our friends and neighbors in the 4th Congressional District, have sternly expressed their feelings that the AHCA would be detrimental, and in some cases disastrous, to them compared to the Affordable Care Act.

The AHCA narrowly passed a hastily-called House vote without any hearings. In fact, several Republican members of Congress admitted they didn't actually read the bill before voting to approve it. House passage came before the Congressional Budget Office (CBO) was able to independently review what the measure would cost, how many people would lose or gain health care and what features would be added or eliminated. We as consumers, the people most directly affected by the bill, were not given an opportunity to weigh in on its merits.  

When the CBO completed its analysis of the AHCA, it discovered the impacts would be devastating to most Americans. It's estimated 23 million people would lose coverage over 10 years, and the bill provides huge tax breaks to the richest people in America. It dramatically reduces federal support to Medicaid funds going to states and repeals the Medicaid expansion – leaving states with a potential financial crisis. 

The AHCA would also repeal the tax credits to citizens for health insurance, and it would allow states to seek waivers to repeal the essential health benefits, such as maternity care and emergency room visits. States could also seek waivers for community ratings in the ACA. This means insurers could charge different prices for people of the same age in an area.

Insurers could charge people with pre-existing conditions more and price them out of insurance options. Please note, being a woman is a pre-existing condition. Sick and elderly people could be priced out of the market, which was the problem we faced before the ACA was enacted. Out-of-pocket costs for consumers would increase, which may lead many people to forgo care.

The proposed Senate Republican version - the Better Care Reconciliation Act

Republican Senate Majority Leader Mitch McConnell unveiled his proposal for health care on June 22. It's called the Better Care Reconciliation Act (BCRA). By most accounts it’s even more destructive to our health care system than the House version. On June 26, the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) estimated that in 2018 alone, 15 million more people would be uninsured under the BCRA than the current law (ACA), primarily because the penalty for not having insurance would be eliminated. The CBO and JCT also estimate the Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under ACA.

Also of great alarm is the impact on people dependent on Medicaid. The CBO and JCT said this bill would reduce projected Medicaid spending by a total of $772 billion in the coming decade, and that the number of people covered by Medicaid in 2026 would be 15 million fewer than under the ACA.

It's been speculated from a number of sources on Capitol Hill that Senator McConnell wrote this bill literally by himself. Although 13 republican members of the Senate were part of the committee, several of them admitted to reporters on camera that they had no idea what was in the bill prior to it's release.   

Senator McConnell intentionally and successfully blocked any Democrats or female members of the U.S. Senate from being part of the bill creation. The exclusion of female insight and input into a revised health care strategy is shockingly shortsighted, but not unexpected from this GOP. In addition, no hearings on the BCRA are scheduled. A vote tally of 51 would get the measure approved under obscure budget rules Senator McConnell is trying to navigate through.

But initial public and political outcry over the BCRA forced the Senator to delay any vote on the bill until after the July 4 break. The opposition was so strong, including from republican members of the Senate, that a procedural vote scheduled for June 28 to even discuss the bill on the Senate floor was cancelled. 

In the meantime, here is what the Washington State Hospital Association released about this ill-conceived Senate proposal.

“Everyone talks about a better health care system, but the Senate’s bill, like the House’s, purposefully limits health coverage for hundreds of thousands of people in Washington state,” WSHA President and CEO Cassie Sauer said. “Denying people affordable coverage doesn’t improve the system — it only makes people sicker and drives up the cost care for everyone, including employers and working families. This bill is the wrong direction for our state, and we are glad that Senators Patty Murray and Maria Cantwell have said they will vote against the bill.” 

It's no secret the 4th Congressional District has a large population of working poor and low-income families. Many of those individuals will lose their health insurance and be back in the cycle of bankruptcy with one major illness or accident. Many are older, disabled or veterans. It’s estimated 50,000 of our neighbors in the 4th Congressional District will lose health insurance. That will have a significant impact on the individuals, but also our communities. There will be job losses in health services, hospitals will have to struggle with uncompensated care, and the strides made in public education on health issues will be set back. One of the most relevant benefits of the ACA has been preventative care. By spending $1 on prevention now we save $7 to $10 when the condition escalates as debilitating or even life threatening. 

My Approach to a Health Care Policy

I believe health care is a right, and not a privilege for the rich or folks lucky enough to be employed by a company offering medical coverage as a benefit. I would work tirelessly to continue the basic coverage features of the Affordable Care Act. In addition, I would encourage my colleagues in Congress to push this to the next level, which is health care for all.  

All other advanced countries in the world have found a way to accomplish this goal. My confidence in American ingenuity and innovation to solve this problem is steadfast.  A recent Gallop poll indicates nearly six in ten Americans want a single-payer system. Even Republicans support the idea with 41 percent favoring a single-payer system.

Medicare is the model we are most familiar with as a single-payer program and most people have favorable opinions about it. Medicare-for-All would require people to pay premiums on a sliding scale. In addition, people would have access to regular doctor’s visits to provide them with preventative care, which keeps people healthier and happier, thus reducing costs. 

We need to reduce the reliance on hospital emergency rooms for non-emergent health care. For example, it's so much cheaper to treat high cholesterol with medications, than treating diabetes. By proactively making drug, alcohol and mental health care treatment widely available, we get much closer to solving these devastating public-health issues.

Most people now believe Medicare-for-All is the future. But to get there legislatively we need bold and committed leadership. We don't have that right now. Republicans control the House, Senate and the White House. Their goal is to cut your health care benefits and give big tax breaks to the richest people and put insurance companies in the driver’s seat of our health care.

Republican Congressman Dan Newhouse has voted repeatedly to repeal the ACA, without any alternative. He said he would vote for Trumpcare – telling his constituents in the 4th Congressional District that he is using our vote to take our health care away. He is putting the greed of the wealthiest Americans and lobby-rich insurance companies in line for an unprecedented pay day.  

There is a ground-swell of resistance growing daily and you can play a key role in deciding the direction we go. Change who represents you. Your vote can elect an independent leader who will work for all of us. Vote to make a difference. 

Committee to Elect Christine Brown
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