Friday, April 20 , 2018, 2:05 am | Fair 55º

 
 
 

Capps Answers Your Questions on Health-Care Reform

Noozhawk readers asked us to get more details, and we're delivering them

Last week, Noozhawk’s Lara Cooper had an exclusive telephone interview with Rep. Lois Capps, D-Santa Barbara, about health-care reform legislation, one of the hottest issues in the country right now.

Because of Capps’ congressional schedule and the breadth of questions that we, and Noozhawk readers, wanted to ask, we were unable to cover as much of the topic as we wanted. Thanks to the assistance of Capps’ spokeswoman, Emily Kryder, we submitted all of the questions, which are answered below.

We’re grateful to Capps, Kryder and Noozhawk readers for participating in our coverage of this hugely important issue.

Noozhawk publisher Bill Macfadyen can be reached at .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk.

» Will the elected officials voting on this issue be under the same health plan as everyone else — or will they continue to exempt themselves and keep their own plan?

The health plans that cover all federal employees, including members of Congress, will be subject to the same rules and regulations that all other plans will have to comply with.

» Can we reduce the risk of lawsuits that doctors have that require high insurance premiums and also protect the patients from neglect? Doctors over-test to protect themselves. Is there a happy medium?

President Barack Obama announced in his speech to Congress on Sept. 9 that the health and human services secretary will begin work immediately to implement a demonstration project designed by the Bush administration to address medical malpractice. This program will be to work with states to seek alternatives to traditional medical malpractice legislation.

» The plan will not insure illegal immigrants, yet there is nothing in place to prevent fraud by illegal immigrants, such as checking identification. Why?

Section 246 of the America’s Affordable Health Choices Act (H.R. 3200) specifically prohibits undocumented individuals from receiving any federal assistance in paying for health care. Under this legislation, to qualify for any federal assistance with health insurance costs an individual must file a tax return and, based on their income level, they may qualify for a subsidy to help purchases health insurance coverage. This requirement is used to prevent fraud from individuals who seek federal assistance to purchase health insurance.

» Rather than overhaul the entire U.S. health-care system, why not tackle simple fixes first? Such as allowing insurance companies to sell across state lines; regulating the insurance industry with things like mandates that require companies to accept pre-existing conditions; stop providing unlimited medical care to illegal aliens; and tort reform?

The health-reform legislation actually builds on what works in our current system and takes steps to make it work better for all Americans, including prohibiting insurance companies from denying coverage because of patients’ pre-existing medical conditions — such as pregnancy or acne — or refusing to cover a consumer’s medical expenses after a serious injury or diagnosis.

» Should prescription drug advertising be banned? Think of that cost added to drug costs.

I have supported efforts in the past to ban prescription drug advertising. Unfortunately, attempts to do so have been opposed. I personally believe pharmaceutical companies should spend more money on research and development rather than advertising.

» National unemployment is hovering at 10 percent. The stimulus bill was rushed through under emergency conditions, but just a small percentage of the funds has been spent and much of the spending won’t happen for years. Why the full-court press on health care and not the economy?

They aren’t mutually exclusive. The United States spends more money per capita on health care than any other country, yet we don’t have any positive results to show for it. To improve our economic situation, we must tackle health-care spending, as we do in this legislation. I also think it’s important to note that when President Obama took office, we were facing the greatest economic crisis in a generation and the economy appeared to be on the verge of a depression. This serious situation demanded swift, strategic action to help prevent a more serious depression. In its first six months, the Recovery Act has worked to stabilize economic conditions, stem job losses, rebuild our economic base, help those harmed by this crisis, and create the stability necessary to get us on the road to economic recovery. While unemployment is still too high, the rate at which we are losing jobs has dropped significantly since the passage of the Recovery Act, and economic experts agree that the U.S. economy is slowly, but surely, recovering. Addressing health reform is part of our larger effort to rebuild the American economy to make it stronger and more stable moving forward.

» The president said in his speech that “a full and vibrant recovery is still many months away.” What is Congress doing to hasten that recovery?

