Health Care Reform

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A discussion with State Rep. Kyrsten Sinema, member of President Obama’s White House Health Reform Task Force, and Dr. Eric Novack, Chairman of Arizonans for Health Care Freedom.

Jose Cardenas: As Democratic congressional leaders and White House officials continue to shape health care bills that will go to the house and senate floor, the fight between both sides of the issue is far from over. Joining me to talk about the latest on the health care deinterstate is assistant house minority leader state representative Kyrsten Sinema, representative Sinema is also a member of President Obama's White House health reform task force. Also here is Dr. Eric Novack, an orthopedic surgeon and chairman for Arizonans for health care reform. Thank you both for joining us on "Horizonte." Dr. Novack, first would you describe the organization that you're involved in, and then we'll talk a little bit about the task force, and then we'll talk some specifics.

Dr. Eric Novack: Absolutely. Thank you very much for having me here. Arizonans for health care freedom, which is at Arizona health care, for people who want to learn more, is a group that's sporting a referendum that will be on the ballot in 2010 that does just two things -- it would put into our state constitution the right to choose to not participate in any government-run or government-controlled or government-sanctioned health insurance plan without a penalty. So they can't force you to join it. And number two, it would put the right in the state constitution to always be able to spend your own money for any legal health care Service. That is it. It will do nothing to damage the state's Medicaid program, as evidenced by our discussions in the legislature with the folks at AHCCCS, and that's all it does. Just two basic rights.

Jose Cardenas: This is something that was on the ballot in the last election that was defeated by the voters.

Dr. Eric Novack: A different version. Proposition 101 was two sentences long. One of the arguments our opponents made was a quote unintended consequence. So we went back, and through many stakeholder meetings improved the language greatly. And I would admit the language is greater. One of the biggest complaints last fall is that the language might put "The Arizona Republic" program at risk. -- the AHCCCS program at risk. The same folks who run that program run it today, even though the party has change the in the governorship, those same people now are neutral on it. So they no longer believe it will adversely -- the new version will adversely impact the state's Medicaid system. We're talking about two basic rights. There are basic rights that were supported by candidate Barack Obama.

Jose Cardenas: We'll come back and talk about that, but in terms of now president Obama, representative Sinema, you're involved in a task force that is focus order health care reform. Tell us about the task force and what you're doing right now.

Kyrsten Sinema: In June of this year, President Obama invited 32 state leaders from around the country to join a task force to do three things. One, to share the president's vision for health reform throughout the country. Two, to provide information to citizens all around the country about what's happening in Congress, and we use English, so people can understand exactly what's happening. A lot of them -- a lot of the bill language in Congress is hard for people to understand. But also to answer people's questions and dispel myths that have been put out there by opponents. Finally, one of our jobs is to gather information and input and data from citizens around the country to give to the president and to Congress to help them shape help reform so it works for our states and for our citizens.

Jose Cardenas: You just had a meeting, your task force, with President Obama?

Kyrsten Sinema: Yes. We met at the White House with Mr. Obama on Wednesday of last week for about three hours. And during that time we shared information that we have learned from our states, but also got detailed updates about what was happening in Congress at the time and what comes next in the process.

Jose Cardenas: So what's what was the most significant piece of information your group had to share with the president?

Kyrsten Sinema: We really shared a lot of information about what states and actors in states are saying. What we found is this. The majority of health providers support health insurance reform, a majority of health providers and citizens across the country support a public option. As one choice among many ways to get health care in our country. But most importantly we sent a message that states need flexibility to enact health reform that's passed in Congress, to make sure it works for our states, and doesn't do anything to harm the good work that states have been doing.

Jose Cardenas: Governor Brewer has expressed concern about precisely that issue, and has pointed out in her judgment the Baucus proposal would be very costly and expensive for states like Arizona. Do you agree with that?

Kyrsten Sinema: There's one provision of the Baucus bill that does have great concern for us in Arizona, and probably other states across the country. It's the provision that would require the state to begin contributing more money to Medicaid, which we call AHCCCS, and to do so pretty quickly. Our state can't do that right now, because we're in a massive deficit. Most other states in the country share that same problem. We anticipate that by around 2013 we'll be able to start putting a little more money into Medicaid, so more people can come on to that health care system. But we want more time. And the house bills and the senate health bill, the other four bills in the process, all give us that time. And we anticipate the final language will also give us that time.

