Healthcare and the F-Word: Health Politics Rank High on November 6, 2018

“Let’s get this thing f-ing done,” Martha McSally passionately asserted on May 4, 2017.

Paul Ryan said, on the floor of the U.S. House of Representatives without cursing, “A lot of us have waited seven years to cast this vote.”

McSally, who represents Tucson, Arizona, in the U.S. Congress, is running to replace retiring Senator Jeff Flake. McSally was one of the 217 Republicans in the House who voted to repeal the Affordable Care Act, subsequently celebrating a victory in the Rose Garden of the White House with jubilant peers. The final vote was 217-213. Here’s the final roll call from the Clerk of the House.

And here’s the notorious tweet about her use of the f-word, and the link to the article in the Tucson Weekly which reported on the day talked about McSally’s enthusiasm for cutting down the Affordable Care Act with her Republican colleagues in the House.

In my 11 years of writing every one of over 2,000 Health Populi posts on this blog, I have never, ever mentioned the “f-word” here.

In this case, I feel it’s important to capture the Zeitgeist of the Republican Party’s commitment to cutting down the ACA since President Trump took office in January 2017. Mitch McConnell and Paul Ryan, helming their leadership posts in the Senate and the House, respectively, had the President’s back on this from the start. They fought to erode key elements embedded in the law meant to protect health consumers’ rights: among them, health promotion, disease prevention, and public health; and the assurance that sick people would be covered by health insurance plans without prejudice. That, in two words, is the protection of people in America with pre-existing conditions.

Truth is, the phrase “pre-existing conditions” wasn’t discussed much among mainstream folks in the U.S. It’s been a concept that, largely, only health policy wonks (like me) talked much about.

What a difference a year makes. Today, most Americans seem to understand what the concept means, and especially how the reality of it translates to them, personally, as patients or people who love sick and diagnosed people.

Each of us has someone who has dealt with cancer or heart disease in our families, or close-in social networks, neighborhoods, and workplaces. Perhaps you or your sibling has been diagnosed with depression or anxiety. Or, had a pregnancy complication or are dealing with diabetes.

The fact is that most U.S. adults believe that health insurance plans should cover people with pre-existing conditions. This is true for majorities of people across political party, the Kaiser Family Foundation found in its August 2018 Health Tracking Poll. The bar chart shows, clearly, that the vast majority of Democrats and Independents, and most Republicans, say it’s “very important” to them that health insurance can’t deny a person in America coverage because of their medical history, or charge sick people more for health insurance premiums.

Back to McSally: Sean Hannity interviewed her on his radio show on 22nd October. McSally said, “Well, Sean, I did vote to repeal and replace Obamacare on that House bill — I’m getting my ass kicked for it right now because it’s being misconstrued by the Democrats,” she said. “They’re trying to, you know, invoke fear in people who have family members or loved ones with pre-existing conditions.” You can listen to that full podcast on the 2018 mid-term elections here.

[As a sidebar, if you’re concerned about the state of civil verbal discourse in America, you may be comforted to know that an Arizona State Legislator Lori Klein (R-Anthem) introduced a law into the State House to prevent teachers from cussing in Arizona classrooms, as this article from back in 2012 discusses. If passed, the bill would punish public school teachers if they use words that violate the obscenity and profanity guidelines set forth by the Federal Communications Commission, the AP articled explained.]

Health Populi’s Hot Points:  Bob Blendon and colleagues from the Harvard Chan School of Public Health wrote about Health Care in the 2018 Election in last week’s New England Journal of Medicine. In their poll of 487 likely U.S. voters, conducted in September 2018, making sure insurance companies still have to provide health insurance for people with preexisting conditions ranks top of mind for likely voters in this year’s elections. The third chart illustrates the healthcare priorities among people likely to vote this yea

Lowering the costs of care, ensuring the integrity of Medicare benefits, ensuring that low-income people don’t lose Medicaid coverage, and lowering prescription drug prices gain majority support across all health care voters who say health care is extremely important in the choice for members of Congress this year.

Professor Blendon pointed out in a webinar last week that covering pre-existing conditions for health insurance coverage is now a “moral and emotional issue.” Ten years ago, he explained, it was only on the business pages as a technical term.

While so much attention is on the House and Senate races in the 2018 mid-terms, we should closely watch the State Gubernatorial elections, too. There will be major health care access implications based on who is voted into their State leadership positions specifically on whether Governors will expand Medicaid to health citizens.

The context for this begins in 1965 when Medicaid was enacted, Blendon said. “Watch the [political] ads,” Blendon recommended. There are “subtle differences to watch,” he observed, stating that, candidates are not running on the Affordable Care Act, but reminding, say, Nebraskans that we’ve had Medicaid for 40 years. Democrats are attacked if they are helping the ACA, Blendon believes, but referendums to take Federal money and expand Medicaid — without uttering the word, “Obamacare” — could be a pragmatic political strategy.

John McDonough, a fellow professor of Blendon’s at the Chan School, was also on the webinar, pointing out the importance of Governors in this year’s election.

“It’s been a long cold lonely winter in terms of Medicaid expansion,” McDonough sighed, “But we might be seeing a sunrise in the near future,” expecting that, “we’ll know more next week.” (That is, tomorrow, as I draft this post).

Virginia will expand Medicaid on January 1, 2019, McDonough asserted, noting that they’ll be state #32 in Medicaid expansion. Then if Maine’s Attorney General, who is a Democrat, wins that state’s Governorship, they would be state #33. Other states, like Idaho, Montana, Nebraska, and Utah, could add up to 37 expansions. “If Kansas goes to the Democrat running, they could expand…Wisconsin, Florida, North Carolina, and others where a change in Democrat control” could move those states to expand Medicaid, as well.

It won’t be in Congress or the White House, but, “democracy in the states and those who have blocked expansion,” McDonough argued, where we could see, “voters coming forward grabbing policy into [our] own hands….amazing to watch,” he said.

At Health Populi and THINK-Health, we’re closely watching tomorrow’s elections for healthcare implications — for national health care reform, action at the state levels, and ultimately, the impacts for patients, consumers and caregivers in the U.S. for the coming 12 to 24 months as we approach the 2020 Presidential election.

To conclude for this moment, looking toward tomorrow’s mid-term election, we end with the historic record. Here is C-SPAN’s video covering the 2017 House vote to repeal the Affordable Care Act. This video is nearly six hours long, so broadcasts the entire event for which the GOP, as Congressman Ryan noted, was seven-years-in-the-making.

 

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