Comments at the Forum hosted by Northern Indiana Community Coalition for Health Care
Health care is one of the most important issues in my platform. We spend $3 TRILLION annually on health care in America – more than any other country in the world, yet we continue to have many uninsured and poorer health outcomes than our peers. We must do better for the American people.
Health care is both an economic issue as well as one of social justice. I will support hard-working Hoosiers by seeking to ensure that all Americans, regardless of income, have access to affordable medical services. I will work with both parties in Congress to make common sense adjustments to the Affordable Care Act. We will increase efficiency and reduce medical spending while also improving health outcomes for Hoosiers. I will also fight to guarantee mental health coverage for all Americans, caring for our minds as well as our bodies.
Amending the ACA will make Hoosiers healthier, improve our quality of life, and move us toward a single-payer system of Medicare for All.
Senator Bernie Sanders has proposed a single-payer health care system in the United States. Is that the type of legislation you would support if you are elected to the House? Why or why not? What are the obstacles to implementing such a plan? How could they be addressed?
The Affordable Care Act is the best thing that has happened to health care in America. Having this legislation for the past several years we understand the advantages and disadvantages of this law. Let’s spend our time and energy making it better.
For example, the efficacy of health insurance exchanges, Medicaid expansion, development of accountable care organizations, and further oversight of insurance companies and their pricing practices remain works in progress. In addition, the ACA does not have any built-in spending controls; indeed, it expressly prohibits the creation of institutes to assess the cost-effectiveness of pharmaceuticals, health services, and care technology. This is madness. We cannot control or reduce costs, if we do not have a clear sense of where reductions can occur. The federal government has tremendous power to negotiate on medical and drugs costs. Just like the auto industries, we must allow imports of medications, such as from Canada, to create competition in a truly free-market society.
Our current health system is geared toward making sure people have access to insurance rather than access to care. We must move toward Universal Health Care so that everyone in America will get the care they need. This will also reduce the financial burden on businesses and, thus, allow them to further invest in their workers. We must have health coverage that includes dental, vision, and mental health care as standard practice.
I support 100% a single-payer health care system. Although the ACA is a good starting point, the Supreme Court has allowed states to refuse Medicaid expansion and deny care to millions of Americans who qualify. This is largely a partisan issue. We must convince states that accepting Medicaid expansion is the right thing to do. This is a human right.
Revisions to the ACA are an important first step in aligning the mechanisms of the health care system toward single payer. I will improve the ACA as an interim step to bring down costs for everyone and begin to align the mechanisms of health care delivery with that of a Universal Health Care system.
Do you believe health is a right? What is the state of racial and economic equity when it comes to health care access and quality?
Absolutely, health care is a human right. Everyone should have access to health care. The state of racial and economic equity is in really poor shape. Jobs that do not offer employer-supported health care disproportionately affect people of color and disadvantaged communities. This limits access to high-quality health care for families. This is why a single-payer system is so urgent; to eliminate the inequality that is inherent in our system. Health care is currently designed for an insurance-based approach and often does not cover preventative care, which keeps Hoosiers healthy, reduces job absences, and benefits everyone.
For instance, the public-health situation is so bad for black men in the U.S. that they often get better health care in prison than they do outside it. It’s important not to be glib about incarceration as it is devastating on prisoners, their families, and their communities. But it’s astonishing that the Supreme Court has ruled that prisoners have a human right to health care, yet outside of prison, there is no such guarantee. Life expectancy in America varies by race and ethnicity with as much as 30 years between the richest and poorest U.S. counties.
America’s poor are sicker than well-off Americans. They get substandard care, live in poor housing and degraded environments, and have higher rates of suicide, violence, drug overdose, accidents, and smoking. Disparities due to poverty hurt racial and ethnic minorities more than other groups because they make up a large proportion of the poor. Not only do they have more ailments, but they often get worse care.
