Getting real about fixing health care

A lot of great quotes have been attributed to Winston Churchill, British Prime Minister during the World War II era. Too bad he didn’t actually say some of them.

That’s probably true of one of my favorites, although I’m not going to let that stop me now.

The nonquote I have in mind goes like this: “Americans can always be counted on to do the right thing — after they’ve tried everything else.”

(He really should have said that.)

That line came to mind after the latest health care roller coaster ride that ended with Arizona Sen. John McCain’s movie-moment no vote.

In his statement, McCain had this to say:

“We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people. We must do the hard work our citizens expect of us and deserve.”

To paraphrase, we’ve already tried everything else. Maybe it’s time to do the right thing, which would consist of keeping what’s working and fixing what isn’t.

Maybe it’s a pipedream in this moment of extremism, but it would be the best solution for the American people.

While I’ve spilt a lot of ink (or pixels) defending parts of the Affordable Care Act, I’ve never been an uncritical supporter. At best, it’s an extremely indirect way of getting part way to where we should be, i.e. covering all Americans. It works really well for millions of people — including around 225,000 in West Virginia — but not much or even not at all for others.

Recently, my co-worker, Lida Shepherd, with help from Andy White, interviewed several people impacted by the ACA who received care from Cabin Creek Health Systems. Some purchased health care on the exchange and some were covered by Medicaid expansion. A former coal miner received additional help for black lung due to ACA amendments pushed through by the late great Sen. Robert C. Byrd, D-W.Va.

Nearly all of those we interviewed had pre-existing conditions, including cancer, diabetes, heart disease, irritable bowel syndrome, thyroid disorders, Hashimoto’s syndrome, sleep apnea, addiction, anemia, arthritis, endometriosis and more

We didn’t talk to enough people to get a scientific sample, but it gave us a pretty good sense of where people were.

Generally, those who received care through Medicaid expansion were very enthusiastic about it. Others, who received care through the exchange, were glad to have coverage, but some were more critical, especially those experiencing rising premiums, co-pays and out-of-pocket expenses.

For those in recovery, addiction treatment through Medicaid expansion was a godsend. One woman put it this way: “I wouldn’t be here without it, that’s for sure. I wouldn’t have a job. I wouldn’t have a home. It’s affected my whole life. Before I came here, I didn’t have a job. Now I’m an assistant manager. I’m healthy. I’m happy. My son has a great life. He’s happy.”

Another woman echoed that sentiment: “You literally wake up one day after you’ve had nine months or more of sobriety and you’re like — OK, I didn’t realize it but my house is clean every day. My daughter always has clean clothes and food. Her hair is always done.”

In some cases, the ACA was a mixed blessing, but still a blessing. The former miner related how he and his wife purchased coverage on the exchange for her, only to find out that she had a potentially fatal heart condition. He said that news “just took the bottom out of my world.”

Thanks to the coverage, she could get lifesaving but expensive surgery. He said, “Obamacare, although I paid a severe co-pay and a severe out-of-pocket pay, which was roughly $15,000 combination of the two, they picked up the rest of the bill. In that perspective, I got a bargain, though it was a large amount of money.”

A woman struggling with several pre-existing conditions and buried in out-of-pocket costs was frustrated with the ACA but said, “You tell me how I’m going to get insurance coverage by anybody else if this does completely go away, because I have pre-existing conditions. I can’t not have health care. I’m terrified. What am I going to do?”

If I had to sum up what everyone had to say in one sentence, it would be something like, “Make it better if you can, but don’t take it away!”

Otherwise, as one gentleman put it, “You might as well dig some graves, ’cause you’re going to be burying them.”

In a less-irrational world, the fits and starts (mostly fits) of repeal would give way to basic problem-solving on issues such as bucking up the individual market. According to the Commonwealth Fund, a private, nonpartisan health foundation, “The immediate concern is stabilizing marketplaces to ensure that the 17 million to 18 million people getting coverage through the individual market will be able to successfully re-enroll during this fall’s open enrollment period.”

Other basic steps would include ensuring that basic plans are offered in areas currently “bare” or without a plan available, and dealing with the issue of reinsurance, which causes problems for patients when one insurance firm acquires another.

West Virginia’s senators, Joe Manchin and Shelley Moore Capito, are uniquely positioned to move the discussion in a more productive direction if they seize the moment.

In any case, I hope all members of Congress and the current administration will consider what one person had to say about it: “Take away your own health care and see how you like it.”

(This appeared as an op-ed of mine in yesterday's Gazette-Mail.)

Could this be real?

I may be dreaming, but I think I just saw an article in the NY Times about how some in Congress are working in a bipartisan way to fix the parts of the ACA that most need fixing, i.e. the individual markets. Some ideas about how to do this are laid out by the non-partisan Commonwealth Fund, a health care foundation. This approach is in stark contrast to certain screeching tweet threats, which some lawmakers from both parties fear will totally destabilize individual coverage for millions of Americans.

I'm not sure how realistic this is, but it would be nice if we could keep the parts that work and actually do some problem solving on the rest.

Not there yet

It's too soon to pop any corks yet, but it is at least encouraging that WV Senator Shelley Moore Capito has come out strongly against the senate version for repealing and replacing the Affordable Care Act.

According to an article published in The Hill,

“I only see it through the lens of a vulnerable population who needs help, who I care about very deeply,” she said during an interview with Politico that was published Sunday. “So that gives me strength. If I have to be that one person, I will be it.”

