A POOR EXCUSE

A version of this article first appeared on April 1, 2015 on Utah's Poor.

by Paul Gibbs

“Great. I'm so excited to pay lazy people's medical bills!” That was the Facebook status update a friend of mine left the day after Barack Obama was elected President of the United States in November of 2008. Coincidentally, it was also one week after I had been diagnosed with end stage kidney failure and told I would need a transplant. The kidney disease, the surgeries I had and the recovery from them was full of many different kinds of pain that one of my surgeons aptly described as “feeling like you've been hit by a truck.” But none was more painful than being called lazy because I was uninsured and needed help.

In fairness, it should be pointed out that the friend in question emphasized that he didn't mean me. No, of course I wasn't one of those people. In fact, I've been told over and over again by people who repeat the stereotypes about lazy welfare frauds that I'm exactly the kind of person the system should be helping. I wasn't some deadbeat that wasn't working, I was working part-time for the Clark Planetarium and as a part-time actor, going to college part-time, and was a full-time care provider for the two greatest kids in the world—my niece and nephew. My sister and her husband both had to work full-time to support their family, so I was living in their basement and helping pay rent while taking care of the kids. The problem is that while in these people's eyes some like me is the exception, experience and statistic show us that I'm pretty average. But it's a lot easier to oppose programs such as Medicaid or Governor Gary Herbert's Healthy Utah plan if we tell ourselves that the people they're helping don't deserve them. That's really the entire basis of stereotyping: it's a way of justifying hating or turning our backs on people.

Because I felt that everyone should have the sort of live-saving access to healthcare that I had, I became an active part of the campaign for Healthy Utah. My activism has primarily taken the form of a documentary film called Enitled to Life, in which I told the stories of some of the tens of thousands of Utahns caught in the coverage gap between traditional Medicaid and premium assistance under the Affordable Care Act. I've continued to document and share the stories of these people, not just in Utah, but also in North Carolina and Florida. In over a year and a half of actively searching out people with stories to tell, I have yet to encounter one single person who was uninsured because they didn't want to work. But I've encountered many whose situations made mine seem easy.

Take my good friend and fellow activist Stacy Stanford, a college student who has started her own online business, and also volunteers with many causes to help disabled people such as herself. She's easily one of the most intelligent, hardest working and most determined people I've ever known. She's also suffering from a neurodegenerative disorder which has put her in a wheelchair. And she can't even get it diagnosed so she can qualify for traditional Medicaid because she can't afford the necessary specialty doctor visits. While Utah does (as Healthy Utah opponents in the legislature keep pointing out) have a strong charity care network, it provides zero options for someone like Stacy who needs specialty care. Free clinics don't give MRIs, and programs like PCN (Utah's Primary Care Network, an integral component of Rep. Jim Dunnigan's poorly named “Utah Cares” alternative plan) doesn't cover them. So Stacy is left gritting her teeth and working and going to school through pain and illness that even I, a chronically ill person myself, can't really imagine. Nobody in history has ever worked hard enough to earn the right to call her “lazy”.

Or take Melanie Soules. Melanie was a CEO and team leader for a local real estate company when she started suffering from symptoms such as hot, burning patches on her forehead and what she described as “hot oil flowing underneath her skin”. She developed vision and memory problems, and eventually lost her job, which left her and her two children uninsured. Melanie suffered from trigeminal neuralgia, and was unable to get access to healthcare. By far the happiest moment of my time as an activist was when I saw Melanie at a meeting and, for the first time since I'd met her, she looked well. I still cry just thinking about that moment. Melanie managed to get employment which gave her insurance coverage and allowed her to receive treatment. But she had to wait a year to get it. Did she deserve that? Was she “lazy” because she tried to keep working but the illness caught up with her?

Sure, people may say, but what about the person who chooses not to work and has 12 kids and uses their SNAP to buy lobster? I can't guarantee you these people don't exist just because I haven't met them. But I can tell you that it's a proven fact that they're in the minority. Research from the University of Utah determined that 65% of those in the coverage gap work at least part time. 85% of familes have at least one working adult. Under Healthy Utah, these people would be eligible for the healthcare coverage they need. Under the alternative plan proposed by Dunnigan and passed by the Utah House of Representatives, 40% of them would be only be eligible for a version of PCN, which we've already seen wouldn't help people like Stacy or Melanie. My friend Clare Richardson, who also suffers from chronic illnesses, explained to me that PCN wouldn't even cover treatment for her ingrown toenail. To claim this is comparable to the sort of care offered by Healthy Utah is so absurd it would be comical if it weren't so tragic. Dunnigan admitted to the House Business & Labor Committee that PCN “isn't a Cadillac plan”, but as I told them shortly after, it isn't even a Pinto plan.