We need to enhance training in medical schools, so that health care providers can not only be aware of, but also address systemic racism that impacts care delivery. A single-payer system will help improve access, but it will not change the bias patients encounter in physicians’ offices or the ER. We need to invest in more community health centers to assist with primary care, be accessible to individuals without transportation, and develop relationships with health care professionals that focus on prevention, wellness, and holistic approaches. High-quality primary care can lead to longer life spans and better health outcomes overall.
What are the most pressing issues on women’s health facing our communities? How will you address these issues in your campaign?
There is a pervasive culture of discrimination against women. Women get paid less AND pay more for everything else. They pay sales tax on hygiene supplies as well as pay more for deodorant, razors, and other personal grooming supplies. Women face inequality in health care as well. We must care for women – our mothers, sisters, wives, daughters, friends, and neighbors – who are the heartbeat of our communities.
A large majority of Indiana’s 6.3 million persons are affected by one or more chronic diseases. Indiana has significantly higher rates than the national median for heart disease, cancer, and stroke, including women. Many of these cases directly link to the alarming rates of obesity and tobacco use in Indiana – 30% of Hoosier adults report being obese and Indiana ranks among the highest in states in adult smoking.
In Indiana, women more likely than the national average to be poor, report mental health issues, and have at least one pre-existing condition. Under the ACA, pre-existing conditions do not preclude future care, an important concern particularly for women. We must continue to fight to preserve this feature of the ACA as well as health and life insurance premiums that do not cost women more than men.
The radicalized, conservative, narrow-minded GOP is systematically removing the benefits for women. For instance, contraception based on religious grounds. The right of privacy between a woman and her doctor is being eroded and undermined. For example, Planned Parenthood provides comprehensive services for women’s health, such as annual exams, screening for sexually-transmitted diseases, holistic health education, and many other critical needs. It is immoral for the government to cut funding for such important care. We must provide better services for women’s health – as well as that of men.
We also need common sense policies, such as more family-friendly paid leave that not only allows parents to bond with a new baby, but give mother time to properly heal and recover after childbirth. We need more resources for health education – such as the unique symptoms of heart attack in women or information and support on breastfeeding. We need to provide preventative care that is also convenient, such as mobile mammogram and health care units.
In my campaign, I am speaking with as many people as possible, listening to them, and utilizing their ideas for how to make things better. We need more funding and vision from the federal government to states and local municipalities. I am committed to improving the health of all Hoosiers, regardless of gender identity, sexual orientation, religion, citizenship, class, and ethnicity.
What has Medicaid expansion (Healthy Indiana Plan) meant for our Congressional District? What is your position on the recently-approved Medicaid work requirements for Indiana?
The Medicaid expansion for our District improved the lives of Hoosiers by providing health care to the most vulnerable amongst us. Indiana expanded Medicaid starting in February 2015, providing coverage to 240,000 people who were previously uninsured. The change helped lower the state’s uninsured rate from 14 percent in 2013 to 8 percent last year. It has supported essential health benefits, mental and behavioral health care, and substance abuse services.
Potential victims of cutting Medicaid include low-income women, single mothers, and sex and gender minorities who primarily access health care from family clinics, such as Planned Parenthood. In its current form, the bill would cut Medicaid funding to those providers. Health care should not be about being able to afford insurance; it should be about being able to afford health care. Medicaid provides funding for care givers and there is a tremendous shortage of these individuals already.
Governor Holcomb’s Medicaid work requirement is cruel and inhumane. They play all the tricks to reduce the funding for Medicaid by giving a huge tax cut to the wealthy and corporations. We discriminate against the poor, disabled, and single mothers. If you do not provide jobs, how are people to work? If people cannot receive employer-subsidized health insurance, they often cannot afford what is available on the exchanges.
