Will the Road to Universal Health Care Run Through the States?

Originally Published in the December 2019 issue of The Retiree Advocate, a newsletter of the Puget Sound Advocates for Retirement Action Education Fund.

Click here for a summary of HR 5010 and a FAQ Sheet.

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On November 8, Bay Area Rep. Ro Khanna (CA-17) introduced the State Based Universal Health Care Act of 2019 (SBUHC or HR 5010) with 15 original co-sponsors, including our own Pramila Jayapal and Adam Smith. This represents an important step in building the movement for a universal national health plan and Medicare for All.

The SBUHC proposal was first introduced by Congressman Jim McDermott
in 2015, and then by Congresswoman Pramila Jayapal in 2018 – both leading advocates of a universal, publicly funded national health plan. Indeed, Jayapal is now prime sponsor of HR 1384, Medicare for All, and Co-Founder of the Medicare for All Congressional Caucus.

The idea behind SBUHC as a pathway to a national plan starts with the reality that several states (including California and New York) are getting close politically to creating universal health care systems, thanks to years of grass-roots campaigns. But to succeed, states would need control of the federal health care dollars flowing to their states (Medicare, Medicaid, CHIP, TRICARE and Affordable Care Act) as well as the regulatory authority to require participation from large, self-insured employers.

The second basis of the SBUHC initiative is the recognition that while
public and Congressional support for universal health care and Medicare for All are at an all-time high and growing, the health care industry and its Republican and Democratic allies will mount an increasingly aggressive campaign to defeat the idea in Congress. Even with Democrats in control of the White House and both houses of Congress in 2021, it may take more than one election cycle to overcome the opposition to a universal, public national health plan. Passage of SBUHC might well be an easier political lift in DC. But starting at the state level has its own advantages.

“I’m proud to support this critical bill, which builds on my state-based universal health care legislation from last Congress. So many progressive accomplishments have started at the state level and grown to fuel national change. Americans are fed up with a broken health care system that lines the pockets of insurance and drug company executives at the expense of families struggling to keep up with skyrocketing costs. Supporting state-based universal health care efforts will help build momentum for the grassroots energy we need to achieve bold, structural federal reforms through Medicare for All.”

– Rep. PRAMILA JAYAPAl,
from Rep. ro Khanna’s Press Releasing announcing the Bill

Indeed, many of our important national policies first started at the state
level. Think marriage equality, abortion rights, Social Security and much more.

This year the WA State Legislature created a Universal Health Care Work
Group to study how our state could achieve universal and affordable health
care. The Work Group includes representatives of consumers, labor, business, health care providers, community health advocates and legislators. It is to report its recommendations to the Legislature right after the 2020 elections. Now it will have SBUHC to consider as
one pathway to the goal.

Advocates for SBUHC in the health justice movement and in Congress are clear that SBUHC and Medicare for All are parts of a two-track, state-federal strategy. It is time for us to win more co-sponsors from our WA Congressional Delegation for both SBUHC and Medicare for All (HR 1384 and S. 1129), and to persuade our state legislators to support a universal and affordable plan for all Washingtonians. If we make this a winning issue in the 2020 elections, we can make real progress in 2021.

Help all Washingtonians Get Access to Dental Care

We all know that good dental health is important to overall health, but insurance plans often don’t cover it. The poorest and most marginalized of us, and people who live in rural parts of Washington, often don’t have good access to dental care. Well, Washington CAN in coalition with the Children’s Alliance, Statewide Poverty Action Network and others, is trying to change that and they need YOUR HELP to do so.

ACTION NEEDED: Take this survey! https://bit.ly/WADental 

More information:

Washington CAN is part of a campaign to improve access for Dental services. We are encouraging people to fill out this survey to help highlight the need for Dental Therapy. Dental therapists have practiced safely and effectively in the United States for 15 years. They are rigorously trained in a narrow set of commonly needed procedures. If authorized by state lawmakers, dental therapists will expand access to dental care and make a positive economic impact. They can offer quality, timely care to rural, low-income communities and communities of color and provide good-paying jobs in communities where dental professionals are hard to find. Dental therapists are already practicing in Washington state, thanks to Native American leaders and state lawmakers. The Swinomish Indian Tribal Community hired the state’s first dental therapist in 2016 to meet their community’s dental care needs. Lawmakers formally authorized dental therapy on Native lands in 2017. Now, we are working to get lawmakers to take the next step, creating good health and economic growth in communities statewide.

