A healthy proposal? Local groups discuss state-initiated health care | TheUnion.com

A healthy proposal? Local groups discuss state-initiated health care

Citizens show their support for a single-payer health care system at the "Medicare for All" rally in Sacramento on Jan 15.
Kent Clark |

Mindy Oberne, chair of Nevada County’s chapter of Health Care For All California, said she is tired of waiting around for the federal government to decide the fate of her health coverage.

She is taking matters into her own hands.

Oberne is organizing support for Senate Bill 562, the Healthy California Act, which proposes an alternative to the federal health-care system for California. She thinks the state should take a cutting-edge approach to health insurance.

Under Section 1332 of the Affordable Care Act, states can apply for Innovation Waivers, which allow them to pursue their own innovative strategies for health care.

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The waivers, which became available on Jan. 1, can be approved for any state proposing a program that is at least as comprehensive and affordable as the ACA, and does not increase the federal deficit.

California’s Senate Bill 562, The Healthy California Act, introduced by Senators Ricardo Lara and Toni Atkins in February, proposes a single-payer health-care system for the state.

If the bill were to pass, California could qualify for an innovation waiver.

Oberne said she’s ready for the fight to make that happen.

Local Perspectives

A single-payer health-care system involves residents paying taxes to the government to cover healthcare costs, eradicating the need for private insurance companies.

Jonathon Pierce, an internal medicine doctor in Grass Valley, said he’s scaled his practice way back in recent years due to the “overwhelming and outrageous burden” of the paperwork involved in billing insurance companies. He said he has to hire at least one full-time employee to take care of billing alone.

Pierce said a single-payer system would alleviate that burden for doctors while also creating a better experience for patients, who are suffering because of high deductibles and high drug costs.

“It’s slam-dunk obvious,” Pierce said.

Critics say allowing government to control health care is a bad idea.

Bob Hren, chairman of the Nevada County Republican Party, said he looks at other government-run health care programs as examples of how a single-payer system might function in California, like the system used by the Veterans Health Administration, or the systems used in Canada and the United Kingdom. U.S. Rep. Doug LaMalfa, who represents western Nevada County in Washington D.C., expressed similar thoughts during a March town hall in Grass Valley.

“They all have the same problems,” said Hren, citing higher taxes for the working middle-class, and health care characterized by “extremely long delays and rationing.”

Hren said the Nevada County Republican Party is in favor of the Trump administration’s proposed American Health Care Act.

Jeff Kane, a retired Nevada County doctor, said that in any health-care system “not everybody’s going to get exactly what they want.” He said a single-payer system, though, would not only be “quite a lot cheaper,” but also “much less complex.”

“What we’re faced with now is a many-payer system. Each one of those payers — private insurance companies, medicare, medical — they all have their own systems, contracts, policies, and procedures. It’s really hard to navigate through that, both for patients and for doctors,” he said.

An innovative proposal?

Supporters of the Healthy California Act say it would create a system with universal coverage, where nobody is left out, and provide better coverage to everybody, with no copays, deductibles, or caps.

Supporters also argue that a universal health care system is more fiscally responsible, saving money on administrative costs.

According to a 2016 annual report by the Board of Trustees for the Federal Hospital Insurance and Supplementary Medical Insurance Trust Funds, private insurers’ overhead costs averaged at 12.4 percent of their revenue during that year versus 2.2 percent for traditional Medicare.

Reducing overhead to Medicare’s level, along with the reduced administrative expenses for physicians and hospitals, would produce an estimated savings of $504 billion annually if a single-payer system were to be adopted nationwide, according to a study published by the American College of Physicians.

The Healthy California bill will have its first hearing in the California Senate Health Committee on Wednesday.

Stalled or not?

Following a decision by President Trump and House Speaker Paul Ryan to withdraw the proposed American Health Care Act in March for lack of congressional support, Trump’s campaign promise to swiftly “repeal and replace” Obamacare appeared to be losing traction.

“We’re going to be living with Obamacare for the foreseeable future,” Ryan said at a March press conference.

But the Trump administration hasn’t entirely moved on from tackling health care in the short term.

On April 6, before members of Congress left for a two-week recess, House Republicans submitted an amendment to the American Health Care Act to the House Rules Committee at the request of President Trump, who reportedly insisted the House take action on federal health-care reform before the start of the recess.

The proposed amendment creates a scaled-down version of Obamacare’s subsidies for the most expensive patients.

Insurers, who would voluntarily participate in the program, would funnel patients with pre-existing conditions or serious illnesses into high-risk pools. The federal government would then subsidize those insurers through the “Federal Invisible Risk Sharing Program,” which allocates $15 billion in subsidies over a nine-year period. The program does not address what would happen after the nine-year funding program’s expiration.

The amendment states that it aims to “lower premiums for health insurance coverage offered in the individual market.”

Obamacare allocated $8 billion per year to subsidize insurers covering high-risk patients in a similar transitional reinsurance program.

Critics say the proposed program wouldn’t provide a large enough budget to subsidize patients with pre-existing conditions.

The amendment shows the Trump administration isn’t finished with its attempted health-care replacement bill, and is grappling with ways to gather more support.

“It’s an unbelievably complex subject,” Trump said in late February. “Nobody knew that health care could be so complicated.”

Getting involved

Nevada County’s chapter of Health Care for All California is now participating in the Healthy California Campaign, a statewide assemblage of single-payer health care advocate groups which were galvanized as a response to the threat of the ACA’s repeal, according to Oberne.

The umbrella group is now the primary force advocating for SB 562.

The local chapter holds monthly meetings, which Oberne expects to grow as the Trump administration continues to discuss health-care reform.

“It’s not going to be an easy fight,” she said.

Advocating for a universal health care system for the state is her way of pushing back against what she calls the federal government’s health-care mess.

Nevada County’s Health Care for All California chapter hosted a training session last Saturday for those interested in advocating for Senate Bill 562, and Oberne said over 30 people attended. Trainees will travel to Sacramento Wednesday for a rally in support of the bill while it is heard by the Senate Health Committee.

The organization will hold its next monthly meeting on Saturday, from 11 a.m. to 1 p.m., at the KVMR Community Room, 120 Bridge St., Nevada City.

To contact Staff Writer Matthew Pera, email mpera@theunion.com or call 530-477-4231.

*Story has been updated to clarify Bob Hren’s quote.

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