Representative Kyrsten Sinema, assistant leader of the House Democrats, and Kim Van Pelt, Associate Director of St. Luke’s Health Initiatives, share their views on efforts to reform the nation’s health care system.
Ted Simons: Last Tuesday Congressman John Shadegg and Steve Forbes held a press conference in support of the Arizona Health Care ? Act that's on November's general election ballet. That same day, Forbes and Shadegg appeared on "Horizon" to explain their criticism of efforts in congress to reform health care.
Steve Forbes: People should have the right to say I don't want to buy this kind of insurance, or if I do I want to buy what I want, not what the government dictates to me. People should have the right if an if a health service is legal to be able to buy that health service. Providers should be able to provide that health service and not be punished by the government for it. Because where we're headed now is the government is going to be telling providers what they can and cannot do and that's wrong.
John Shadegg: There's a huge disconnect between the service provider today and the consumer of that service. That disconnect is we've put employers and plans in between. Now, what we're going to do is put the government in between. What Steve and I are saying is, let's get everybody out, lets have you and I as individuals be able to pick our own plan with the doctors we want or the services we want or the hospitals we want and get both employers out of middle and the government out.
Steve Forbes: If you allow nationwide competition, you're going to get literally hundreds of companies trying to figure out how to win your business. On TV every night, you have Geicos ads, you got the progressive ads, All state ads, other kinds of ads -- that's the kind of competition you want. So somebody is going to want you because they'll figure out to make money. And the other thing is when you get with true entrepreneurship, people will provide healthcare services at a more affordable cost like we do with the rest of the economy.
Ted Simons: Here now with another perspective on health care reform is democratic state representative Kyrsten Sinema, a member of President Obama's White House healthcare reform taskforce and Kim VanPelt, associate director of St. Luke's Health Initiative. Good to have you both on "Horizon" thanks for joining us.
Kim VanPelt: Good to be here.
Ted Simons: All right Kyrsten, compare and contrast the two bills right now, trying to be reconciled.
Kyrsten Sinema: Well in many respects, the two bills are identical and in many other respects they are largely similar. There are a few key differences and a couple of those are important for us here in Arizona. One version we've heard a lot about is the senate version of the bill which basically punishes Arizona for having done the right thing through a voter initiative years ago, by expanding Medicaid or as we call it in Arizona, AHCCCS, to more people. That bill, if it stays in that form will cost Arizona more money in the long run to continue to provide healthcare for those individuals. Under the house version though, Arizona actually gets a benefit of $7 billion over the course of ten years. So we're acrually rewarded for increasing insurance for individuals who are low income.
Ted Simons: When you talk about AHCCCS, there are interesting aspects as far as federal version but we've got the governor afternoon lawmakers saying we can't afford the funding source is not there anymore. What do we do with these folks? What happens to the program?
Kim VanPelt: The governor is proposing to essentially have the legislature refer back proposition 204 to the voters. This is again, the ballot initiative that was passed in 2001 which extended eligibility for AHCCCS up to 100% of the federal poverty level. If that's indeed rolled back, about 350,000 Arizonans would lose health coverage and these are folks who really don't make much money and they could go uninsured. I mean that could have profound impact on those people and our overall health care costs. So it's a significant proposal in terms of the impact on Arizona and the number of uninsured we might have in our state.
Ted Simons: And yet Kyrsten, these are lawmakers who say again the funding source simply is not there for this program as it stands or as it may stand even with reform.
Kyrsten Sinema: Well, with reform the house version of the reform actually helps us so we'll get a great infusion of cash to help bury that burden and provide that healthcare for those Arizonans. I think it's important to note that if we were to take that healthcare away from those 320,000 Arizonans, most of whom are working families that we're still going to provide care for those people through emergency rooms and that's what we call uncompensated care. So all of us pay for that in our taxes each year. It's much more expensive than providing health coverage and it provides for worse outcomes for all Arizonans. So I don't think it's a good idea, not a good proposal.
Ted Simons: As far as the federal versions are concerned again we had Congress man Shadegg and Steve Forbes in studio last week. Congress man Shadegg saying that these bills do nothing to control costs because the market is further afield and the government is right there in the middle of everything. You're thoughts?
Kim VanPelt: Well, the federal proposals really do have an impact in terms of coverage. They make significant increases in terms of the number of people to be covered nationally to the tune of 30 million Americans who will have coverage. That's a big deal for states like Arizona where one in five Arizonans are without health insurance. So that will definitely have an impact on cost. But there are certainly reasons to be concerned about how well the federal proposals will control costs over time. There are a lot of ideas in there, a lot of sort of nipping at the edges in terms of controlling costs, but there's some truth to say that without further reforms, the overall healthcare costs may have continue to rise.
Ted Simons: We had senator KYL speak to this as well. Congress man Shadegg certainly mentioned this as did Steve Forbes the idea of Medicare advantage, the idea that senior's choice for seniors will be limited. Something simply will not be there anymore. These are concerns people have. How do you respond?
Kyrsten Sinema: Well, right now we do have a lot of choice in the market. The problem is that you're ability to choose among the choices in the market is incredibly dependent on your own personal wealth or the type of job that you have. The nice thing about both packages, the health and senate versions, is that that choice remains for Americans but subsidies put in place for individuals who don't have the power to make the choices they want to make today. So the truth is this legislation actually increases choice for most Americans.