Most poor people aren't poor by choice, and to portray them as such as ridiculous as to claim that people choose to get sick. But it's a way to deny compassion to our fellow human beings without feeling guilty about it. We can even be self-righteous about it and claim we're sticking up for good values. But the people who are suffering, and those of us who work with them and love them, know that simply isn't true.

CADILLACS, PINTOS AND YUGOS

by Paul Gibbs

Healthy Utah finally got its committee hearing on Wednesday, March 4, in the Utah House Business and Labor Committee. This was a little bit like having Olympic figure skating judged bu plumbers. But this bizarre non-sewuiter was no mere chance: it was a committee stocked with far right-wingers like Rep. Jacob Anderegg, and one one where "Utah Cares" sponsor Jim Dunnigan would have a lot of imfluence. It was a hearing, but not a faor one, and despite extensive expert testimony and overwhelming evidence, Healthy Utah lost.

In presenting his "Utah Cares" plan, Dunnigan admitted that Utah's Primary Care Network (PCN), on which his plan heavily relies, is "not a Cadillac plan". In my testimony, I countered that it isn't even a Pinto plan. Later, Dunnigan compared his plan to a Yugo.

The problem with "Utah Cares" is that PCN provides unbelievably weak and liimited coverage. No specialty care. No behavioral health care. No hospital care (my friend Clare Richardson couldn't even get help with an ingrown toenail). Very limited ER and prescription drug coverage. It's only because of a motion by Rep. Edward Redd that it now includes Mental Health care (which raises the level of care from "patthetic" to "poor"). Perhaps Dunnigan's Yugo analogy is apt in the following ways:

1) It's "affordable," but it's not there when you need it. 
2) The Yugo came out of a Communist country that had no compunction about engaging in rationing, and PCN is rationing, plain and simple, no two ways about it. 

Some are encouraging those of us who support Healthy Utah not overlook the good because we want the perfect. That's wrong on two levels:

1. "Utah Cares" can and at very best be called "mediocre". It fits no reasonable definition of "good".
2. A huge number of of us who support Healthy Utah do so because we are accepting the "good" of "Healthy Utah" because we couldn't get the "perfect" of Medicaid expansion.

Compromise is a good thing. It's the way a democratic government works. But "Utah Cares" isn't the compromise. If Rep. Dunnigan is willing to work with Senator Brian Shiozawa on a compromise between Healthy Utah and his bill, maybe we can work up a compromise more like a  Toyota Camry: not the best, but solid and reliable. Until then, "Utah Cares" isn't a compromise, it's a defeat for everyone.

"BETTER THAN NOTHING"

by Paul Gibbs

As Healthy Utah now advances toward a committee hearing, it does so along with the latest incarnation of "Utah Cares", an alternative plan from Utah legislators. The name of that plan is inadvertently telling: its purpose is to send a message that these legislators aren't a bunch of heartless bureaucrats who don't care about people who are suffering. Sadly, the bill seems far more concerned with sending that message than actually helping people.

"Utah Cares", sponsored by House Majority Leader Jim Dunnigan, relies on a mix of traditional Medicaid and heavy reliance on Utah's Primary Care Network (PCN). Dunnigan himself has, on multiple occasions, referred to PCN as "better than nothing". Is that really what we plan to offer as a solution?  PCN covers primary care only, which means no specialty care, no urgent care, no mental health coverage, and only limited prescription drug coverage. In essence, "Utah Cares" has morphed from a Senate plan which only covered people after they got sick enough to a plan which only helps people until they get sick.

Dunnigan defends this (as Allen Christensen defended his SB 153) by saying it's a big step, that it expands some form of coverage to a lot of people who didn't have it.  That's a very skewed way of viewing the situation. It's not about how their plan compares to the status quo, it's about how it compares to the very effective alternative we have in place, and comparing Healthy Utah to "Utah Cares" is like comparing the Superman to Justin Bieber. Healthy Utah gives actual help to those in need, and brings a lot of tax money back to Utah and into our economy in the process. "Utah Cares" spends a lot of new money so we can pat ourselves on the back and say we tried.

