Senator Jeff Merkley of Oregon tackled questions from women bloggers on health care this week- answering on topics ranging from the public option's chances to exactly how the proposed reform would work for a particular family.
You can listen to audio of Senator Merkley's call here:
Or you can read the transcript here:
Nancy Watzman: Hi. Welcome everyone. I’m Nancy Watsman of the Sunlight Foundation, representing BlogHer today in their community journalism initiative on healthcare policy.
The Sunlight Foundation is a nonpartisan, non-profit dedicated to using the power of the internet to catalyze greater government openness and transparency.
As CEO, Lisa Stone, announced BlogHer has been sponsoring a bipartisan series of telephone conference call to connect women bloggers directly with their legislators.
Today on the call we’re lucky to have Jeff Merkley from Oregon and I’d like to turn it over to him for a brief introduction and then we’ll start taking questions.
Jeff Merkley: Thank you very much Nancy and thank you to the entire community of BlogHer for allowing me to participate. I’m pleased to be here to discuss current efforts of - our current efforts to reform our healthcare system.
I’m a member of the Health Education Labor and Pensions committee or better known by the acronym HELP committee. And that committee put out a healthcare reform bill in July. Just last week we received a bill out of the finance committee as well and those two bills are being merged.
They are different in some significant ways. One is that the bill from the HELP committee had a strong, robust public option. The bill from the finance committee does not.
There are a host of issues that are really at the heart of this reform but perhaps the very heart is the idea of creating a market sometimes called a gateway or exchange where every individual and business can go and select from a range of healthcare insurance choices.
This enables our individuals and small businesses that have had to buy insurance on their own, to buy now by being a part of a very large pool. And by so doing, getting a much better price and much better range of choices.
So that’s at the heart of this. Also key pieces are investment in prevention, investment in disease management, a series of insurance reforms such as the insurance company would have to accept anyone who applied - guaranteed acceptance.
They would have to cover existing conditions or preexisting conditions. And they could not dump folks out of health insurance once they were members of the plan. Currently you can pay your premiums for 15 years, get seriously ill and then have the insurance not renew your insurance.
And that’s really outrageous and unfair and it needs to stop. So we have insurance reforms. We have an extension of insurance so those who don’t have it. And we have serious efforts such as the public option to bend the cost curve.
So that’s - those are kind of the three big components. And with that, I’ll just thank you again for inviting me to be a part of this conversation.
Nancy Watzman: Okay. Let’s move to questions. Can we get the first caller?
Operator: Yes, thank you. Ladies and gentlemen, if you would like to register a question please press the 1 followed by the 4 on your telephone. You’ll hear a three toned prompt to acknowledge your request.
If your question has been answered and you would like to withdraw that registration please press the 1 followed by the 3. If you’re using a speakerphone we do ask that you please lift your handset before entering that request.
One brief moment for our first question. Our first question comes from line number 678W. Please proceed with your question.
(Danine): Hi. My name is (Danine) and I’m calling from Wisconsin. I had a spinal cord injury in 2005 and I was paralyzed from the neck down. I have recovered my mobility for the most part but I have a lot of health problems.
And I’ve been on disability and Medicaid since then. I’m hoping to work my way toward self employment but in order to do that I need affordable health insurance. And I need - my guess is that the best way to do that is through a public option.
We’ve heard Senator, recently that they’re talking about talking about a public option in combining the two bills. What is the status of the public option in the Senate?
Jeff Merkley: (Danine) thank you for your call and I’m sorry to hear about your injury. Your situation is not unlike that of many Americans who would be helped dramatically by this healthcare reform.
Because you would be able to go as an individual to the healthcare exchange or gateway and you would not have - there would be no ability of an insurance company to deny you, the ability to join and get a policy or to not cover a preexisting condition.
You would have a full range of choices at the exchange including hopefully, from my point of view, a public option. So there might be Blue Cross/Blue Shield, there would be a Kaiser plan, there would be AETNA and so on and so forth through the list of companies but also hopefully, a public option.