Ted Simons: The Republican idea of tax credits for folks, they can have the money and go ahead and choose what they want without anyone telling them what to do or where to go. Why is that a bad idea?
Kyrsten Sinema: It's a great idea if you're young and healthy and will never get into an accident at all. But if you have a pre existing health condition, if you develop a disease or disorder or if something happens in your life that you're not expecting, than those tax credits won't cover the cost of your care.
Ted Simons: Is that how you see it as well?
Kim VanPelt: I would just add too that, tax credits don't really mean much if you're not paying taxes to begin with and certainly if you are low-income and can't afford to buy coverage, they're meaningless.
Ted Simons: So if there is a program set for those folks who can't afford it, to get on a different exchange or covered in different ways, that still doesn't cut it?
Kim VanPelt: The tax credits aren't really significant enough to really have an impact on health coverage for low-income people.
Kyrsten Sinema: There's not even enough for most middle income people to be honest. We're talking about tax credits that cost less than the cost of giving birth to a baby in a hospital. If you plan to get pregnant, your tax credit is not enough.
Ted Simons: We heard Steve Forbes comparing health insurance to auto insurance to comparing it to food stamps, these sorts of things. Apt to comparison?
Kyrsten Sinema: I think there are some key differences. When one goes without health insurance, it affects all of us. Not only do they receive coverage solely through hospitals, which you and I pay for through the emergency rooms, but they also increase the risk for public health concerns. Spread of communicable diseases is increased when we have lower levels of health care coverage. And that's a key difference from auto insurance.
Ted Simons: And yet the free market folks are saying that these health insurance companies don't have to compete. There are so many middle players that most of us don't know what the procedures we're getting cost. By way of this and that and the other, everything clogs in the middle. Make it an open market, prices will come down and they will give you better service. Again?
Kim VanPelt: Well there certainly are problems with transparency in the system right now. We really don't know what things cost and that does contributes to overall healthcare costs. But I think part of Steve Forbes argument was that ultimately the government shouldn't be involved in the free market. I think most people really don't think that there's a need for more freedom with health insurance companies, they think that there's a need for oversight.
Ted Simons: Is there enough transparency in what you're hearing coming out of the federal bill?
Kim VanPelt: I think there's efforts to tinker at controlling costs in the healthcare system but over time, we're going to have to readdress that issue.
Kyrsten Sinema: The establishment of the commission is I think one of the key ways to get to that transparency. But, you know, back in terms of the idea of competition, one of the nice things about the exchange, and this exists in both bills, it that there are opportunities for companies that operate in the private market today and our private corporations to form nonprofits to provide this care and the fact that you're utilizing a nonprofit helps to drive down the cost. Because there's no inducement to have a profit margin. And so that provides some more competition within the exchange and it also helps keep the cost down.
Ted Simons: I know that senator KYL and we've heard from the Republicans, one of the things they mention is tort reform. Is it time to address tort reform?
Kyrsten Sinema: The president already did. Last year in September when he made his address to congress, he announced he was starting a pilot project in numerous states throughout the country to try out various types of medical malpractice reforms. Those pilots are in process right now and the federal government will have a report sometime this year. To talk about which ones are the most effective.
Ted Simons: Pilot project is one thing, actual hard tort reform is another. Is that something that could be considered a compromise with Republicans?
Kim VanPelt: I believe it could be considered a compromise. And I think there probably is need for tort reform but we'll see how it rolls out in what's being proposed by the president.
Ted Simons: I want to get back to AHCCCS and the future of AHCCCS here in Arizona. President Burns had a quote regarding people not being qualified anymore. His quote was they need to make choices as to how they spend the money they earn. The idea there may be sacrifices that need to be made among folks who right now aren't making them. How do you respond to that statement?
Kim VanPelt: Health insurance is not cheap. The idea of low income people buying it in the free market is hard to understand. It's clearly a problem that has to be addressed systematically, this isn't a free market problem.
Ted Simons: When you have heard senator Burns say that?
Kyrsten Sinema: I think it's important to remember who is on AHCCCS in Arizona. To qualify for AHCCCS you have to live at $18,000 a year for a family of four or less. There are single person healthcare plans in this state that cost that much money. So there's no ability for a family of four people that makes $18,000 a year to go purchase healthcare on the open market. I think there's a misunderstanding or lack of understanding about who these folks are on AHCCCS. Over the last year and a half, we've seen a great surge in enrollment in the AHCCCS program because middle class families, when one partner loses a job, in that family, boom, within two weeks they're eligible for AHCCCS.
Ted Simons: Last question someone watching right now is afraid and concerned that if one of these bills passes, they're going to lose options and coverage. What do you say to them?
Kim VanPelt: I think that the healthcare proposals being discussed in Washington actually offer Americans more choices. They certainly offer you more choices for example if you have a healthcare problem. Choices that don't exist today. They offer more protection for consumers in general, in terms of making sure that insurance companies actually live up to their obligations. You're going to have more choices over the long term, not fewer.
Ted Simons: All right we'll stop it right there. Thank you both for joining us.
Kim VanPelt/ Kyrsten Sinema: Thank you.
Kyrsten Sinema:Assistant Leader House Democrats;Kim Van Pelt:Associate Director of St. Luke's Health Initiatives;