TMC follows up on questions from overflow crowd at June 26 health forum

Health Care ForumTucson Medical Center on Monday held a health care forum designed to share information about the impacts and implications of federal health care reform proposals.

The panel, which included health care experts in the areas of pediatrics, public health, rural health, primary care and hospitals, answered as many audience questions as they could within the 90-minute discussion.

TMC President and CEO Judy Rich committed to answering the remaining questions, which are shared below. In the interest of reducing duplication, topics were grouped if there were multiple questions on a topic.

For those interested in watching the entirety of the session, please visit https://youtu.be/z28iVHy1pto

Single-payer related questions:

  • Do you support Medicare for all? Even under ACA, things are way too complicated, costs too high and 28 million uninsured. – Andrea
  • Why can’t the U.S. provide universal health care when every other developed nation can? – Warren
  • Since there is no way to cure the problems affecting our health care system unless we eliminate the profit motive, what are you doing to advocate the only plan that does that: Medicare for all? – Lee
  • Do you support a single-payer system like Medicare for all? – Maddy
  • Why not Medicare for all? – Tony
  • How do we achieve single payer, efficient health care? – Gary
  • What would it cost and how can it be implemented to build public health care infrastructure – the like V.A. – for civilians? – Howard
  • Will you support a single payer Medicare for all health system? – Barbara
  • What position does the AMA take on single payer? – Elizabeth

Thank you all for your question. Since they all follow a similar thread, we have grouped them together for one answer.

A single-payer system is certainly one of the policy options being considered. It’s a difficult question to answer because, as is usually the case, it depends on the details of the legislation. We are strong advocates for affordable and accessible health care insurance for all members of our community. Between Medicare, Medicaid and Tricare, government is a significant payer for most hospitals, so it’s possible there would be some system savings by consolidating at least those into a single program. Our commitment is to advocate for coverage, access and efficiency in a health care system and, as discussed at the forum, there are multiple ways to achieve that end. Unfortunately, the legislation currently proposed by the House and Senate do not achieve those objectives.

Affordable Care Act related questions:

  • How many insurance carriers have pulled out of Arizona since ACA? – Kathleen
  • ACA is collapsing under its own weight. What is the panels’ suggestion for a system that will work?  -Mike

Thank you for these questions. Kaiser Health News published a story that reported that Arizona had eight insurance carriers in 2014, 11 in 2015, eight in 2016 and two in 2017. The uncertainty of the future of the marketplace has impacted insurance companies’ interest in participating in the exchanges. (http://www.kff.org/health-reform/issue-brief/2017-premium-changes-and-insurer-participation-in-the-affordable-care-acts-health-insurance-marketplaces/)  But, remember the marketplace is just one small piece of the Affordable Care Act and, frankly, the portion of the legislation that, in our opinion needs to be addressed. Here is an opinion piece by Andy Slavitt, former director of Centers for Medicare and Medicaid Services, one some commonsense solutions that would stabilize the health care exchanges: https://www.usatoday.com/story/opinion/2017/03/26/bipartisan-path-forward-health-care-trumpcare-obamacare-column-andy-slavitt/99661882/

  • With this current political turmoil, what is the future of the Az-CHIP program? – Preshit

We agree with our colleagues at the Children’s Action Alliance, who have concluded the future of KidsCare,  Arizona’s CHIP program, is at high risk.  That means affordable coverage for more than 21,000 children already enrolled is in danger.

As Children’s Action Alliance President and CEO Dana Naimark explains, “Currently, our federal tax dollars pay for the full cost of KidsCare. Our legislature and Gov. Doug Ducey just put a provision into our state budget that says if the federal funding falls below 100 percent, then enrollment in KidsCare will be frozen again.  The federal funding expires Sept. 30, 2017.  So Congress must act soon to reauthorize funding  for all states.  And the funding must be reauthorized at the current level for KidsCare to continue. Without KidsCare, many more children will go without the check-ups, treatment and behavioral health services that keep them healthy. 

There is still bipartisan support for KidsCare and CHIP. But the issue has gotten both sidetracked and tangled in with the fights over repealing and replacing the Affordable Care Act. We will all need to raise our voices on this in the coming weeks.”

Political process

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  • What does budget reconciliation allow you to do? – Brenda

Brenda, the reconciliation process may be complex, but it is also faster because it takes only 51 votes to pass a bill – allowing senators to sidestep the threat of filibuster, which would take 60 votes. Although there is some transparency in the sense that the bill is reviewed by the Congressional Budget Office and members do have an opportunity to amend the bill, this process has not been reflective of what is typical of legislation of this magnitude. The process typically includes extensive hearings as well as input from stakeholders.