I am fighting very hard for this. And to give you a sense, we have a public option in Oregon in our workers’ compensation market which is a different part of the health insurance market. It covers injuries sustained while at work.
We have found that the public option has resulted in the cost today per hour being one half of what they were 20 years ago in workers’ compensation. Senator Whitehouse promoted the public option workers’ compensation in Rhode Island and similarly, their rates dropped by 50%.
So having a competitor, a competitor that is not dedicated to treating healthcare as a source of profit but healthcare as a source of healing, makes an enormous difference.
And so I think the odds are very good that there will be a public option come out of the negotiations taking place currently in the Majority Leader’s office. We’re hoping to have that bill on the floor next week. So the rubber is really hitting the road now.
(Danine): Okay, thank you.
Jeff Merkley: Thank you very much.
Nancy Watzman: Okay, yeah. Let’s take our next question.
Operator: And our next question comes from line 692W. Please proceed with your question.
(Audrey): Good morning Senator Merkley. My name is (Audrey) and I’m joining the call from Maine. My question is brief but it’s twofold. I have a chronic illness which has depleted our family’s financial cushion despite the presence of health insurance through my husband’s employer.
And one of the things that has slowed our inevitable descent into foreclosure has been our health savings account. Why are HSAs still not a viable part of the any of the current proposals for healthcare reform? Because if anything, an HSA would help people keep the insurance they like.
Secondly, it’s in regards to tort reform. I was reading the CBOs on estimates. Tort reform, meaningful tort reform would reduce the federal deficit by at least $54 billion over ten years.
I’m having a hard time understanding why this isn’t an integral part of the reform process. Can you help shed some light on both of these questions?
Jeff Merkley: Certainly I can sure try. Let me start with tort reform. Tort reform has been experimented with in various states so we have a good sense of the results out of those laboratories. We have found that it has reduced the cost of liability insurance to doctors by some modest amount.
It has not however, had any impact on reducing the cost of healthcare to the citizen. So the insurance companies have done better and in some cases the providers of healthcare have done better but citizens have not.
The amount of the change is estimated to be about half of a percent in terms of the impact of potential tort reform up on healthcare. So it’s a very tiny part of the puzzle. Place that in perspective, we currently have rates that are doubling every six to eight years.
And so that’s 100% increase over the course of six to eight years. Tort reform would be a 1% impact on the cost so it’s very small impact. Furthermore, tort reform - you can call it tort reform but from the point of the citizen, is taking away the fundamental right to compensation for gross negligence.
That is a huge decision of the government to take away a common law right that has existed since we were first a nation and to say that indeed you do not have the ability to seek compensation for gross negligence.
And so that’s basically outlines of the tort reform debate. Second, you raised the question of health savings accounts. Certainly health savings accounts for those who are in a position to be able to save tax free an account, it’s a wonderful thing just like IRAs are a wonderful thing.
But for most working Americans they’re not in a position to be able to set funds aside in a health savings account. They’re not in a position to be able to set much aside in the way of retirement accounts. That’s why we have social security because it’s not feasible for every family to save on their own.
And it’s why affordable, accessible healthcare necessitates providing a structure that every American can take advantage of, not those just in a financial place, a beneficial place where they’re able to set aside extra funds.
So while health savings accounts may be a nice addition to whatever reform is involved it doesn’t go to the heart of the challenge for most working families.
Nancy Watzman: Now (Audrey) did you have any follow up to that?
(Audrey): Well kind of because it kind of goes back to the conversation I had with Speaker Pelosi last week. Like I said, we’re headed into foreclosure because of our copays and our - I mean we’ve got an insane deductible. We have a $10,000 yearly deductible on our insurance.
And then she mentioned this 400% federal poverty level. Well we’re right above that. That this healthcare reform is mostly going to help - I mean everything that I’ve read and listened to and have heard there’s this magic number of 400% of the poverty level.
