On the heels of the much-debated Senate health care bill, commonly referred to as the American Health Care Act (AHCA), some concerned citizens convened at the D.W. Wilson Community Center in order to listen to medical experts discuss the potential impacts of the bill, and what rural Tennessee would look like should it pass.
Moderated by Sandy Rice, of Sewanee Organize and Act, the Tullahoma indivisible group, Indivisible TN-06, hosted a panel of five experts in the health care and insurance fields to discuss fears and spitball ideas on how to help solve the health care crisis in the United States.
The five panelists brought in to discuss the bill included local and out-of-town guests, knowledgeable in various fields of health care, from an Affordable Care Act (ACA) enrollment volunteer, to physicians to an insurance agent.
Nancy Silvertooth, the former Franklin County Circuit Court Clerk of 24 years, is a certified enrollment counselor for the ACA and Medicaid.
Cheryl Lankhaar is the school nurse at St. Andrew’s-Sewanee School. She is a certified women’s health nurse practitioner with 26 years of experience in both publicly funded and privately insured hospital and outpatient facilities.
Bill Zechman is a State Farm Insurance agent based in McMinnville, and sold health insurance to individuals through a partnership with Humana and the federal marketplace before it withdrew from the ACA exchanges in Tennessee.
Kelly Gregory is a public speaker, a veteran and a stage four metastatic breast cancer patient involved with Moral Movement Tennessee. For the past six years she has been living with terminal breast cancer, and is currently covered by TennCare.
Dr. Carol Paris is the current president of Physicians for a National Health Program (PNHP). She practiced psychiatry in Nashville for several years before her retirement in 2014 and is an outspoken critic of the private insurance system in the United States.
During each panelist’s introduction, they spoke to the issues that were the most pressing for them personally.
For Silvertooth, expanding TennCare, the Tennessee Medicaid program, was paramount.
“There’s a need for, of course, an expansion of Medicaid,” she said.
Having helped people who previously experienced problems with Medicaid enrollment, Silvertooth said helping those in “the gap” of insurance coverage — those who didn’t qualify financially for subsidies or tax credits — was where the focus should be locally.
Lankhaar focused her introduction on the importance of women’s health in particular, covering contraceptive care, preventative care and prenatal care as paramount in the fight for better health care.
Cost was the main focal point of her discussion, saying that if the AHCA passes in its current form, preventative and contraceptive care costs would possibly shift to individuals, making those essential services less attainable for those financially struggling.
Under current law, preventative procedures such as mammograms, pap smears and colonoscopies are fully covered under insurance plans. The same goes for 18 different forms of contraceptives, said Lankhaar.
Her worry was that, if the AHCA passes, insurance companies would no longer offer to cover those services, and the high price tag would prevent individuals from getting them.
A mammogram, she said, can cost $200, and a colonoscopy can cost $1,400.
Women using birth control pills would likely see a 61-percent increase in their monthly payments, up from a zero-dollar co-pay.
She further explained that long-term forms of birth control, such as intrauterine devices (IUDs) and etonogestrel implants can cost in the hundreds or thousands of dollars.
“The Nexplanon (implant) runs about $450 to get it put in and $450 to get it taken out in three years,” she said. “An intrauterine system, which 10 years, depending on the type, is about $1,000 to $1,100.”
Lankhaar rounded out her introduction with discussion on prenatal care.
“We know that prenatal care is important,” said Lankhaar, who worked in labor and delivery and high-risk obstetrics.
“Women are five times more likely to die if they do not get prenatal care,” she said.
Proper prenatal care can also reduce the risk of pre-term births, which would also help keep costs low in the long run.
“Twelve percent of all births in United States are pre-term. If we can prevent pre-term birth, we can prevent those babies form going into the newborn intensive care unit by taking care of the mothers — that’s a smart thing to do,” she said.
“We as women have not been replaced by incubators,” she added.
Zechman, who said his worst days at the office were the days that he had to tell people they did not qualify for health insurance due to a pre-existing condition, heralded the ACA for putting a “humane soul” into the capitalist nature of private health insurance.
He said that while he understand a private health insurer’s reticence to cover someone with a pre-existing condition, it was still the right thing to do.
“I understand the health insurance industry’s stand on that, because if you come in with a chronic heart disorder, let’s say, or diabetes, that’s kind of like insuring a house that’s already on fire — you know you’re going to have a loss, and it could be a catastrophic loss,” he said for an example. “That’s cruel, that’s inhumane, but that’s the basic economics of the situation.”
However, he said, once the ACA removed that “morally loathsome feature of the private health insurance market,” it “advanced our society.”
“It was wonderful,” he said.
“We enrolled 12 million people into the health insurance market that didn’t have health insurance previously,” he said. “I can’t help but think a large segment of that was people who were just waiting outside the door, who couldn’t get in, who couldn’t get their ticket punched because of that pre-existing condition, and heaven knows those are the people who need the coverage more than anybody,” he said.
But the overriding obstacle in the health care debate, he said, has nothing to do with health care at all. In fact, he said, the health care crisis was more tied to politics than anything else.
“The problem we have is the political problem,” he said. “It’s a failure in leadership.”
Zechman said it seemed like elected officials were more concerned with getting re-elected rather than actually helping people with health care.
“We’re just going to have to get those candidates who have humane spirit, the raw view of things, to be willing to run and to be willing to risk defeat,” he said.
There are worse things than a defeat at the polls, he said, and having people who are willing to run and spread a message while also being willing to lose would have to happen before any real progress on health care would come about.