Penalties are also excessive. Since November 2015, more than 91,000 enrollees in Indiana have been kicked off Medicaid for failing to complete the eligibility redetermination process. Nearly 100,000 additional Hoosiers were kicked off or locked-out of receiving coverage for six months for failure to pay their Medicaid premiums. This is not only a despicable action because it denies people health care benefits for which they are otherwise eligible and worsening chronic conditions because of an absence of care, but the Federal government reimburses 100% to the state. Thus, Indiana is making a profit by requiring Medicaid recipients to pay a premium in the first place.
The work requirements also use a very narrow definition of disability that is dismissive of invisible disabilities, such as debilitating pain, fatigue, cognitive dysfunctions, and mental health disorders. These are not always obvious to an onlooker, but can sometimes or always limit daily activities.
Indiana’s Medicaid policies discriminate against low-income Americans who are just trying to stay healthy and get ahead. We must renew our commitment to keeping Hoosier families healthy.
What, if any, changes would you make to the Patient Protection and Affordable Care Act (“Obamacare”)?
There are a number of relatively straight-forward policies that could be instituted almost immediately to improve the ACA:
We must include dental and vision coverage, since our teeth and eyes are very much part of our bodies and essential to good health!
We must expand access to mental health and addiction services. Even with private insurance, there are too few providers. Patients must often seek care from a practitioner who is out-of-network, incurring additional out-of-pocket medical and transportation costs along the way.
We must allow the government to negotiate drug prices, which are 30 to 60% lower in other countries. A 15% reduction in the price of prescription drugs would produce more than $600 billion in health-care savings over the next decade, which would lower private premiums while saving taxpayers billions on Medicare costs.
We must allow competitive bidding for medical equipment and devices, such as diabetes test strips, which Congress currently restricts. Competitive bidding would save at least $50 billion over the next decade, which could be used to increase premium support for older ACA enrollees.
Sensible tort reform is also needed that balances accountability with the actual needs of victims. Abuse of malpractice suits is a real issue because it leads to over-treatment and over-testing. But if tort reform reduced health-care costs by even ½%, it would save close to $200 billion over a decade.
Reducing excess medical spending would free up resources to provide comprehensive, holistic care for all Americans. We must also support related out-of-pocket expenses, such as transportation, child care, paid time off, and other hidden costs.
What is your position on the elimination of the ACA’s individual mandate that was part of the Republican tax bill approved at the end of 2017?
The mandate makes sure that healthy people as well as the ill are paying into the system. Although they may not utilize it in the short-term, they will one day need health care. It is not possible to predict what illness or injury may happen tomorrow. To make the system economically-viable, everyone must contribute regardless of their health status for the benefit of all. When you want a better paying job, you go to school. But you must study, so you pay the price upfront for future benefits. Many people are currently paying penalties because they cannot afford the insurance. The premiums are also very high as a result of the uncertainty of cutting subsidies. People – old, young, healthy – should all participate with fair and reasonable premiums. Quality control doesn’t make money; it has a price. Because of quality, people come back. Although the individual mandate seems like a burden, it is not because of these long-term benefits. We must invest in the common good, just like quality, and not focus solely on individual needs.
The Congressional Budget Office estimates that premiums will be 15-20 % higher with the elimination of the individual mandate. A Brookings report has warned that increasing premiums will lead an increasing number of healthy people opting out of insurance, which would in turn lead to an increasingly sicker pool of insured patients and eventually to a collapse of the individual market. This, of course, is the GOP’s intent. Since they were not able to repeal and replace the ACA through the legislative process, they are seeking to actively undermine it through tactics such as this.
The individual mandate is essential for sustaining the economics of the ACA and assuring access to insurance for as many Americans as possible.
How has the opioid epidemic affected communities in our Congressional District? What can Congress do to address this health care crisis?
The opioid crisis has significantly affected our communities. Nearly 1 in 20 people in Indiana reports having used opioid pain relievers for non-medical uses. Fatal overdoses rose by an average 3.5 percent each year in Indiana from 2011 to 2015. Indiana loses approximately $1.25 to $1.8 billion in gross state product because of the lost productivity due to opioid abuse.