  • What formal process is TMC using to register our community protest against this law? – Linda

Hello, Linda, and thank you for your question. As you know, there has been limited discussion about this legislation. TMC held this forum in an effort to share the expertise of those in the medical field about the impacts they foresee on the work they do and the people they care for. 

It was intended to provide audience members with real facts about the implications and hopefully inspire them to engage directly with their elected leaders. TMC has shared our own concerns with our federal delegation. We also will provide those leaders with a link to the forum and to these answers to your questions.

  • I’ve been told our senators do not keep a tally of calls they receive. What is the point of calling? – Robin

Although elected leaders have different approaches to how they keep track of comments directed to their offices, they absolutely know the pulse of their constituencies. Every call, every letter, every email, every tweet – they all add up and make a difference. Advocacy – not apathy and ambivalence – is ultimately what drives change, so please continue sharing your thoughts and expectations with your elected leaders.

  • Who are the senators on the fence and how can we contact them? Many of us have already reached out to Sens. Flake and McCain. – Suzann

The bill’s fate hinges on two Republican votes. At least four senators – Rand Paul, Ted Cruz, Ron Johnson and Mike Lee, are holdouts, saying the bill does not do enough to reduce the deficit or repeal the Affordable Care Act. Several others have voiced concerns about the deep cuts to Medicaid, including Dean Heller, Rob Portman, Shelly Moore and Susan Collins. The U.S. Senate website has a list of senators and their contact information at https://www.senate.gov/

General impacts

  • Are you aware of a Harvard research study that 24 million people losing health insurance means 45,000 additional deaths per year? Do you agree? – Guy

The American Journal of Public Health in 2009 published a study that associated 45,000 deaths annually with a lack of health insurance.  The study, conducted at Harvard Medical School, analyzed U.S. adults under age 65 and found the uninsured have a higher risk of death than those with private insurance. The study’s co-authors noted the numbers indicate one American dies every 12 minutes from lack of health insurance. There have been other studies that have come up with varying numbers, but the bottom line is that the body of evidence – combined with what we know as a health care provider – shows without question that coverage saves lives.

forum2Is it true that the number of uninsured will likely increase even more than the CBO score after the 10-year period? – Barry

Hello, Barry. It will probably serve best to quote directly from the report by the Congressional Budget Office and the staff on the Joint Committee on Taxation, which found that by 2026, there would be 22 million more people uninsured. “In later years, other changes in the legislation—lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market—would also lead to increases in the number of people without health insurance. By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”

To read the report in its entirety, please visit https://www.cbo.gov/publication/52849

  • So the emergency department becomes the primary care for all who do not have insurance. How will the hospitals cope and who will cover the cost?  – Paul

Unfortunately, Paul, those of us in Arizona know all too well what happens when large numbers of people lose access to care. After enrollment in our state’s Medicaid program was frozen in 2011, more than 160,000 people fell off the program rolls over the course of the next two years. They began showing up in our emergency department and those of hospitals across Arizona, seeking health care of last resort for the uninsured. Uncompensated care at Tucson Medical Center alone climbed to more than $25 million. Last year, that number had dropped to about $8 million, thanks for expanded coverage. For many hospitals, and particularly those in rural areas, that burden may be too much to bear, reducing access to care for many who need those critical services.

Medicare impacts

  • How will this bill impact people who are on Medicare? Not on Obamacare? – unsigned
  • How is Medicare affected? – Melvin
  • What does the Senate’s BRCA do to Medicare? – Judith

Although the proposed Senate bill does not make changes to Medicare eligibility or benefits, it will reduce Medicare revenues by eliminating Medicare taxes paid by high-income earners.

Currently, Individuals who are paid annual wages more than $200,000 ($250,000 for married couples) pay a Medicare payroll surtax – a tax higher than those who are paid wages less than $200,000 annually.

The Senate bill will eliminate the Medicare payroll surtax on high-income wages by 2023.

The proposed Senate legislation also repeals the Net Investment Income Tax – a tax implemented by the Health Care and Education Reconciliation Act to help fund Medicare. This tax applies to individuals that annually earn more than $200,000 ($250,000 for married couples) on certain investments (interest, dividends, capital gains and rental income).

The Senate bill makes this tax cut on high-income investments retroactive to Jan. 1, 2017.

It is not just health care entities who are concerned about these proposals. Nancy LeaMond, president of the AARP, has expressed deep concerns about the impact of the bill.  The Senate bill also cuts funding for Medicare which weakens the program’s ability to pay benefits  and leaves the door wide open to benefit cuts.”

These are the answers we have for now. We continue to work on more questions, and will provide answers in a future blog.

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Tucson Medical Center | 5301 E. Grant Rd. | Tucson, AZ 85712 | (520) 327-5461
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