Again, in a little over six months since it was signed into law, the Recovery Act has been successful in stabilizing the economy and laying the ground work for a full recovery. It’s important to remember that we didn’t get into this economic crisis overnight and that it will take some time to fully recover, but we are headed in the right direction. Click here to learn more about how the Recovery Act is helping to repair and strengthen our economy.

» How are you going to pay for an overhaul of the U.S. health-care system? How can all of these reforms not add “a dime” to the deficit?

Doing nothing will add more to our deficit because of the uncontrolled spending on health care in this country. We are taking many steps to pay for health-care reform and ensure it is deficit-neutral — something that was never done under the Bush administration or Republican-led Congress when they pursued costly initiatives, such as the tax cuts of 2001 and 2003, the Medicare Modernization Act of 2003 or the Iraq and Afghanistan wars. Reducing fraud and waste in Medicare — like overpayments to drug and insurance companies — will save us $500 billion alone over the next 10 years. Click here for more information about how we pay for comprehensive health-care reform.

» Do you stand behind the Congressional Budget Office assessment that the White House cost estimates are wildly optimistic?

One thing to be aware of is that the CBO only makes estimates for a 10-year period. Many of the investments we will make to improve our health delivery system will take longer than 10 years to show savings, but are vital to our nation’s future health.

» The president has said — repeatedly — that if you like your doctor, you can keep your doctor, and if you like your insurance, you can keep your insurance. But if the government is assuming the role of competitor and referee, and private companies that currently provide health insurance can drop that coverage and pay a penalty equivalent to 8 percent of payroll, how will millions of Americans who like their doctor, get to keep their doctor, and who like their insurance, get to keep their insurance?

There is an incorrect assumption in this question. Two separate entities would be managing the public insurance option and the Health Exchange. The Health Exchange will establish the rules that all insurance companies must follow, and the public insurance option will be beholden to those rules.

Right now, most people who enjoy health coverage from their employer have no role in choosing that health coverage; it is left up to their employer to decide which insurance plan to choose.

» What are your three most important issues/reasons in the legislation? The three things you can’t live without?

This is a comprehensive piece of legislation and no one piece is more significant than the sum of the whole, but for me the three provisions that I think are particularly important are:

» Public option being offered as a choice to consumers

» Investments in preventive care

» Training of health professionals, such as physicians and nurses

» You said at the Democratic Party’s Labor Day picnic that you would be voting for a public option. How committed is the House Democratic Caucus to the public option? Is a “trigger” or co-op an acceptable substitute?

I favor making the public option available as soon as possible and not relying on a trigger before it goes into effect. I’m not sure the co-op is an alternative to the public option; rather, it should be a complementary measure to provide consumers with choice and lower costs through competition. Co-ops exist now and are explicitly allowed to continue operating in the future.

» The president conceded that Medicare and Medicaid are plagued by “waste and inefficiency.” Do you agree? Given that, why should we expand federal authority over the rest of the health-care system?

The biggest waste and inefficiency in the Medicare program has been the enormous overpayments to drug companies and insurance companies. For example, Medicare overpays insurance companies in the Medicare Advantage program an average of 14 percent and as high as 20 percent in some parts of the country. Stopping those overpayments, which H.R. 3200 does, would save more than $100 billion over the next 10 years. And the bill puts more resources toward stopping day-to-day Medicare fraud to safeguard taxpayer dollars. Stopping fraud has to be an ongoing effort and for too many years there weren’t enough resources dedicated to addressing these problems.

» Do you support cutting Medicare Advantage? How many of your constituents are enrolled in Medicare Advantage?

When Medicare Advantage was created, insurance companies argued that they could provide care to Medicare beneficiaries more efficiently than traditional Medicare and were paid 95 percent of what Medicare would pay in the fee-for-service program. Instead, the Bush administration and Republican-led Congress allowed their payments to increase to a point where some Medicare Advantage plans get paid 130 percent of what traditional Medicare pays for the exact same services. This is wasteful, and we will bring Medicare Advantage back to where it should be — providing care for the same price, or less, than traditional Medicare.