Dr. Eric Novack: Take a little issue with the topic of the public plan. The recent poll that was just released and got big fanfare from "The Washington Post" A. couple of issues about it. They made it as a massive increase in support for a public plan, but it was really within the statistical margin of error from the last time they did the polling, number one. Number two, the sampling of the poll absolutely positively skewed Democratic only 20% of the respondents in the poll were Republican. What's very, very telling is that when you look at overall support for reform, it's just not there. You still have more people opposing the overall package than are supporting it. Remember --

Jose Cardenas: Americans overwhelmingly seeming to calling poor health care --
Dr. Eric Novack: In health care, the details matter. When someone comes to see me with a knee problem, they do not want me standing on the exam table and pontificating about the knee. They come with specific complaints and they want detailed answers. The problem with the health care reform -- we all agree, we want to increase access, lower costs, and increase quality. But again, in health care the details matters. And what we saw all summer and what we continue to see today is that the more Americans learn about the details of the planning being proposed, the less they like them.

Jose Cardenas: There does seem to be growing support for the so-called public option, whatever that may be. The poll results you mentioned seem to be consistent with the Cronkite 8 poll showing while many don't understand the public option, the majority of those who do profess to understand it support it.

Dr. Eric Novack: Look. How they word the question matters. In the "Washington Post" poll, that's getting at this news, they never even mention the word "public option." They just talk about an alternative to private health insurance. That got 57% support in this very skewed poll in terms of the polling -- who they talk to. However, another poll done at the same time that spoke about it differently, the support was only 50%. So it's true that A, the majority of people don't know what the public option is, B, the wordings of the questions matter, and frankly, the president has yet to articulate an actual vision of what a public option ought to be. So there's a good reason for this confusion.

Kyrsten Sinema: Maybe I can help with that.

Jose Cardenas: I was going to ask you, you've been doing these teletalk town halls, and you've done two of them, and have another one coming up. What are you hearing about the people on this public option?

Kyrsten Sinema: First, actually, as part of the task force, I held nine public forums over the course of the summer, and am now doing biweekly teletown halls to keep people update order what's happening. I think what -- I know Eric has talked about some of the details and what he sees are deficiencies in the creation of these polls. But poll after poll across the country, and here in Arizona, has shown that Arizonans and Americans support a public option. But it is true that people aren't sure what it is. So what I'd like to do is explain what it looks like.

Jose Cardenas: Please do.

Kyrsten Sinema: So we have what's called a health insurance exchange in Arizona. And this is a system that all the built- bills in Congress would establish. It's a government managed entity that contracts with private companies in order to allow them to have access to all wide and broad range of patients. We have it right now in AHCCCS and kids care. And the good news is here in Arizona we have the best functioning health insurance change in the country with an overhead rate of only 3%, and medical inflation rates that are some of the lowest in the country. So the health insurance exchange that's proposed in these bills is already in place in Arizona. So that saves us some time and money in implementation. What the public option means is simply this -- in an exchange, that you can have Blue Cross/Blue Shield, united health care, mercy care, maybe you've got Aetna, and those are all the choices that people who choose to participate in the exchange can buy. They can buy from any of those companies. A public option is simply one more company but instead of being a privately owned company that has its bottom line profit, it's a government-run entity that functions more like a nonprofit. And we have seen nonprofits that work very effectively here in our country. Kaiser Permanente, etc. So there are opportunities to have a nonprofit entity providing health care. People may choose to participate in that health insurance company or they could choose a private company like they do right now.

Jose Cardenas: Are you saying that there currently is a public option in the Baucus bill, for example?

Kyrsten Sinema: No. The Baucus bill is the one bill out of the five bills in Congress that doesn't mandate a public option. But all the bills have this health insurance exchange. And that in itself is a very important part of this legislation. It provides all clearing house for companies to get access to patients and for patients to have choices to -- so they can choose the kind of plan that works for them while still being guaranteed the same level of benefit from each of those plans.