WHO'S BULLYING WHOM?

by Paul Gibbs


The fight for Healthy Utah has taken perhaps its oddest turn yet over the past week: Despite the Utah Senate passing Healthy Utah by a vote of 17-11, and rejecting Sen. Allen Christensen's competing SB 153, Utah House Speaker Greg Hughes is refusing to bring Healthy Utah to a committee hearing in the House. While Hughes claims this is because there is no significant support for it in the House, Republicans such as Rep. Becky Edwards have expressed support and called for Speaker Hughes to bring the matter to a hearing. One source even quoted me a GOP House member claiming the possibility of enough votes to pass the bill with Democratic support, though I freely admit I have not been able to confirm this as more than rumor.

Perhaps oddest of all is Speaker Hughes' assertion that his attitude has been caused in no small part by a flyer sent to the constituents of House Majority Leader Jim Dunnigan, encouraging them to contact the Representative and tell him to support Healthy Utah. Hughes calls the flyer "bullying" and even made melodramatic references to "dark money" , but what's in the flyer that has him so outraged? There is no character assassination, no personal attacks. Hughes and Dunnigan claim they flyer says Dunnigan is trying to hurt Utah families,
but no such claim is made, only that failure to pass Healthy Utah hurts Utah families (a claim supported by evidence and a far cry from accusing Dunnigan of deliberately hurting anyone). Has Hughes shown similar outrage at the larger campaign conducted by the Florida based Foundation For Government accountability, which has been making accusations at least as damaging against Governor Gary Herbert? What makes Jim Dunnigan so special that criticizing his position warrants circling the wagons and keeping the public out of the legislative process?

While we live in a representative democracy which calls on legislators to act in our behalf, make no mistake, they represent the public. To kill a bill which poll after poll shows has the overwhelming support of the people of Utah without even allowing the people of Utah to know which representatives support it and which oppose it is outrageous.  And for people who are blocking healthcare access to over 100,000 people in need because one legislator apparently can't handle criticism to cry "bullying" is comically absurd.

In the meantime, while Hughes continues to assert that Healthy Utah is dead, Dunnigan now says he has a compromise plan (ignoring that Healthy Utah itself is the conservative compromise for Medicaid expansion, and the current Healthy Utah 2.0 is a compromised compromise). Dunnigan's plan costs rejects federal funding and costs more to cover fewer people. I'd like to be able to call this a unique approach, but it's what Healthy Utah opponents have been putting out there all along. It's all they can put out there because they do not have a plan which will do as much good and spend less money.

Healthy Utah opponents in our legislature have been playing the "bullying" card for months, accusing the federal government of bullying them by trying to make us take back our money and only giving in to some of their demands instead of all of them.  They continue to portray themselves as the little guy pushed around by the feds, but the little guy is the poor peopls of Utah being pushed around their own Representatives.  Healthy Utah has gotten more concessions from the federal government than any other state's proposed Medicaid expansion alternative (including putting the money into privatized insurance instead of just expanding the existing Medicaid program), yet they continue to accuse the federal government of being unreasonable. Where are the concessions made by our legislature? Our Governor and the federal government have fashioned a compromise which was passed by our own state Senate, but the House leadership refuses to even allow it a committee hearing becau
se one legislator had his ego bruised. Which group seems unreasonable here? Which seems like the real bullies?

If there really isn't enough support to pass Healthy Utah in the House, show us with public proceedings. Asking us to take it on blind face because one official said so is not how America or Utah works.

VOTING WITH THE FACTS

by Paul Gibbs

As the Utah State Senate voted 21-8 to bring Healthy Utah to a third and final reading on Tuesday, February 25, many senators took the opportunity to stand and make long speeches about the reasoning behind their vote. The most intense and ironic of these was from rabid Healthy Utah opponent Allen Christensen, who ironically stated with an emotional appeal that "We're not talking about voting with emotion, we're talking about voting with the facts."

So let's examine the facts of the differences between Healthy Utah and Christensen's SB 153:

Healthy Utah will bring coverage to 47,000 Utahns in the coverage gap. SB 153 will leave 46,000 without coverage.

Healthy Utah returns over $2 billion in Utah taxpayer dollars to the state. SB 153 rejects all federal funding and is paid for entitely by the state, with a higher cost per patient than any other proposal.

Rejecting Healthy Utah will in no way  contribute to deficit reduction, as the money currently paid by Utah tax payers will then go to Medicaid expansion in other states.

Healthy Utah is the result of two years worth of study and deliberation by top state and federal officials as well as the medical community and insurance industry. SB 153 was unveiled in a single afternoon by a small committee of legislators with no public feedback and recommended in a partisan vote.

The Utah Hospital Association has conditionally pledged $22 million per year in support of Healthy Utah.

SB 157 covers only the "medically frail" and therefore does not accomplish providing routine and preventive care.

No state which has expanded Medicaid has experienced "crowding out" those covered by traditional Medicaid.