» Democrats have an absolute majority. Why do you even need Republican support?

President Obama and congressional Democrats have repeatedly reached out to Republican members for their input and support on this and many other issues. Unfortunately, it appears that the Republican leadership has made a calculation that it is better politics to oppose our reform efforts and is doing its best to delay and ultimately kill the reform legislation. I think it is very telling that when Republicans had control of both the White House and Congress they did not seek to address the serious problems in our health-care system.

In addition, I think it is important to note that many bipartisan legislative initiatives are included in the bill. For example, several of my initiatives which were included in H.R. 3200 are based on bipartisan bills introduced earlier in the year. Here are a few examples: the Nurse-Managed Health Clinic Investment Act of 2009 (H.R. 2754), which I sponsored with my House Energy and Commerce Committee colleague, Rep. Lee Terry, R-Neb.; parts of the National Pain Care Policy Act (H.R. 756), which I sponsored with my committee colleague, Rep. Mike Rogers, R-Mich.; and the expansion of the Centers for Disease Control and Prevention’s (CDC) WISEWOMAN heart disease screening program for low-income and uninsured women, a key provision of legislation authored by my committee colleague, Rep. Mary Bono Mack, R-Palm Springs, and me, the Heart Disease Education, Research and Analysis, and Treatment (HEART) for Women Act (H.R. 1032).

Additionally, the Energy and Commerce Committee considered a number of amendments offered by Republicans and Democrats. Some passed and were accepted and some failed and were not, but here is a list of Republican members of the committee whose amendments were voted on and passed during committee consideration: Rogers and Reps. Steve Buyer, R-Ind.; Phil Gingrey, R-Ga.; Tim Murphy, R-Pa.; John Shimkus, R-Ill.; Cliff Stearns, R-Fla.; John Sullivan, R-Okla.; Greg Walden, R-Ore.; and Ed Whitfield, R-Ky.

President Obama and congressional Democrats will continue to seek Republican support and input for this reform legislation, but we will not allow reform efforts to languish unfinished to placate Republicans who seek this as an opportunity to win a political victory rather than do the right thing and fix our broken health-care system.

» Do you support the legislation from Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee? How does the House view that? As a first step, as a viable option, as a nonstarter?

As a member of the House, I have been concentrating on supporting the House version of health reform legislation because I believe it takes the right steps. I disagree with several aspects of the Baucus approach, namely the lack of a public option.

» Which chamber wins in the House-Senate conference?

That remains to be seen, but conferences usually result in compromises between the two bodies.

» Anti-abortion Democrats and Republicans want a yes-or-no vote on your abortion amendment. Do you support that? Will the amendment pass?

We did have a recorded “yes-or-no” vote on my amendment in the House Energy and Commerce Committee and it was passed with support from committee members whose records span the pro-life and pro-choice spectrum. Under my amendment, no federal funds may be used to pay for abortions that are not allowed by current law (the Hyde Amendment, which makes exceptions in the case of rape, incest or to protect the life of the mother). The only funds that may be used to pay for other abortion services are from private funds generated by the policyholders’ premiums, whether the policyholder is covered by a private plan or the public option.

» What was your office’s tally of constituent calls, letters and e-mails about health-care reform?

We’ve been contacted by more than 5,000 constituents through letters and e-mails about health-care reform since July 1.

» After the August recess, what has been the mood in the Capitol since your return?

We’re very energized and committed to enacting health insurance reform. The president’s speech was an important reminder to us all that this debate isn’t about political gamesmanship but rather the health and well-being of millions of Americans.

» Any updates you can give on stimulus spending in our district?

Just as it has nationally, the Recovery Act has had a positive impact on the Central and South coasts, protecting key services and making investments to help our economy recover in the short term and prosper in the long term. Click here and click here to learn more about economic recovery funding in my district.

» Has the California congressional delegation had any meetings regarding California’s precarious financial state? Are there things you all can do to provide leadership or direction?