Getting responses from this survey will help us get our message out and convince law makes to prioritize dental health!

Rep. Ro Khanna Introduces HR 5010, The State-Based Universal Health Care Act

Original Co-Signers include Reps. Pramila Jayapal and Adam Smith 

HR 5010, “The State-Based Universal Health Care Act (SBUHC) of 2019  is a landmark step toward empowering states to expand health coverage to every resident. Recognizing the unique position of American states to lead the push for universal health care, Rep. Ro Khanna’s bill provides states with historic access to federal funding streams and regulatory flexibility necessary to implement and support affordable, universal health care plans.” – Rep. Khanna’s Press Release

For background, see HR 5010 Summary & FAQs

HR 5010 gets an initial boost from its 15 original co-sponsors, including Reps. Pramila Jayapal (WA-07) and Adam Smith (WA-09) from Washington state, as well as many Progressive leaders: Rep. Blumenauer (OR-03), Rep. Bonamici (OR-01), Rep. DeFazio (OR-4), Rep. Garcia (IL-04), Rep. Grijalva (AZ-03), Rep. Lee (CA-13), Rep. Ocasio-Cortez (NY-14), Rep. Omar (MN-05), Rep. Pocan (WI-02), Rep. Pressley (MA-07) Rep. Raskin (MD-08), Rep. Schakowsky (IL-09), and Rep. Watson Coleman (NJ-12).

“I’m proud to support this critical bill, which builds on my state-based universal health care legislation from last Congress. So many progressive accomplishments have started at the state level and grown to fuel national change. Americans are fed up with a broken health care system that lines the pockets of insurance and drug company executives at the expense of families struggling to keep up with skyrocketing costs. Supporting state-based universal health care efforts will help build momentum for the grassroots energy we need to achieve bold, structural federal reforms through Medicare for All.”

— Rep. Pramila Jayapal, Rep. Ro Khanna’s Press Release Announcing HR 5010

Advocates from here in Washington state were involved in bringing this bill forward.

Medicare for All Would Cut Taxes for Most Americans

Over a dozen Washington single-payer advocates attended the National Single-Payer Conference held in Portland, OR October 18-20.  The conference was sponsored by Labor Campaign for Single-Payer and Healthcare-NOW. Check out the conference, including recorded sessions,  here.

One of the primary messages from Mark Dudzic, National Coordinator of Labor Campaign Single-Payer, is that right now, as we gather with friends and family for Thanksgiving and the Winter Holidays, we need to inoculate people against the propaganda and attacks from the formidable opposition to Medicare for All and single-payer from the health care industry and their Republican and Democratic allies. 

Here’s an article, that addresses one of those attacks: “Your taxes will go up. It will cost you more.” Two economists argue the opposite:

Not only would universal healthcare reduce taxes for most people, it would also lead to the biggest take-home pay raise in a generation for most workers

Health care premiums, they argue, are taxes.

Although they are not officially called taxes, insurance premiums paid by employers are just like taxes – but taxes paid to private insurers instead of paid to the government. Like payroll taxes, they reduce your wage. Like taxes, they are mandatory, or quasi-mandatory.

Working and Middle-Class Americans spend between 30 and 40% on taxes and health care. Further, they point out that healthcare premiums are a regressive tax. $15,000 for health care to a middle-class person such as a secretary earning $50,000  is a huge hit to income and affordability as compared to $15,000 spent by a millionaire for the same health care.

Emmanuel Saez and Gabriel Zucman are economics professors at the University of California, Berkeley, and the authors of The Triumph of Injustice: How the Rich Dodge Taxes and How to Make Them Pay, from which the article is adapted.

Emmanuel Saez

Gabriel Zucman

Trump’s Ghoulish Threats to Medicare

Pro-Corporation Rather Than Pro-Patient

Trump’s most recent Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors is the worst kind of evil: the evil you don’t see coming. Disguised as an effort to “save Medicare,” it is a wolf in sheep’s clothing. It is a giveaway to corporate insurers who sell Medicare Advantage plans. Now, these corporate insurers have the green light to cherry-pick the healthiest of seniors and others relying on Medicare, and to use all of their tricks to avoid paying the bill — narrow networks, no out of state coverage, high deductibles, etc.
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It is no surprise that Trump would go after Medicare. It is something he campaigned on, after all. But don’t be fooled by the spin! It is actually an attempt to weaken Medicare by allowing Big Business to compete with Medicare and charge more, and make a big profit while they’re at it — and it is subsidized by the majority of beneficiaries who are in traditional Medicare.

