Thursday, July 28, 2016

In Presidential Election, There Is Only One Choice For Healthcare

by Paul Gibbs

I dread presidential election years, and Facebook has made it so much worse. It used to be easier to get away from the vitriol and avoid political tension with friends. And this year it got very intense very early, as the primaries were more heated than usual. I found myself in the position of staying fairly quiet about my preference, and doing my talking mostly with small monetary contributions. But with the primaries over and our choices narrowed, I feel I can't do this anymore in good conscience, because not only are we in danger of not moving forward with any improvements in health care, most of the candidates would destroy any and all progress that has been made in recent years (and both the numbers and the personal experiences of people like me and many others I've encountered as an activist show we have made considerable progress). As a health care advocate, there is only one possible choice I can make for my vote, only one candidate who shows both an understanding of healthcare issues and a longstanding desire to improve America's health care system. Only one who won't throw away all of the work we've all been doing. And that candidate is Hillary Clinton. 

It's obviously not Donald Trump. Trump doesn't have a realistic, solid or detailed proposal for anything. He tells us his healthcare plan would be great, it would be wonderful, it would do everything for everybody. But he's given us next to nothing in terms of details. And there's not a consensus among Republicans to accept a Trump plan, especially with House Speaker Paul Ryan having proposed his own plan. Both Trump and Ryan want to repeal the Patient Protection and Affordable Care Act, and with a Republican president and congress, it would happen. The exchanges would close, causing tens of millions to lose their healthcare coverage.  Pre-existing conditions would again block people from being insured, which would have a devastating effect on people like me with chronic conditions (while I could theoretically fall into Ryan's "except for those with continuous coverage" exemption, there are any number of ways my coverage could get interrupted, and the lack of online exchanges would make getting new coverage that would count as "continuous" much harder.). This, of course, doesn't even go into the myriad of other problems with Trump, an unambiguous racist who has been caught in more lies than all other 2016 presidential candidates combined, and whose dangerous views on foreign policy have caused former officials from Republican administrations to endorse his Democratic opponent.  

What about Libertarian Gary Johnson? Sorry, but Johnson, while seemingly a solidly honest and upstanding guy, shows a frightening lack of understanding of healthcare issues. He even wants to abolish most forms of health insurances, relying on an absurdly naive and unsupported belief that the free market would drive prices down to an affordable range. As an activist who's been working with people who in some cases can't afford the possibility of $10 co-pays or other such expenses but are suffering from devastating ailments, I find this to be the most ridiculous statement on healthcare I've heard in recent years. This is based on an ideological deification of the free market, not on any kind of logic or evidence. He also favors making huge cuts in Medicare and turning Medicaid into a block grant program which would allow states to cover fewer people than they are now, anathema to a Medicaid expansion supporter like me. Johnson seems to me to be a far better human being than Trump, but on the issue of health care, he's not a better candidate. 

And Green Party candidate Jill Stein? While she's a physician, she's also an advocate for fringe pseudo-science and panders to the anti-vaccination crowd. I don't trust someone with such a questionable grasp of medical science to take care of healthcare issues. Besides, while she supports universal health care, any progress that is going to be made on proposals like a "Medicare for all" single payer program would require a huge majority of votes in congress, one which seems incredibly unlikely to happen no matter who wins. And since a third party candidate can't carry down ballot votes with them, any third party candidate inherently helps the "repeal Obamacare" status quo. I find many supporters of Stein or Johnson seem to be voting that way as a moral stand against two major party candidates they see as corrupt or embarrassing.  Sorry, but I cannot let my vote contribute to the risk of taking health care access from tens of million of people so I can feel pure or stick it to the establishment.  I see no morality in that. 

So that leaves us with the much-maligned former Secretary of State. I could go into why I think she's the best candidate on foreign policy and overall economic issues, and at very least the best middle ground on social issues,  but that's not the subject of this blog. So I'll stick to why I believe she's the only reasonable choice for a healthcare activist like me: with Clinton in the White House, the ACA will not be repealed, but it will likely be improved. Those of us who support and defend the ACA are well aware that it's a flawed piece of legislation, and there are problems that need to be fixed. But tell the millions of people who suffer from chronic or potentially deadly illnesses who can now get insurance they couldn't get before that it's not helping anyone. Tell the tens of millions of people who are now insured and weren't before. All credible evidence supports the idea that millions of people have been helped by this law.