The California Democratic congressional delegation has had numerous meetings to discuss the serious challenges facing California. We’ve also met with state and local leaders and the Obama administration to discuss the ways in which the federal government can be more helpful in spurring economic recovery in California. The Recovery Act has been helpful to both the state and local governments in providing additional funding to protect key services like education, law enforcement and health care, and make investments in areas like transportation, infrastructure and research to grow California’s economy over the long term.

» While I understand that illegal immigrants will not have subsidized health insurance, won’t illegal immigrants still be able to obtain emergency medical care at a hospital without payment? Personally, I wouldn’t want to see anyone denied emergency care, but what is your take?

Health professionals — doctors, nurses — are in the business of providing health-care services, not checking citizenship documentation. Anyone, regardless of where they are from, deserves access to medical care in an emergency, just as you would want the same if something happened to you while you were traveling abroad. The potential H1N1 flu epidemic this fall is a reminder that in emergency situations we want to make sure people have access to emergency care so they do not spread infection or are a health danger to others.

» May we see the complete list of all the insurance programs — including cost, coverage and other comparable details — available to members of Congress?

It is the same as that available to all federal employees. Click here for the details.

» Does the legislation still contain a provision for a study of equal medical treatment for minorities? Is there also a study for language accessibility? Why is money being spent this way when it doesn’t increase health care?

There are provisions to research better ways of ensuring equity in care for all people regardless of race or ethnicity. For example, we need to put an end to the current situation in which certain minority groups experience higher rates of maternal and infant mortality. We also make key investments in health professionals so we are training more doctors, nurses and other key professionals that provide vital care, and providing these professionals with incentives to practice medicine in medically underserved communities — such as urban and rural areas — that often don’t have enough health professionals to provide the care needed by the community.

» Why is there no comprehensive tort reform?

As I mentioned earlier, the president announced in his speech that the health and human services secretary will begin work immediately to implement a demonstration project designed by the Bush administration to address medical malpractice. This program will work with states to seek alternatives to traditional medical malpractice legislation. A demonstration program like this one will be helpful in giving Congress more information on this issue and what potential solutions would be effective. Several states have adopted tort reform policies individually, but there are questions about whether this issue is best left up to individual states to regulate or if a national policy would be more effective. Traditionally, questions about insurance policies and medical licensing have been left up to the individual states to decide, but there are some who believe that a federal policy on this issue would be more effective. The demonstration programs can help us answer that question.

» Will illegal aliens receive health care under this bill?

As I mentioned earlier, section 246 of the America’s Affordable Health Choices Act (H.R. 3200) specifically prohibits undocumented individuals from receiving any federal assistance in paying for health care. Under this legislation, to qualify for any federal assistance with health insurance costs an individual must file a tax return and, based on their income level, they may qualify for a subsidy to help purchase health insurance coverage. This requirement is used to prevent fraud from individuals who seek federal assistance to purchase health insurance.

» The president says we can keep our insurance if we like it, but he is cutting Medicare Advantage plans that many of us are very happy to have. Why?

The proposal doesn’t “cut” Medicare Advantage, it stops overpaying the companies that provide Medicare Advantage so that they get paid the right amount for providing their services. Independent studies from the nonpartisan Government Accountability Office (GAO) have shown that traditional Medicare provides the same health-care services as Medicare Advantage, with the same or better health outcomes and at a lower cost to tax payers (Click here and go to the last paragraph on page 7 of the report). By ending the overpayments to private health insurance companies that provide Medicare Advantage services, we will save taxpayers money.

» If there are such big savings to be had by cutting waste and mismanagement in Medicare, why isn’t the government already doing that now?

The previous administration wasn’t committed to enacting these changes, but we are now and that’s one of the many reasons we can’t wait to enact health-care reform.

» The plan supposedly will not insure illegal immigrants, yet there is nothing to prevent fraud by illegal immigrants, such as checking identification. Why?

Section 246 of the America’s Affordable Health Choices Act (H.R. 3200) specifically prohibits undocumented individuals from receiving any federal assistance in paying for health care. Under this legislation, to qualify for any federal assistance with health insurance costs an individual must file a tax return and, based on their income level, they may qualify for a subsidy to help purchase health insurance coverage. This requirement is used to prevent fraud from individuals who seek federal assistance to purchase health insurance.