Between now and whatever happens next, it will be important to continue to contact her office first to say thanks for this stand and second to encourage her to hold the line. We need to provide as much political cover as possible for her to do this.

Here are some more reasons why this is important and here are some ideas for immediate action.

Justice calls for justice

Here's another big "thank you!" to WV Governor Jim Justice for standing up for West Virginians and opposing the senate "health care" bill in the strongest terms. Here's part of what he wrote in a letter to Senators Capito and Manchin:

While the impacts outlined in the Congressional Budget Office report are cause for serious concern, the reality is things are worse than they seem. I want you to be fully aware of the impact the current legislation would have on the state we both love.

Since so many of our people count on Medicaid, any cut to Medicaid would destroy families in West Virginia. We can't put the 175,000 West Virginians who benefit it from the Medicaid expansion at the risk of losing coverage. The consequences would be beyond catastrophic.

In the face of our drug epidemic, fewer people would have access to drug treatment programs under the current proposal. As the  debate moves forward, I hope you and your colleagues will consider the fact that it will only make it harder to combat e the drug problem that's ravaging West Virginia.

And that's no BS...and you know this governor knows a thing or two about that.


The whole letter is here.

Happy 4th!

A bad deal all the way around

According to the Congressional Budget Office, the "kinder, gentler" senate non-health care bill will cut off 22 million people from coverage. According to the NY Times, the CBO...

 ...found that next year, 15 million more people would be uninsured compared with current law. Premiums and out-of-pocket expenses could shoot skyward for some low-income people and for people nearing retirement, it said.

You can check out the CBO report here.

This bill would also be devastating to tens of thousands of people in WV, not to mention the whole country, who are getting help for addiction thanks to the Affordable Care Act. (You can read more about real people who could be impacted by ACA repeal here.)

Meanwhile, WV Republican Senator Shelley Moore Capito continues to straddle the fence. Yesterday, six West Virginians were arrested for sitting in at her Charleston office. That action came one day after around 2,000 West Virginians attended a rally there that featured local people as well as Vermont Senator Bernie Sanders.

As Bob Dylan sang, you gotta serve somebody. The question is, will Capito choose to serve Republican Senate Majority Leader Mitch McConnell or the people of West Virginia? I wish I felt better about how that might turn out

A polite word for crash

West Virginia is a state that benefited more than just about any other from the expansion of Medicaid under the Affordable Care Act.

Thanks largely to it, our rate of uninsured West Virginians has plummeted. By 2016, it fell from 14 to 6 percent.

In a 12-month period, it covers 200,000 West Virginians. At any given moment, it covers around 175,000, nearly one in 10.

According to DHHR Secretary Bill Crouch, it made treatment for opioid addiction available to 50,000 people in desperate need of recovery.

It’s also been a boon to rural health care providers and helped preserve and create thousands of jobs in the health care sector.

In 2014, its first year of implementation alone, it reduced the cost of uncompensated care at 24 West Virginia hospitals by $264,829,374. Those are costs that weren’t be passed on to consumers in the form of higher costs.

The Republican-supported American Health Care Act, which passed the U.S. House in May, would phase out Medicaid expansion and mean a loss of Medicaid coverage to around 14 million Americans by 2026, according to the Congressional Budget Office.

The Economic Policy Institute estimates that these cuts would be a severe blow to our economy and could result in the loss of 23,000 jobs in West Virginia by 2022.

Given all this, it’s been a good thing that a few moderate Republicans in the U.S. Senate, including West Virginia’s Shelley Moore Capito, have spoken up in support of preserving Medicaid expansion.

Unfortunately, that might be changing.

According to The Hill, “GOP moderates in the Senate are open to ending federal funding for ObamaCare’s Medicaid expansion, but want a longer deadline for ending the additional funding than their leadership has proposed.”

These senators say they want “a significant glidepath” to end the coverage.

With all respect, I think glidepath is a polite way of saying plane crash.

Aviva Avon-Dine, of the Center on Budget and Policy Priorities, argues, “That approach would not preserve anyone’s coverage in the long run. It also would do next to nothing to preserve Medicaid expansion in the short run.”

According to one May poll, the House version is a little more popular than bubonic plague, with about one in five Americans supporting it. A more recent poll found that only 8 percent think the Senate should pass the House version.

But even a slower Senate version isn’t much more likely to receive public support.

According to the Kaiser Family Fund, “The vast majority of the public — including a majority of Democrats (93 percent), independents (83 percent), and Republicans (71 percent) — say it is important that states that received federal funds to expand Medicaid continue to receive those funds.”

The fate of a lot of people here and around the country is going to rest in the hands of a very small group of people. I hope that the lives and well-being of millions of Americans will outweigh political pressures and ideology.

(This ran as an op-ed in today's Gazette-Mail.)

A close one

According to The Hill, WV Congresswoman Shelley Moore Capito, who has previously supported retaining Medicaid expansion, is now open to phasing it out. This would be a disaster to the Mountain State, where 175,000 people have gained coverage. According to WV DHHR Secretary Bill Crouch, that includes 50,000 people getting treatment for opioid addiction in a state that leads the nation in overdose deaths.

The House plan, according to the CBO, would over time cut Medicaid coverage for 14 million people. Even a kinder, gentler, slower Senate phaseout could end coverage for millions.

Just another reason why it's important for West Virginians to contact Senator Capito's office and urge her to preserve this lifeline for so many West Virginians. To find out how to do that, click here.