Hillary Clinton supports reducing the cost of insurance plans on the healthcare exchanges by extending tax credits up to $5,000 to help families struggling with premiums and and deductibles. And reviving the "Public Option" through an optional state by state process that would not require passing congress.  Through these provisions she'd improve the "Affordable" part while preserving the "patient protection" part.

For me, choosing a president is first and foremost about what they'll do and whether they're qualified and capable to do the job. The only candidate I feel has good ideas on health care and is capable of implementing them is Hillary Clinton. I believe the other three would set us back in ways I can't accept. And that's why, from my healthcare activist perspective, she's the only candidate I can choose.

Sunday, January 24, 2016


by Paul Gibbs

With the 2016 Utah General legislative Session about to begin, the debate over whether Utah will implement a form of Medicaid expansion to cover the 44,000 Utahns in the coverage gap rages on, and less clearly than before. Because unlike 2014, this isn't a debate over a straight-up expansion of traditional Medicaid under the Affordable Care Act. And unlike 2015, it's not about Gov. Herbert's Healthy Utah plan. Both of these unfortunately failed to pass our legislature (and for about the 50 billionth time, no, Gov. Herbert can't just unilaterally pass either one without the legislature. Railing against Herbert on this is a waste of time, effort and breath that we can't afford). What we have now is multiple different potential bills which attack the problems from different directions. Some of these have the potential to be effective. Some, frankly, don't.

We'll learn more about each of these proposals as the session progresses, but here's a preliminary rundown of what we do know, who is sponsoring them, and their respective pros and cons. Along with the basic facts of each bill, I've offered my personal opinion of it's potential effectiveness.  While these opinions are admittedly subjective, I hope you'll notice that they're non-partisan. My support or opposition for these or any other proposals is based on their effectiveness in providing much-needed healthcare coverage to people who can't get it somewhere else. not on which party it comes from.


House Majority Leader Jim Dunnigan, architect of the failed "Utah Cares" plan and a member of the Gang of Six who devised the failed "Utah Access +" plan, is proposing a partial expansion which would cover a very small percentage of the gap population, 0-10%.

I've disagreed with Rep. Dunnigan more often than not in this debate but unlike some of his colleagues further to the right, he seems to recognize that there is a serious problem here in need of a solution, and I believe he sincerely wants to solve it. But this plan doesn't even come close to doing that. When Dunnigan acknowledged to a house committee that the coverage provided under "Utah Cares" wasn't "a Cadillac plan", I expressed the opinion that it wasn't even a "Pinto plan". This new plan is one roller skate with a broken wheel. It leaves tens of thousands of Utahns without insurance access and leaves millions of dollars of our tax payer money going elsewhere instead of helping Utah citizens in need. And the promised potential to put higher income people in the gap on PCN (Utah's Primary Care Network) doesn't make it better. PCN offers very limited coverage with no specialty care at all. My aunt who was on PCN had to wait over a year to even get the necessary tests to diagnose an illness that turned out be cancer of the esophagus. She passed away in late 2015.


The bill from Sen. Allen Christensen (R-Ogden) looks to make Dunnigan's look good by comparison. It also only covers a small percentage of those in the gap, and only if they qualify as "medically frail". Aside from fitting the same problems of leaving far too many uninsured and not bringing back tax payer money, it does nothing to address one of the current problems faced by many in the gap who face serious problems: inability to get the healthcare needed to diagnose them as qualifying for help. Christensen has long been one of the most staunch ideological opponents of Medicaid expansion/Healthy Utah/Any version of expansion that uses federal funding, and this bill caters to that ideology, not to fixing the problem. This is the weakest of the plans being proposed.