The agreement with the federal government allows Utah to back out of Healthy Utah if the federal government does not fulfill its commitment.

Despite fears from Healthy Utah opponents that employers will drop employee coverage as a result of Healthy Utah, strict federal penalties are are in place (including fines of up to $2,000 per employee dropped) for employers who drop coverage. No state which has expanded Medicaid has yet experienced employers dropping coverage.

The Church of Jesus Christ of Latter-Day saints issued a statement supporting a compassionate solution to the coverage gap issue involving consideration from both the public and private sector. Healthy Utah is the only current proposal developed by cooperation between the public and private sectors.

Research by Harvard University has determined that an average of 316 Utahns will die per year without coverage.

Healthy Utah is supported by:
The Salt Lake County Council
United Way of Salt Lake
Intermountain Healthcare
Molina Medical
University of Utah MedicalCenter
IASIS Healthcare, Mountain Region
MountainStar Healthcare
Association For Utah Community Health
Association of Substance Abuse Providers
National Association of Social Workers
University of Utah Healthcare
Utah Academy of Family Physicians
Utah Academy of Physician Assistants
Utah Association of Addiction Treatment Providers
Utah Association of Local Health Departments
Utah Chapter American Academy of Pediatrics
Utah Healthcare Association
Utah Hospital Association
Utah Medical Association
Utah Nurse Practitioners
Rural Hospital Network
Utah Nurses Association
Utah Occupational Therapy Association
Utah Public Health Association
University of Utah Health Plans
AARP Utah
Alzheimer's Association
American Cancer Society-Cancer Action Network
American Heart Association/American Stroke Association
Catholic Community Services
Coalition of Religious Communities
Community Action Partnership
Community Action Partnership
Diabetes Association
Disability Law Center
First Step House
Legislative Coalition For People With Disabilities
National Alliance on Mental Illness - UT (NAMI)
National Association of Social Workers
National MS Society
National Tongan Association of Utah
New Frontiers for Families
Odyssey House
Peace and Justice Commission
Pioneer Park Coalition
Planned Parenthood of Utah
Susan G. Komen
Utah Citizen's Council
Utah Health Decisions
Utah Health Policy Project
Utah Housing Coalition
Utah Pride Center
Utah Support Advocates for Recovery Awareness (USARA)
Utah Women's Health Coaltion
Voices For Utah Children
Women's State Legislative Coalition
Sentencing Comission
Utah Substance Abuse Advisory Council
Utah Chiefs of Policy Association
Utah Commission on Criminal and Juvenile Justice
Utah Law Enforcement Legislative Committee
HealthInsight
Leavitt Group
Salt Lake Chamer
Provo/Orem Chamber of Commerce
South Salt Lake Chamber of Commerce
Ogden/Weber Chamber of Commerce
Utah Food Industry Association
Utahn Manufacturers Association
Utah Mining Association
Utah Retail Merchants Association
Gail Miller, Larry H. Miller Group
Karen Hunstman
Lane Beattie, Salt Lake Chamber
Mark Miller, Mark Miller Dealerships
Associated General Contractors
Harmon's Pharmacies
Smith's Pharmacies


SB 153 is supported by:
Sen. Allen Christensen

So, I guess for once Sen. Christensen and I agree. Let's vote with the facts.

TWO PLANS, ONE SOLUTION

by Paul Gibbs

Over the past two weeks, two alternatives to Medicaid expansion have made it past the Utah Senate Health and Human Services Committee. I testified in behalf of the first, Senate Bill 164, Healthy Utah (as sponsored by Sen
. Brian Shiozawa). The second was Senate Bill 153, sponsored by Sen. Allen M. Christensen. While there are two plans, only Healthy Utah offers a workable and well-reasoned solution to the problem of Utah's coverage gap.

Christensen, one of the most vocal and staunch opponents of Healthy Utah, has presented a plan to cover only those who qualify as "medically frail". This fits his ideological belief that taxpayers shouldn't be providing healthcare to "able-bodied" people who don't work (despite the fact that multiple studies have conclusively proven that the majority of those in the coverage gap are working), and also fits his belief that the most vulnerable among us do deserve some help. While I greatly take issue with the first concept, the second is admirable, and demonstrates that, as insensitive as Christensen has sometimes appeared, he isn't heartless. I'll admit it took me some time to reach that conclusion, but speaking to some of his colleagues who have told me about good things he has done for patients and the medical community (while disagreeing with his current stance) has convinced me that we're not dealing with a melodrama villain here, just a basically decent man who also happens to be so ideologically stubborn that he refuses to see facts as facts if they disagree with his politics.

