The fate of America’s health-care system, the focus of our nation’s most important — and most heavily politicized — public-policy debate is in the hands of the Senate, where senators get their turn to find a balanced and sustainable approach to health-care reform.
It is clear that the bill passed by the House in May will not meet the challenges of our health-care system. This bill calls into question coverage for the vulnerable, fails to provide the necessary resources to ensure that no one is left out and puts the health and well-being of millions of hard-working people in our states at risk, while shifting significant costs to the states. Medicaid provisions included in this bill are particularly problematic.
All Americans will come out on the losing end if we simply replace one divisive plan with another, having failed to find a bipartisan solution to bringing lasting reform that can be sustained across administrations. It will be worse yet if senators — like House members before them — decide these questions behind closed doors, avoiding the open discussion and transparency needed to make the American people full participants in this vital debate.
We certainly agree that reforms need to be made to our nation’s health-care system. But as governors from opposite sides of the political aisle, we feel that true and lasting reforms are best approached by finding common ground in a bipartisan fashion.
Along with other governors — Democrats and Republicans — we agree that the best place to start is to restore stability to our nation’s health insurance system.
We and other like-minded governors have been working together to create a blueprint that can result in an improved health insurance system that is available and affordable for every American. We recognize that this is not an easy task. That is why our first step has been to develop a set of guiding principles that will positively impact the coverage and care of millions of Americans, including many dealing with mental illnesses, chronic health problems and drug addiction. These principles:
— Improve affordability: Insurance reforms that increase access to quality, affordable health insurance coverage must be coupled with reforms that address rising health-care costs. Insurance reforms should be made in a manner that is consistent with sound and sustainable cost-control practices.
— Restore stability to insurance markets: Americans without access to employer-sponsored coverage or government plans need to be able to choose from a healthy, stable and competitive market of insurers.
— Provide state flexibility and encourage innovation: As laboratories of democracy, states can develop innovative approaches with the potential to strengthen health insurance for all Americans. Within broad standards, states should have appropriate flexibility to implement reforms in a manner that is responsive to local and regional market conditions.
— Improve the regulatory environment: As the principal regulators of insurance, states are in the best position to promote competition within state insurance markets. Federal efforts should limit duplicative and burdensome regulations and provide relief to small-business owners and individuals.
The Affordable Care Act expanded coverage, but it needs improvement. Uncertainty in our current health insurance market has helped make it unstable. As passed by the House, the American Health Care Act threatens to create greater uncertainty. Historically, one-party solutions are not sustainable. The bipartisan principles we propose provide a more stable starting point to bring Republicans and Democrats together on lasting reforms.
Ensuring that quality health insurance is available and affordable for every American is a bipartisan responsibility. The states are uniquely positioned to meet this responsibility and to make our health insurance sector vibrant, stable and fair.
As governors, we and our colleagues who have signed on to this effort stand ready to work with our congressional delegations to develop a proposal that is fiscally sound and provides affordable coverage for our most vulnerable citizens. Our states — and all Americans — deserve nothing less.
In May, the US House of Representatives narrowly passed the American Health Care Act (AHCA). The proposed federal law would reverse coverage gains and fiscal savings realized in Idaho since we established our state health exchange in 2014. This exchange has provided coverage to over 90,000 Idahoans (36,179 are in rural areas) and has reduced state and county government spending from $55.3 million in 2012 to $34 million in 2016. As a physician serving rural residents in the Twin Falls area, I know Idaho can’t afford the AHCA.
The fine print of the bill provides massive tax cuts to insurance companies while enabling insurance companies to charge you more — especially if you have a preexisting condition (cancer, diabetes, asthma, heartburn, and insomnia to name a few). The bill also cuts $834 billion dollars from Medicaid — threatening access to life saving coverage for kids, families, seniors, and people with disabilities. Children in Idaho’s small towns and rural areas, like my hometown of Twin Falls will be especially hard hit.