This matter should be treated not as a crime, but as a public health crisis. We need to provide Hoosiers with rehabilitation rather than putting them in jail. I propose that we decriminalize marijuana. People are often in a state of pain, depression, and have other invisible illnesses. If we can relieve people’s pain and depression without criminalizing them, we will reduce the need for a dependency on opioids. We must also eliminate the racial bias in which drug use for black citizens is likely to end in a jail sentence, while white citizens are more likely to go to drug rehab.
Congress must assure that mental health coverage is not only a standard part of insurance, but we must also increase funding significantly for training and caregiving to end this crisis. We need to increase funding for programs, such as the Police Assisted Addiction and Recovery Program in LaPorte – where addicts can come into any police station and will be taken to a rehabilitation center for care rather than arrested. Instead of opening more prisons, we need more rehabilitation centers and mental health care providers. We spend $80 billion annually on incarceration and these resources could be better utilized caring for addiction and supporting families in crisis.
What, if any, changes to Medicare would you support as a member of Congress?
Our communities are greatly enriched by our senior citizens. They are retirees as well as workers, grandparents and volunteers. Their contributions strengthen our families and add to the vibrancy of Indiana’s 2nd District. We must support and strengthen Medicare.
We must do more to help seniors stay in their own homes and communities rather than be forced to move into nursing homes. For example, the cost of installing a hand rail or widening a doorway is only about $6 per Medicare eligible enrollee per year. This small investment to help someone live at home is better for the person and less expensive than institutional care in the long run.
We also need to expand the Medicare/Medicaid program known as PACE or the Program of All-Inclusive Care for the Elderly. This is the “the gold standard” of care that offers comprehensive medical and social services for people requiring institutional care. PACE has been found to reduce hospitalizations, nursing home use, and mortality. Thus, this program not only reduces costs, but is people-centered – as all quality care should be.
We must also address the high out-of-pocket costs of prescription drugs for our seniors. By 2020, the ACA will close the coverage gap for medications, meaning there will be no more “donut hole.” Still seniors will pay 25% of the costs of drugs until they reach the yearly out-of-pocket spending limit of $4,750. Since the median per capita income for retirees is currently less than $15,000 (actually $14,664), this means that many individuals will still be forced to choose between food and medications. As noted above, by allowing negotiation of drug costs, we can reduce spending and apply savings to provide additional subsidies to seniors for their medications.
How has your experience as an employer shaped your stance on health care?
I strongly believe that workers are the success of our company. We have provided 100% employer-paid health insurance for all employees – men and women – since 1995. My first-hand experience is that three lives have been saved as without insurance, they would not have received quality care nor been able to afford the half-million dollars in medical costs. Ten years ago (2008), the average cost per employee was about $164/month with a $2,000 deductible; today, we pay nearly three times that — $480 with a $5,000 deductible. Inflation is 22% while our health care premiums increased 292% with a 250% increase in deductible. Last year (2017) at GTA Containers, we spent $283,144 on health and dental insurance premiums for our employees.
Health insurance for everyone is absolutely vital. Despite rising costs and the impact to our company profits, we continue to pay full premiums for all of our workers. Just saving one life is much more important than our bottom line. We as a nation need to prioritize caring for the health needs of all Americans.
Access to health insurance is not the same as access to health care. Often people with high-deductible plans do not use their benefits because they cannot afford to. Health care is delayed and, thus, often more expensive to treatment. We need more community-based health services, such as community health centers, mobile health clinics, mobile mammogram screening,
Ultimately, the US needs to move toward Medicare for All. Yet, since nearly 1/5th of the economy is health care, it will not be an easy transition. Sensible revisions to the ACA are a crucial first step toward resolving inefficiencies, reducing costs, and overall aligning the machinery of health care in the direction of single payer system. Health care is a human right and caring for Hoosier families must be a top priority. Jackie Walorski has repeatedly voted to take health care away from Americans. This is unacceptable and I will fight to keep Hoosiers healthy, while also caring for them when they are sick.