» The president says that if you want to keep your insurance you can keep it, yet that will not be the case if the government option puts insurance companies out of business, or if employers drop the benefit because there is a government option. How do you explain that?

This is one of the most misunderstood parts of our health-care reform legislation. An employer can never force you to take the government health insurance option. If an employer doesn’t provide you with health insurance, you’ll have a choice of several insurance plans, including private health insurance and a public health insurance option.

» Why are tax-free health-savings accounts not considered?

Health-savings accounts are just that — savings accounts. Nothing prohibits people from having a health-savings account to set aside tax-free dollars to pay for out-of-pocket expenses, but they are not a substitute for health insurance. Nothing in this legislation prevents people from using health-savings accounts.

» Why are co-pays to discourage fraud and abuse not considered?

Under our legislation everyone will pay something for their health insurance coverage but for preventive-care services, like annual physicals or mammograms or screening for heart disease, we have waived the co-pay fees because charging co-pays for these preventive services are a “penny wise-pound foolish” policy. It is much less expensive and more effective to diagnose and treat heart disease or breast cancer in early stages before the patient’s condition is more serious.

» Why is the idea of allowing insurance companies to compete across state lines not considered?

This would set us up for a lowest-common denominator scenario. California, especially, has enacted many strong consumer protection laws that aren’t in place in other states. If insurance companies could sell across state lines, they would all move to whichever state has the fewest protections in place for patients. One such example is mandatory minimum stay in the hospital after a mastectomy, which isn’t a protection afforded to people in every state, but it is in California. I want Californians to retain this protection.

» Why should we trust the government to set aside money when it has proved incapable of doing that with the Social Security trust?

Social Security has been in place for more than 70 years and has helped tens of millions of seniors, disabled, widows and orphans avoid living in poverty. The Social Security trust fund is fully backed by the federal government and no benefits are at risk.

» Why is the government considered capable of running an efficient low-cost option that pays for itself?

Traditional Medicare, the Veterans Administration and TRICARE (health care for members of the military) have all proven to provide quality health care at a good price for the taxpayer. These programs’ participants have consistently rated their care favorably; indeed, at a higher rate of approval than those who have traditional private insurance. While there are areas in Medicare and Medicaid where we can improve efficiency and do more to reduce wasteful spending, we do have a model of care that has proven to be cost-effective.

» The United States admits more than 1.5 million immigrants per year on temporary and permanent visas. The U.S. population is projected to grow to 1.1 billion by 2100, primarily because of high immigration, legal and illegal. Do you believe such a densely populated nation is desirable and sustainable, or would you consider any reduction in immigration levels?

Right now, Congress is focused on enacting comprehensive health-insurance reform, but I do think we also need to enact comprehensive immigration reform. I personally believe the United States is a nation that has been built by immigrants and that immigration has always been a source of strength for this country.

» Can drug company and health-care profits and executive pay be reduced to a reasonable level?

One provision of this bill is to require that at least 85 percent of insurance company revenues are spent on actually providing health care. This means that less of your money paid into the company can be used to line the pockets of executives.

» Can the conflict of interest of doctors owning testing companies be limited?

There are some provisions addressing the conflicts of interest that can sometimes arise from physician-owned facilities.

» Can the paperwork and approval burden be reduced for doctors?

Yes.  Earlier this year in the Recovery Act we made major investments to encourage the adoption of health information technology that reduces costs and medical errors. We take many additional steps in our health-insurance reform legislation to streamline administrative burdens, such as encouraging the adoption of health information technology, like electronic medical records, but also standardizing forms that doctors use to submit reimbursements to insurance companies and Medicare, etc.

» Were any hard lessons learned on deployments of federal assets during the Jesusita Fire? Were those lessons applied in the La Cañada/Flintridge Fire?

I would have to refer these questions to local firefighters and the U.S. Forest Service.