And these reforms that are - that you guys are proposing are going to help people who sit in that bracket. Well we’re slightly above that so we’re kind of still going to be in the same place.
And without the ability to save for these deductibles and whatnot - because if we’re excluded from the most beneficial portion of this reform that’s being proposed we’re going to be in the same boat. And it’s a horrible to thing...
Jeff Merkley: Hey (Audrey)?
(Audrey): ...to be in.
Jeff Merkley: (Audrey) let me ask you this question. Do you buy health insurance through a small business or on your own or...
Jeff Merkley: ...through a large business?
(Audrey): It’s provided through my husband’s employer.
Jeff Merkley: Well there - let me give you a couple of examples of how this might affect you. Your husband’s employer would be able to go to a Healthcare exchange and be part of a much larger pool and therefore enable you to - the company to buy that insurance at a lower price because they’re now part of a larger negotiating group.
And in addition, the way the bill is structured in the health committee, when the company goes to that exchange they could choose to provide a gold plan or a silver plan or a bronze plan.
But you would have the choice as a family, of which gold plan, which silver plan, which bronze plan so you could pick the plan that best fits the circumstances of your particular family, greatly increasing competition and creating a better fit between individual plans and where individual families are.
In addition, a lot of what’s driving the increase in healthcare is the uninsured going to the emergency room and those costs getting transferred onto insurance.
But if we create a circumstance where virtually everybody is in the pool, then we break this (desk) cycle insurance where there’re more uninsured, more and more cost transfer, more and more upward pressure on rates so you would also benefit from that aspect.
And then finally, I would note that should you have - your husband happen to leave his job you would now have a transferable, portable insurance policy. And leaving a job doesn’t result in a double whammy of both losing your job and losing your healthcare all at the same time.
Nancy Watzman: Okay. Let’s go onto the next...
(Audrey): Thank you.
Jeff Merkley: You’re welcome.
Operator: Great. Our next question comes from the line 702W. Please proceed with your question.
(Susan): Hello Senator. My name is (Susan) and I am from the Madison, Wisconsin area. As you can imagine, me saying that I’m going to be talking to a senator has kind of elicited people’s thoughts and ideas of healthcare.
And one of the things that a lot of people have been asking about for me to ask and what seems to be a bipartisan effort, is to lose the antitrust exemption that health insurers have.
That is a - seems to be a bipartisan effort. What else seems to be something that both sides can agree on and what sort of efforts are democrats having a hard time battling republicans with?
Jeff Merkley: Well there’s a great deal that is in the healthcare reform - and thank you (Susan) for calling in today. There’s a great deal that democrats and republicans have agreed on.
They’ve agreed that we need to have much more investment in prevention, much more investment in disease management. There are about four diseases that constitute about 70% of our healthcare dollar expenses.
There is agreement to invest in healthy choice incentives which are - the approach is taken by self insured companies like Safeway and Pitney Bowes where they provide incentives in terms of vacation days or bonuses to individuals who do a better job of either quitting smoking or managing their diabetes or hypertension.
And the result is, is not only is the individual employee assisted but the cost of the entire pool of healthcare goes down because those costs are so significant within the system.
Another area that there is a lot of agreement on is the investment in the workforce. We have the challenge of so many doctors and nurses and nurse practitioners retiring because they are a part of the Baby Boom generation.
At the same time all the rest of us who are part of the Baby Boom generation, need more healthcare. So you have demand for healthcare going up when the number of providers is going down so we need to invest in the workforce. So those are all areas of substantial agreement and cooperation.
I think probably the area that most highlights the different in philosophy has been this issue of the public option. Virtually all of my republican colleagues have said we believe in a for-profit system.
We do not want there to be a choice that is a non-profit choice because that might undermine the success of the for-profit companies. I couldn’t disagree more. You have a very successful system of for-profits in Germany. You have a system of for-profits in France.
