Pragmatism, not ideology, needed in health care reform

The problem with voting for president is you can’t take your vote back for a refund when you realize you got a bum deal.

For a hint at why even a Fox News poll showed President Trump’s approval rating dropping by five points while the latest Quinnipiac poll shows his support eroding even within his core base of white Republican men, consider the heartbreaking case of former “Trump Troubador” Kraig Moss. CNN caught up with Moss, who spent last year following Trump around on the campaign trail after selling off the equipment for his construction business and stopping mortgage payments on his home.

Moss had lost his 24-year-old son to heroin addiction and believed Trump’s campaign rhetoric about healthcare, particularly specific promises he made several times on the campaign trail to help families suffering from addiction.

Then reality hit. The “I’m-going-to-cover-everybody” healthcare plan Trump promised is estimated to increase the number of uninsured by 24 million people by 2026, increase premiums for older Americans, remove the mandate that Medicaid cover basic mental health and addiction coverage, and roll back the Medicaid expansion that allowed many of the states suffering the most from the opioid epidemic to provide coverage. In Connecticut, over 770,000 people are covered by Medicaid, about 230,000 of those are covered by Medicaid expansion, and another 111,000 under the Affordable Care Act. We rank 5th out of 30 states in terms of opioid-related visits to emergency rooms.The latest Quinnipiac poll shows 56 percent of voters disapprove of Trump’s plan and only17 percent approve.

“The bill is an absolute betrayal of what Trump represented on the campaign trail,” Moss told CNN this week. “I feel betrayed.”

Here in Connecticut I’ve sat through many “Coffee with your Legislators” events listening to my Republican state representatives extolling the virtues of a free market in healthcare — which I’ve never found to be a convincing argument since I am a self-employed person with pre-existing conditions who paid through the nose in the high-risk pool and faced premium increases of 18 to 20 percent annually before the ACA. And always under the constant threat of losing coverage if they decided I was too much of a risk.

But if Republicans really do believe in the free market, then consumers need a free flow of information in order to make informed decisions. Yet when our open government-minded state comptroller, Kevin Lembo, proposed SB 925, a bill to stop skyrocketing prescription drug costs, including measures that would establish price transparency when drug prices are increased excessively beyond a certain threshold, Republicans (and one Democrat) on the Insurance and Real Estate Committee voted against it.

My attempts to understand why they voted this way yielded limited response, but the two representatives who did respond seemed to be representative of the larger debate playing out in Washington.

State Rep. Rob Sampson, a Republican from Wolcott who is a ranking member on the committee, explained: “The bill went too far. It gave the state broad authority to regulate pricing, which will have the effect of stifling innovation.” During a lengthy conversation, Sampson made it clear that he believes that we need a free market in health care — to the point that consumers should pay doctors directly and get reimbursed by insurers.

Let’s leave aside for a moment the very real issue of the cash flow stress Sampson’s idea would place on low income and middle class families. I’d like to share a story from my pre-ACA days in the high-risk pool, when my family didn’t have prescription coverage and we had to do exactly the kind of thing that Sampson proposes for our prescriptions. At one point United Healthcare, who was our insurer in the high-risk pool, owed my family over $10,000 in reimbursement claims. I spent a great deal of my time calling them to chase up claims, which they told me they’d “lost” and I’d have to resend.

Finally, I wrote a letter of complaint to the chairman of United Healthcare, copied to my thenCongressman Chris Shays and Senators Chris Dodd and Joe Lieberman. What do you know? Magically, United Healthcare “found” my claims and the reimbursement checks that I’d been chasing up for months started arriving.

But leaving aside Sampson’s ideology, what is concerning — as a former legislator who voted to put our town employees into the state health insurance plan administered by Lembo and as a consumer who counts on legislators to make factual, rather than ideologically based, decisions — was his claim that the bill gave the state “broad authority to regulate pricing.”

Comptroller Lembo stated:

“It would be a shame if this legislation to fight unsustainable prescription costs was voted down due to a lack of comprehension by the Republican co-chairs — particularly because it was made quite clear during multiple meetings with them, the public hearing and of course the plain language of the legislation that it certainly did not include any mechanism whatsoever to impose price regulation.

“Not only did I engage with every possible stakeholder before proposing this legislation, but I even adjusted it to reflect concerns that Republican leadership raised after multiple meetings. There has been ample opportunity to understand the legislation, and to suggest improvements to it — including a public hearing where few questions were asked and the many weeks before the legislation was rejected on a procedural motion by the Republican leadership of the Insurance and Real Estate Committee.

“All of that being said, it’s not too late to revive this important measure to fight skyrocketing prescription costs, and to allow for a full debate about this in the General Assembly.”

State Rep. Tim Ackert, R-Coventry, gave some hope for this, allowing that some components of the legislation could be incorporated into other bills.

As we watch ideologues in Washington attempting to strip healthcare from millions of Americans, it would be really great if we could see more pragmatism close to home. Sarah Darer Littman is an award-winning columnist and novelist of books for teens. A former securities analyst, she’s now an adjunct in the MFA program at WCSU (and as such is an AAUP member), and enjoys helping young people discover the power of finding their voice as an instructor at the Writopia Lab.