Sen. Gene Davis (D - Salt Lake City) is again proposing the straight-up expansion of traditional Medicaid provided under the ACA. This certainly would accomplish the goals of providing quality coverage to all those in the gap, and bringing back the maximum amount of tax dollars. The is problem is, it just doesn't stand a realistic chance of going anywhere. The straight expansion has failed in the legislature for three consecutive years and is anathema to the far-right legislative contingent that has stalled previous efforts to cover the gap. Nothing has changed over the past year to give us any reason to believe the result will be any different. I've met personally with Sen. Davis before to discuss the coverage gap situation and the various plans to address it. I appreciate his commitment to providing quality healthcare coverage to those in need, and I certainly don't oppose this bill. But I feel that in this case idealism has to be tempered with practicality in order to achieve results, and that efforts are better spent on plans which would offer comparable coverage (Healthy Utah, for example, would have covered the same number of people and brought back as much federal funding) but stand a greater chance of passing a vote. I'd love to be wrong and see this go further than I expect it to, but I'm not holding my breath.


Rep. Raymond Ward (R-Bountiful), a physician who has dealt with many patients in the coverage gap, plans to propose a plan which has been described by some as a mix between Healthy Utah and Utah Access +, bringing back the maximum federal funding and covering up to 138% of the federal poverty level. Of all of the proposed bills, this is the one which has me most optimistic. Rep. Ward has been one of the most tireless supporters of helping those in the gap since before he was even elected to the House of Representatives, and this sounds like potentially the best deal in terms of providing real coverage,  returning tax dollars, and actually having a chance of going somewhere. The downside is that since Ward is in the house, that's where the bill will start, and opposition to expansion in the house is strong to say the least. I'm afraid it may take quite a bit of pressure to convince Speaker Greg Hughes to even give this one a fair chance, and we need to make sure that pressure is there.


Rep. Rebecca Chavez-Houck (D-Salt Lake City) is another legislator I greatly respect, and if we can't get something like Rep. Ward's bill passed in this session, her proposal to put the issue on the 2016 General election ballot (the result would be a recommendation to the legislature, not a binding decision). This would be a full expansion which, like Ward's bill, would cover up to 138% fpl and bring back the 90/10 match rate from the federal government. If it passes, it will be interesting to see if the staunch ideological expansion opponents in the legislature will exceed my expectations and put the will of their constituents ahead of their agenda.


Sen. Brian Shiozawa (R-Cottonwood Heights), last year's sponsor for the healthy Utah bill, plans to introduce a message bill, telling the federal government Utah would implement a partial expansion of of up to 100% fpl if the government were to extend to us the 90/10 match rate, instead of the 70/30 that would normally come with such an expansion. While I'm in favor of a full 138% fpl expansion, I certainly understand where Sen. Shiozawa (who as much as anyone is responsible for keeping the idea of a from of Medicaid expansion in Utah alive and is one of my favorite Utah elected officials of either party) is coming from. Expansion opponents or doubters have frequently expressed that they would be willing to support or at least consider such a partial expansion, therefore this one might have a chance of passing if the federal government would approve it, which they have previously refused to do. Even if this one does manage to get over its many hurdles it's not the best plan, but it's far superior to Dunnigan or Christensen's, and I hope expansion supporters don't mistakenly turn against one of our biggest allies for trying to do the best he can under very difficult circumstances.


The bill proposed by Rep. Robert Spendlove (R-Sandy) is similar to Shiozawa's, but adds a purely ideological requirement that people receiving benefits would work. I, like all expansion supporters, am exhausted by now of pointing out to opponents that the data clearly establishes that the majority of people in the gap already work and most of those who don't are disabled or otherwise unable to work. A work requirement serves no legitimate purpose and would make the plan less likely to get federal approval, as the federal government has already refused to accept a work requirement.

With 45 days to go in the legislative session, it's difficult to predict which, if any, of these potential solutions or non-solutions will gain gain support. But it's certain that tens of thousands of Utahns will suffer needless until a solution is found. Contact your legislators and tell them you support a real and substantial Medicaid expansion plan.

Watch ENTITLED TO LIFE and learn about the people in the coverage gap