The first problem with the "medically frail" option was illuminated by Se. Edward Redd, a Republican who supports Healthy Utah: there simply is no such thing as a stable, easily identifiable group of "the medically frail". Health is not a steady state, it's something that changes over time. Those who are healthy now may be "medically frail" in a short time. Many may think they're healthy and, because they are uninsured, choose not to perform necessary routines such as check-ups. I fell into this category. It was only because my primary care doctor was called as an LDS Mission President and I was required to meet my new doctor to get some prescriptions renewed that I lucked into getting the diagnosis that my kidneys were failing and I needed a transplant. Under the status quo, I simply would have kept going until it was too late. I would not have qualified as "medically frail" under SB 153.

The second problem is that even those would qualify are now placed under an undue burden to prove that they do. My friend and fellow activist Stacy Stanford(who is in a wheelchair to a neurological condition) would not qualify as "medically frail" for the same reason that she doesn't currently qualify for traditional Medicaid: she can't afford to go to a doctor and get diagnosed. It's the height of irony that a plan presented by a staunch opponent of "socialized medicine"  (often claimed by its opponents to involve unnecessary bureaucratic complications) would, by its very nature, increase the bureaucratic hoops people are forced to jump through to get care. 46,000 people would be left with no option but to either pray they don't get sick, or, perversely, to pray they get sick enough to qualify for help/

Third, SB 153 simply makes no fiscal sense. It would allow $260 million of Utah taxpayer funds to keep going to other states, while 46 thousands Utahns go without any access to insurance. It would cost Utah an additional $30 million per year, while providing access to only about 10,000 Utahns. While Healthy Utah is the result of 2.5 years of study from the public and private sector, SB 153 was unveiled in a single meeting by a small group of legislators, with zero public input. It would be a tragic absurdity to accept a poorly reasoned plan which doesn't work financially or medically just to send a message that the majority of Utahns didn't support Barack Obama. I actually think Obama knows that already.

While two plans are on the table, only one solution is. Please contact your legislators immediately and tell them you support Healthy Utah, the real solution, and not the ill-advised SB 153.

ONE VICTORY DOWN, TWO MORE TO GO

by Paul Gibbs

4-1. That was the final number of the vote to take SB 164, Healthy Utah, past the senate Health and Human Services Committee and on to the senate as a whole.  It came at the end of a long and tense meeting where advocates on both sides of the issue, including me, made their cases. Thankfully, they who were with us were more than they who were against us (literally, though if you wish to infer that I mean that in any other way you're free to do so), and the only no vote came from committee chair Evan J. Vickers (Sen. Allen M. Christensen, also on the committee and one of the staunchest foes of Healthy Utah, had to leave the meeting early).  The other members of the committee saw past the paranoid Obamacare arguments of the Anti-Healthy Utah speakers, and voted the only way that made sense. While I think those of us who testified (perhaps even me) deserve some credit, the lion's share goes to Republican Sen. Brian Shiozawa, the sponsor of the bill, and man I'm proud to say appears in Entitled to Life. Senator Shiozawa was a joy to watch both at the HHS committee meeting and the earlier house Social Services Appropriation committee hearing. His knowledge and poise allowed him to run circles around his opponents, and he perfectly conveyed the truth of our message: Healthy Utah is good for everybody and it would be absurd and foolish to reject it.

But as gratifying as yesterday's victory was, less than 24 hours later the time for patting ourselves on the back is already over. There are bigger hurdles ahead: the senate, where plenty of strong opposition (including from Sen. Christensen) still exists, and then the house, which is going to make the senate look easy. For the moment we've stolen the momentum away from Christensen's "Frail Utah" plan, but we can't afford to squander that. More than ever we need to be relentless in pressuring GOP legislators to support Healthy Utah. Please note that I am not trying to take partisan sides, it's just that we really have no opposition from Democrats on the hill. But aside from Shiozawa Republican legislators Edward Redd and Ray Ward also distinguished themselves yesterday. If Healthy Utah passes, it will not be a Democratic victory, it will be a Utah victory.

Two legislators of particular importance are Senate President Wayne Neiderhauser and, as always, Rep. Jim Dunnigan. They can be contacted at:

Sen. Niederhauser:
Home: 801-942-3398
Work:  801-538-1035
Cell:    801-742-1606
Fax:    1-866-283-7751
wniederhauser@le.utah.gov

Rep. Dunnigan:
801- 840-1800
jdunnigan@le.utah.gov

The first battle of this session is won. But we'll have to double our efforts to win the two battles ahead.