» Why would you vote to completely change one of the best health-care systems in the world to that of the ailing Medicare and Medicaid or a Canada- or England-style health care?

I haven’t and I won’t. Our plan does not create a single-payer system such as exists in Canada or the United Kingdom. This is a uniquely American approach to reforming our broken health-insurance system that relies on innovation, competition and the private sector to provide Americans with greater health-care choices, reduced costs and increased coverage.

» Will you vote for health-care legislation that exempts members of Congress?

Our legislation does not exempt members of Congress.

» Will you vote for health-care legislation that exempts labor unions?

Our legislation does not exempt labor unions.

» If this health-care plan is so great, why is Congress exempting itself?

This legislation does not exempt members of Congress. The plans that cover all federal employees, including members of Congress, are subject to all the same rules and regulations as every other health insurance plan.

» How does spending $900 billion on health care make it cheaper?

First, much of that money is actually redirected money we are currently spending on health care in inefficient ways. In addition, if we don’t enact health reform, we’ll spend a lot more than we do now. We are also going to realize a lot of savings from many of the steps we are taking. It’s been more than 15 years since we last attempted to fix our broken health insurance system and, during that period, health-care costs have continued to rise faster than the rate of inflation and more Americans find themselves underinsured or uninsured. Again, we need to enact these reforms to help American families, businesses, as well as the government, that are facing unsustainable increases in health-care costs.

» We have 1,300+ insurance plans out there now. How does adding a public option make it more competitive?

In most areas of the country, only one or two plans control the market. This is certainly true on the Central Coast. In fact, the plan that has a virtual monopoly in San Luis Obispo County is raising its premiums and reducing physician reimbursements precisely because no competition exists.

» Why can’t Americans buy insurance across state lines if they can find a plan that fits their needs and is cheaper?

As I mentioned earlier, this would set us up for a lowest-common denominator scenario. California, especially, has enacted many strong consumer-protection laws that aren’t in place in other states. If insurance companies could sell across state lines, they would all move to whichever state has the fewest protections in place for patients. One such example is mandatory minimum stay in the hospital after a mastectomy, which isn’t a protection afforded to people in every state, but it is in California. I want Californians to retain this protection.

» How does cutting $500 billion out of Medicare help seniors?

We’re generating $500 billion in savings through the reduction of waste, fraud and abuse to be able to better provide care to seniors in Medicare. One such example is allowing the health and human services secretary to negotiate cheaper drug prices with drug companies just as we currently do with the Veterans Administration. This will reduce costs for the Medicare program and for seniors.

» Why aren’t you advocating for a government-administered prescription drug plan for seniors that permits the health and human services secretary to directly negotiate drug prices with manufacturers?

I am and we are! The legislation that we passed in the Energy and Commerce Committee finally allows the secretary to negotiate prices with drug manufacturers. It also closes the infamous “doughnut hole” in prescription drug coverage for seniors. I was proud to co-sponsor the amendment that allowed this to happen.

» Will you hold firm to the Progressive Caucus’ idea that without a strong and robust public option from Day One, meaning without any so-called triggers, that there can be no health-care reform?

I strongly support the public option and have repeatedly worked to ensure that it is included in our health reform legislation. The bill I voted for in the Energy and Commerce Committee included a strong public option and I expect to vote for a bill on the House floor that includes a strong public option. I have talked to the speaker (House Speaker Nancy Pelosi, D-San Francisco) about this recently and she expects the bill to pass the House with a strong public health option. I’m not going to sign a pledge or box myself in at this early stage, but I certainly think the best way to increase the number of folks with health insurance coverage and lower costs for everyone is to have a public health insurance option.

» Why must I be required to have health insurance against my will?

Health care is a shared responsibility. To make this work best for everyone in our country, individuals, the government, employers, pharmaceutical companies and insurance companies must all share responsibility. We require drivers to carry auto insurance; it only makes sense that we require individuals to carry health insurance. Taxpayers and particularly those of us with health insurance, already pay extra for uncompensated care to cover those who do not have health insurance. By having more people buy health insurance, we can lower costs for everyone.

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