Dr. Eric Novack: Well, I think there are big issues here. Arizonans can understand this. First of all, health care group, which you I'm sure are familiar with, was the effectively a public option. It allowed small businesses and individuals to buy into the state's AHCCCS or Medicaid center. Our former governor guaranteed that under her plan, it would be fully self-sustaining by 2007. Now, what happened to this public plan that was supposed to be self-sustain something it was in such massive deficits, it raider $8 million bailout of public money, eligibility was reduced, and the benefits were reduced as well. And when you talk about this idea of an exchange, you have laid out exactly why we're regardless of what the insurers may be saying publicly, privately the largest national health insurers are rejoicing. Because the vision of health care reform that they have for every single American is that every person is forced into AHCCCS. And so the biggest health insurers, there may be united health care, there may be a Cigna, there may be some other company, so you can choose column A, B, C, D, the benefits will be designed by the federal government, number one, number two, the payment is going to come directly from the federal government and go to these companies, which is why behind the scenes they've been supporting. And under any version of an exchange, and even with a public option, which I will say as an aside, even the house bills, it creates a public option, but for those of you looking at the bills on page 117 of HR 3200, it specifically gives the federal government the right to outsource running the public option to private companies without allowing them to have any insurance risk.

Jose Cardenas: Let me ask you this -- the opposition to the public option at least one of the state oppositions is it would put private health care insurers at a disadvantage. And if I hear you right you're saying they actually support it.

Dr. Eric Novack: Well, I would say that publicly people don't want to support it. But if you were some of the largest insurers, there's probably some pretty good money to be made administering these programs. Much like, for example, triwest runs tricare and makes money, united health care does the same thing for a good portion of the southeastern United States for the VA program. So the largest health insurers are actually net winners in form of a public option, but they all win because everybody in these plans is being essentially having government forced insurance or you're going to pay a penalty. And "The Buried Secret" of that penalty will fall almost entirely on the one group that the president said he wouldn't touch. That all those penalty and all those increased taxes will fall on people making less than $250,000 a year.

Jose Cardenas: Is that accurate?

Kyrsten Sinema: I think we have some differences of opinion here. One of the key things is that Eric continues to use the word "force." And one of the things the president has made very clear, as have all of the bills that are moving through Congress, this health insurance exchange would be optional. Only those people who want to participate could participate. And even more so, Jose, for the first five years of the program, only those people who can't get health insurance from their employers would be eligible to participate. So it's not an issue of forcing someone to participate in a certain kind of exchange with a certain level of benefit. One other quick point --

Jose Cardenas: Does everybody have to participate to make this work?

Kyrsten Sinema: Everybody has to participate in health insurance, but no one would be mandated to participate in the exchange. And no one would be mandated to participate in a public option. Those are clearly options. And I think one more point that's important about the public option. The reason why the president has supported the public option is that the public option, because it doesn't have a profit motive, creates competition in the market. Which is truly what America is all about. And allows private corporations to compete with a nonprofit entity that is seeking to provide care not for profits, but solely as a Service to the public and that helps keep costs down and prevents what we've seen lately, which is increases of premiums of over 130%, which is just unaffordable for pokes in the middle class, even folks above the middle class.

Dr. Eric Novack: Do you believe, though --

Jose Cardenas: This will be the last question. On public option, if you have that many choices, would your group still be opposed to a requirement that everybody participate in health care?

Dr. Eric Novack: Let me read to you from candidate Obama. Every plan being proposed has an individual mandate. The most El Jeff Kent point of the individual mandate was senator and candidate Obama. This is from February 21st, 2008 in the CNN Univision debate with Senator Clinton. In Massachusetts he has a mandate right now. They've exempted 20% of the uninsured because they concluded 20% can't afford it. People are paying fines and can't afford it so now they're worse off than they were, and there's actual data demonstrating in Massachusetts, people who are being forced into these plans are saying that they are worse off than they were before.

Kyrsten Sinema: I think this shows why our president is such a good president. He's listened to the American public who have said over and over in polls that they believe in individual mandate is fair. Because then everyone is participating in the system, and then you and I aren't paying a hidden health care tax. Which is over a thousand dollars a year per family. Subsidizing the care for other people.

Jose Cardenas: On those two quotations of the same person, we'll have to end our show. Thank you both for being on "Horizonte."

Kyrsten Sinema:State Representative;Dr. Eric Novack:Chairman of Arizonans for Health Care Freedom;

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