Gregory, who works with the Tennessee Justice Center in Nashville, gave harrowing testimony about her experiences with stage IV metastatic breast cancer, as well as pointing out how the AHCA would negatively impact both cancer patients and veterans in the nation.
Her main points were that there were 2 million veterans who rely on Medicaid for their health care, and with the proposed Medicaid cuts in the AHCA, they would likely lose any health insurance available to them.
In Tennessee in particular, there 43,000 veterans who receive TennCare health care, and another 28,000 who exist in the coverage gap, according to Gregory.
Should the AHCA pass, estimates vary as to how many veterans would lose their health care, said Gregory, but “anywhere from 15,000 to 25,000 veterans would lose their health care.”
As far as cancer patients go, she said, Gregory took another path. Instead of bombarding the room with statistics, Gregory simply asked how many people knew of someone with cancer.
A cursory glance around the room saw every single attendee in the room raising their hand.
“There you go,” she said. “That’s how it’s going to affect cancer patients.”
Additionally, Gregory spent some time talking about the specific “legislative language” of the bill, which she said was designed to do harm to a great many people.
“On the issue of pre-existing conditions, this legislative language allows states to proffer waivers for the coverage of pre-existing conditions,” she said.
What that means, essentially, is that while insurers are still barred from denying coverage to people with pre-existing conditions, it allows for an insurer to “refuse to cover anything related to that pre-existing condition or to charge you an astronomical amount in order to cover that pre-existing condition.”
It also changes the process for receiving a waiver, Gregory said.
Currently, there is a two-step process, wherein a state must fill out a form and present a case for receiving a waiver and then send that form to the Department of Health and Human Services. Federal officials then look over the case and they decide if the state will be granted a waiver, said Gregory.
According to Gregory, the process under the AHCA is only an executive decision on the part of the state wanting the waiver.
“It changes that waiver process to a single executive decision, meaning a governor fills out the form and that’s it,” she said. “There’s no legislative input, there’s no input from DHS, it’s only the decision of the governor.”
If states are more easily able to seek and receive waivers, Gregory speculated that having cancer would very well likely be considered a pre-existing condition once again, and getting health care for an affordable price would likely be impossible.
Gregory also took issue with the subject of annual and lifetime caps for coverage, which would also come to pass under the AHCA.
There is a proposal, she said, to offer a $1 million lifetime cap in health care coverage under the AHCA. As a metastatic breast cancer patient, Gregory finds the idea of lifetime caps insulting and ridiculous.
While most people might think of $1 million as a large amount of money, in the world of health care —and particularly in the world of cancer — $1 million doesn’t amount to much.
“A million dollars barely gets you a seat at the table,” she said of the impact of money in cancer treatment. “I passed the million-dollar mark within the first year of my treatment,” she said.
She said that there are some cancer treatment options that cost $300,000 per treatment, so having a million dollar cap amounted to nothing for those with cancer.
“This coverage… is zombie coverage,” she said. “It’s worth nothing.”
Gregory wrapped up her introduction by discussing essential health benefits (EHBs), which are a list of procedures that was designated by the ACA as required for all insurers to cover. Most of the procedures are preventative in nature, she said, and the language of the AHCA does away with EHBs.
If EHBs are not covered, she said, more people will get sick and they will die because they will not be able to afford to be treated for preventable diseases like cancer.
“This is a horrendous bill, whose idea is predicated on the notion that people are disposable based on their health and their wealth,” she said in conclusion.
Dr. Carol Paris
Paris centered her discussion on how things benefitted from the ACA, how things could be better, and how everyone would benefit from a universal health care system.
Firstly, Paris pointed out that everyone benefitted from the ACA — not just those who purchased health insurance through the exchanges or those who received subsidies through the marketplace.
By eliminating the notion of the pre-existing conditions, she said, everyone who had health insurance in the last several years was able to receive better care.
She also pointed out that despite early rhetoric by former President Barak Obama, the ACA did not lower premiums as originally thought.
“The cost of premiums has skyrocketed,” Paris said.
It also did not control costs across the board, she said, so she understood why people voted for someone who said they would “cover everyone, lower premiums and improve choice.”
Unfortunately, she said, “you can’t do that and keep the for-profit insurance industry in the equation.”
She said that what was happening in Washington was “essentially, a whole lot of wordsmithing” so that the bill would technically deliver on most of its promises, but at the expense of those most vulnerable.
It wouldn’t cover everyone, she said, and while it would lower premiums, it would do so at the expense of young, healthy people, the elderly and the disabled, to name a few.
As far as improving choice goes, Paris said it would only improve the choice of “how much money you have to spend” on insurance.
It would be great for people who are “young and healthy and never have to use it,” and that’s all.
“The only way you can have a premium that keeps the costs down is by using a mechanism called cost-shifting,” she said.
That means that the deductibles and co-pays would be “sky-high,” and the insurance plan “wouldn’t be worth the paper it’s written on,” much like insurance worked before the ACA took effect.
Her solution to fixing the broken health care system was a “private extraction, rather than a public option,” meaning removing the for-profit insurance industry from the equation.
“If we eliminated profit and bureaucracy by eliminating the for-profit industry, we gain a half a trillion dollars a year,” she said.
“Add to that another $100 billion in negotiated drug prices, we’re up to $600 billion a year,” she added, which would be enough money to cover everyone in the country.
That would allow people to actually have a choice in their health care, she said, by allowing people to be able to choose which doctor or hospital to go to without having to worry if that physician or facility is in their network.
“What do we get the choice of? Any doctor, any hospital, anywhere in the United States — I think that’s the choice we were actually talking about,” she said.
Erin McCullough may be reached by email at firstname.lastname@example.org.