Democrats get started

State gov­ern­ments start fol­low­ing through on cam­paign prom­ises

Albany Times Union (Sunday) - - FRONT PAGE - By Sally Ho and Ge­off Mul­vi­hill As­so­ci­ated Press Seat­tle

Cam­paign to ex­pand health care un­der way in states.

Rid­ing the mo­men­tum from Novem­ber’s elec­tions, states’ Demo­cratic lead­ers are wast­ing no time de­liv­er­ing on their big­gest cam­paign prom­ise — to ex­pand ac­cess to health care and make it more af­ford­able.

The first full week of state leg­isla­tive ses­sions and swear­ingsin for gov­er­nors saw a flurry of pro­pos­als.

In his ini­tial ac­tions, newly elected Cal­i­for­nia Gov. Gavin New­som an­nounced plans to ex­pand Med­i­caid to those in the coun­try il­le­gally up to age

26, im­ple­ment a man­date that ev­ery­one buy in­sur­ance or face a fine, and con­sol­i­date the state’s pre­scrip­tion drug pur­chases in the hope that it will dra­mat­i­cally lower costs.

Wash­ing­ton Gov. Jay Inslee pro­posed a pub­lic health in­sur­ance op­tion for peo­ple who are not cov­ered by Med­i­caid or pri­vate em­ploy­ers and have trou­ble af­ford­ing poli­cies on the pri­vate mar­ket.

Democrats in sev­eral states where they now con­trol the leg­is­la­ture and gover­nor’s of­fice, in­clud­ing New Mex­ico, are con­sid­er­ing ways that peo­ple who are unin­sured but make too much to qual­ify for Med­i­caid or other sub­si­dized cov­er­age can buy Med­i­caid poli­cies.

And in the na­tion’s most pop­u­lous city, New York Mayor Bill de Bla­sio an­nounced a pub­licly run plan to link the unin­sured, who al­ready re­ceive treat­ment in city hos­pi­tals, with pri­mary care.

It’s all in keep­ing with the main theme Demo­cratic can­di­dates pro­moted on the cam­paign trail in 2018.

They touted the ben­e­fits of for­mer Pres­i­dent Barack Obama’s health over­haul — such as pro­tec­tions for peo­ple with pre-ex­ist­ing con­di­tions, al­low­ing young adults to re­main on their par­ents’ health in­sur­ance poli­cies and ex­panded cov­er­age op­tions for lower-in­come Amer­i­cans. At the same time, they painted Repub­li­cans as seek­ing to elim­i­nate or greatly re­duce health care op­tions and pro­tec­tions.

“Once you give some­thing to some­body, it’s pretty hard to take it away, and I think we see that with how the sup­port for the (Af­ford­able Care Act) has grown over the last two years,” said Wash­ing­ton House Rep. Eileen Cody, who is lead­ing the state’s pub­lic op­tion pro­posal.

The ac­tions also rep­re­sent a push­back to steps taken by the Trump ad­min­is­tra­tion and con­gres­sional Repub­li­cans to un­der­mine the Af­ford­able Care Act.

The GOP tax law stripped away the in­di­vid­ual man­date, which was in­tended to sta­bi­lize in­sur­ance mar­kets by en­cour­ag­ing younger and health­ier peo­ple to buy poli­cies. And last sum­mer, the Trump ad­min­is­tra­tion said it would freeze pay­ments un­der an “Oba­macare” pro­gram that pro­tects in­sur­ers with sicker pa­tients from fi­nan­cial losses. That move is ex­pected to con­trib­ute to higher pre­mi­ums.

The Demo­cratic pro­pos­als fall short of pro­vid­ing uni­ver­sal health care, a goal of many Democrats but also an elu­sive one be­cause of its cost. In re­cent years, Cal­i­for­nia, Colorado and Ver­mont have all con­sid­ered and then aban­doned at­tempts to cre­ate state-run health care sys­tems.

Still, many Democrats are ea­ger to take steps that get them closer to that.

“This is not just a moral right,” Inslee said in an­nounc­ing his pub­lic op­tion pro­posal this past week. “It is an eco­nomic wis­dom, and this is very pos­si­ble.”

Some law­mak­ers in Colorado, where Democrats now con­trol the leg­is­la­ture and the gover­nor’s of­fice, are propos­ing a state-run health in­sur­ance plan sim­i­lar to that an­nounced by Inlsee. It would reach those who don’t qual­ify for fed­eral as­sis­tance or who live in ru­ral ar­eas with few health care choices.

Both states plan to rely on their agen­cies that ad­min­is­ter Med­i­caid, the state-fed­eral pro­gram that pro­vides health cov­er­age for roughly one-in-five Amer­i­cans. Repub­li­cans are skep­ti­cal about whether the states can af­ford it, since they al­ready pick up a por­tion of Med­i­caid costs.

“This is about hav­ing the gov­ern­ment com­pet­ing in the pri­vate mar­ket. Medi­care-for-all will be priced out,” Wash­ing­ton state Rep. Joe Sch­mick said.

Tak­ing in­cre­men­tal steps to in­crease cov­er­age op­tions and make health care more af­ford­able may be a smarter strat­egy than pur­su­ing a costly and com­pli­cated all-or-noth­ing pro­posal for uni­ver­sal cov­er­age, said Kather­ine Hemp­stead, se­nior pol­icy ad­viser at the Robert Wood John­son Foun­da­tion.

“Ev­ery­body wants to pay less for health care,” she said.

Democrats now have more lever­age to ex­per­i­ment. Cam­paign mes­sag­ing around health care helped them flip seven gover­nor’s seats to bol­ster their num­bers to 23 across the coun­try and win back sev­eral state leg­isla­tive cham­bers. They gained full con­trol of state gov­ern­ment in sev­eral states, in­clud­ing New York and Ne­vada.

That power will al­low them to con­sider health care ex­pan­sions that Repub­li­cans have re­sisted.

In Ne­vada, for ex­am­ple, the state’s Demo­crat­i­cally con­trolled leg­is­la­ture passed a bill in 2017 that would have let any­one in the state buy into a Med­i­caid in­sur­ance plan, sim­i­lar to the op­tion be­ing pushed in New Mex­ico. But for­mer Gov. Brian San­doval, a Repub­li­can, ve­toed it.

The new gover­nor, Demo­crat Steve Siso­lak, is form­ing a com­mit­tee to look at health care op­tions, in­clud­ing the pos­si­bil­ity of re­quir­ing ev­ery­one to have in­sur­ance. In ad­di­tion to the Cal­i­for­nia pro­posal, that man­date al­ready is in place in Mas­sachusetts and New Jer­sey, with Ver­mont fol­low­ing in 2020.

It’s a sim­i­lar dy­namic in New Mex­ico, where Demo­cratic law­mak­ers have talked for years about al­low­ing peo­ple, in­clud­ing non-cit­i­zens, to buy into Med­i­caid if they can­not af­ford in­sur­ance any other way.

Colin Bail­lio, pol­icy di­rec­tor for the ad­vo­cacy group Health Ac­tion New Mex­ico, said a bill is be­ing drafted with the goal of get­ting it adopted this year and im­ple­mented for 2020.

Reed Saxon / As­so­ci­ated Press

Hun­dreds of peo­ple march through down­town Los An­ge­les in 2017 protest­ing Pres­i­dent Don­ald Trump’s plan to dis­man­tle the Af­ford­able Care Act, his pre­de­ces­sor’s sig­na­ture health care law.

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