Researchers at Georgetown University and the University of North Carolina indicate that a larger share of children and families living in small towns and rural areas rely on Medicaid for health coverage. In Idaho, 39 percent of children in rural areas and small towns receive coverage through Medicaid, compared to 35 percent in urban areas. Nationally, there is a direct correlation between increases in Medicaid and CHIP coverage and reductions in the rate of uninsured children in small towns and rural areas.
Even Idahoans who aren’t directly covered by Medicaid should be concerned about what cuts to the program would mean for hospitals, clinics, and physicians serving our state’s small towns and rural communities. Rural hospitals would be dealt a bigger blow from Medicaid cuts given that the program is such an important source of health coverage for its patients. ER visits and hospitalizations continue even when people are not covered and this uncompensated care drives up costs for all of us and threatens to bankrupt rural hospitals. Strong rural hospitals are essential to supporting strong rural communities.
Medicaid is a lifeline that runs through rural Idaho, ensuring the most vulnerable Idahoans get the care they need. It keeps our rural hospitals running and able to serve patients who otherwise would be forced to drive hundreds of miles to receive care. Cutting Medicaid does nothing to reign in personal healthcare costs. Instead, these cuts take away coverage from friends and neighbors who need it most. Idaho can’t afford to turn our backs now on the progress we’ve made in getting our children the health coverage they need.
The AHCA now sits in the Senate. There appears to be a rushed effort to pass the bill without public input. I’m asking Sens. Crapo and Risch to oppose any legislation that cuts Medicaid or removes protections for Idahoans with pre-existing conditions and to resist a hurried passage of the AHCA. I hope you’ll join me.
There was some positive movement in the Legislature this week when it was reported that House Speaker Scott Bedke no longer opposes a plan to give cost estimates to legislation. I must wonder why it was something he was skeptical about in the first place, but any positive movement in the direction of fiscal control is a good thing. The article did say that the business community supported it to supply data when considering tax cuts, but I’m not sure if it was because they are pushing for more cuts or they are worried that Idaho is at bare bones now.
I believe we are at bare bones in many areas, especially in education spending. The Times-News article about the need for early childhood education is one example. For good or evil, kids have a higher level of achievement to reach today than ever in the past. The people of Idaho need to rethink our entire education system from early childhood to advanced degrees. We especially must have an accurate estimate of the total cost of making sure our young people have enough education to be functionally literate in a complex world. We also must provide pathways for adults to catch up to their kids.
The definition of functional literacy I’m talking about is not enough education to “get by.” I am including critical-thinking skills, specialized vocabulary for vocations and enough basic knowledge of science, math, English, and the humanities to make sense of the world as it changes. All adults must accept the responsibility to become lifelong learners. We have the technology to bring knowledge to every person on the planet, and increasingly it is the people who work to keep up with that knowledge who will have the resilience to adapt to change.
Education is not free, but the benefit of an adequate education is priceless. I have never completely understood why Idaho is so reluctant to have a robust world-class education system. When talking to legislators I often hear, “But that would require new money.” When talking to some conservatives I hear, “Why should we throw more money at a problem when the money that is being spent is not being used wisely.” When talking to parents I hear, “I want my children to succeed, but I feel overwhelmed when I try to have any interaction with the education system.” Many adults are resentful of the experiences they themselves had in school.
Our system of government depends upon public education. If we don’t want to turn our lives over to some form of autocratic rule, we must have a functionally literate population. In the early days of our Republic, only white male landholders could vote. The rules changed, not only because of fairness, but mostly because of universal education. We are at a point in time where it is increasingly difficult to be an informed voter. Disinformation would be a harder sell if more people could say “hogwash!”
It is critical for the state to consider how much of a burden for the costs of education to place on the learners themselves. A case can be made for both more and less. However, what would our state be like if most of our population had an educational level of at least two years past high school?
It is beyond time for school boards and educational leaders to step up, look at cradle-to-grave educational needs as far as we can predict them now, design a comprehensive system, and tell people what it would cost the state to implement. It is time for the Legislature to ask the citizens of Idaho if they are willing to pay more in some form of tax to pay for the education our children and our adults need to function successfully as the world changes during the 21st century.