But what they can charge is highly regulated so it’s regulated like a utility is here in the United States. But what we have are for-profit companies with no price regulation and therefore, what we’re paying for healthcare is 2-1/2 times roughly what Germany or France is paying even though all three have for-profit systems.
So one way we can approach this within our own system is to have a non-profit competitor, a competitor that is dedicated to healing, not dedicated to revenues for its stockholders. And so I think that’s an effective way within our system.
But there is a fundamental, philosophical divide in - on that particular issue.
(Susan): It - what do you think it would take for the republicans or those who don’t believe in the public option for it to happen?
Jeff Merkley: Well one of the ideas we’ve been talking about is providing a state opt out so that if a particular state said we don’t want to have a public option in our state a governor or an act of the legislature in that state could say okay, this particular state be it - choose a state, Kansas, Oklahoma, Texas says we don’t want to be part.
That would allow us to have those states that do want to pursue this who do feel that you need to have a healthcare plan dedicated to healing as part of the mix. Then those states would be able to proceed as well and it allows everyone to come together around kind of a federalist view of the power of states.
So that may be a bridge that can help connect both progressive democrats with moderate democrats and progressive/moderate democrats with their colleagues across the aisle.
Nancy Watzman: Thanks. I know our time is short so let’s go onto the - we have a few more callers so let’s go onto the next one. The senator only has a couple more minutes.
Operator: Our next question comes from line 714W. Please proceed with your question.
(Karoli): Hi there. My name is (Karoli) and I’m from California. We’re currently uninsured and our 20 year old son has just been diagnosed with two chronic diseases, one of which is diabetes.
What do you see as the bridge that will be made available for people like us between now and the year 2013 when all of these reforms are supposed to take effect?
Jeff Merkley: (Karoli) that’s an excellent question and I don’t have an excellent answer for you. The - as you correctly point out the plan to establish state level exchanges under the healthcare reform is anticipated to take three to four years to set up.
I have been asking the question of whether it has to take that long. If you have a willing state why can’t they go ahead and set up the exchange in a year? Now if it’s a state that really desires to do it they might be able to do it in six months.
States like my home state of Oregon, have been very involved in healthcare. They have a healthcare commission. They have a legislature that’s deeply in tune with the need for reform.
And I just would like to see a pathway that states could move a lot more quickly. But as you rightly point out, under the current - certainly the way the bills are structured, it would take a while to set up these commissions and a while to set up a public option as well.
But we can move individual pieces faster. That’s certainly something I’m encouraging. A lot of other senators are making the same point. So I don’t think we’ve seen the end of this conversation of what can we immediately start investing in prevention and in disease management.
Can we immediately provide a policy - the term that’s being used is a policy for our young invincible - young folks who generally have good health but need catastrophic coverage in case something goes dramatically wrong.
But in this case I feel like you put your finger on an excellent question and (data) is still underway on how we can move key components of healthcare reform up sooner.
Nancy Watzman: Okay. Well I’m getting word that Senator, you have to go. I really appreciate your time here today. And...
Jeff Merkley: Well it is a pleasure joining you all. Thank you very much Nancy for the invitation.
Nancy Watzman: Yeah. Thank you so much. And, you know, hopefully we’ll have the chance to talk more.
Jeff Merkley: And I appreciate everybody tuning in and the fact that you all have an enormous ability to reach out and connect with so many Americans through your blogging.
And this greatly expands the conversation and it expands it in ways that are so much more intelligent than the conversation that often takes place in many of our media (outlets). So I just appreciate so much that - your all dedication to conversing about the issues that challenge us as a nation.
Nancy Watzman: Well thanks so much. That wraps up today’s call with Senator Merkley and BlogHer. Thanks for participating and thanks bloggers for joining us.
Keep an eye on BlogHer.com for the audio and transcript of this call and the announcement of the next call where we’ll give you another opportunity to talk about healthcare reform with legislators. Thanks.
Operator intro and outro have been deleted
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