“… to the extent there are improvements they are all focused on the private Medicare Advantage plans that are by most measures overpaid compared to normal Medicare,” Paul Van de Water of the liberal think tank Center on Budget and Policy Priorities said of the plan. “The Executive Order continues to privilege the Medicare Advantage plans and make some proposals that could disadvantage two-thirds of the Medicare enrollees.”

Vox, Oct 7, 2019

Read on for the October 3, 2019 Statement of Eagan Kemp, Health Care Policy Advocate, Public Citizen

Note: Today, President Donald Trump issued an executive order that would harm seniors and others who rely on Medicare by weakening protections for seniors in traditional Medicare and undertaking efforts to push more Americans into Medicare Advantage plans, where they may face denials of care and limited doctor or hospital choice. These changes would cost the government more while threatening the long-term solvency of Medicare.

It is unsurprising that this administration would mislead Americans with lies about “Keeping the Government’s Hands Off Medicare,” but that is exactly what this order does. It is just one more example of an administration focused on ending access to affordable health care, whether through sabotaging the Affordable Care Act, seeking to harm immigrants’ access to care or cutting Medicare. The uninsured rate has risen under this administration, due to its reckless and immoral actions.

This order serves only the powerful corporations that seek to profit off the health care of seniors. By continuing to allow Medicare Advantage plans to cherry-pick healthy seniors while leaving the sickest to be covered through traditional Medicare, these plans threaten access to health care for seniors and people with disabilities as well as the solvency of Medicare in the long term. By failing to hold pharmaceutical companies accountable for price gouging and patent abuses, this order ensures that Americans will continue paying the highest prices in the world for drugs.

This administration seeks to ensure that health care titans can continue to line their pockets while seniors and working families struggle to get the care they need. As with so many other issues, the president’s health care agenda is bought and paid for by the corporate interests that profit off our broken status quo.

But the people are tired of getting a raw deal. That is why Medicare for All remains popular with a majority of Americans. By improving Medicare and expanding it to everyone in the U.S., Medicare for All would ensure that Americans can finally get the care they need when they need it, regardless of income.

State-Based Universal Health Care Act of 2019 is on the Way

HCHR-WA Co-Chair David Loud will announce that Rep. Ro Khanna (CA-17) will be introducing the State-Based Universal Health Care Act of 2019 by the end of the year at the National Single-Payer Conference in Portland, OR this weekend.

The State-Based Universal Health Care Act responds to the calls for complete access and greater affordability of health care for all Americans coupled with a uniquely American tradition–namely, capitalizing on the role of states as incubators of policy from our founding. As such, states should be able to provide health care for all.

This bill enables states to bring health care costs under control for the first time with several tools: (1) greatly expanding the risk pool; (2) eliminating much of the administrative and profit-oriented cost of private insurance plans, estimated to represent 15-30 percent of American dollars spent on health care; (3) allowing the creation of global health care budgets with negotiated reimbursement rates for all providers; and (4) reorienting health care towards prevention and primary care.

In Washington State, the SBUHC Act would make it possible to implement a single-payer system. It would offer the same federal support needed by nearly 20 other states, including California and New York, that are working to achieve universal and affordable health care for all their residents.

Following is a Summary of the Bill presented at the 2019 National Single-Payer Conference in Portland:

Sec. 1 Short title and purpose
Bill is referred to as the ‘State-Based Universal Health Care Act of 2019’ and describes its purpose as providing flexibility for states to offer comprehensive universal health care coverage to all residents in a given state and/or regional state collective.

Sec. 2 Waiver for State Universal Health Care
Creates a new State Innovation Waiver in the Affordable Care Act (P.L. 111-148) with a provision that allows states to combine several federal health care funding streams if the state offers a comprehensive universal health care plan that guarantees all residents of their state are covered. To be eligible for this waiver, states would have to provide a detailed description for enacting a comprehensive universal health care plan and provide an implementation plan for meeting the requirements of the waiver.

Implementation plans would have to show how states would provide health care for 95 percent of their residents, with no more than five percent spending over 10 percent of their adjusted gross income on health care. After five years, participating states would be required to demonstrate that they reached these targets and provide a plan to cover the remaining five percent of their population. States that do not reach the 95 percent target after five years would have to revise their plan to achieve the targets. Technical assistance would be available.

It makes clear that the benefits provided by states have to be equal to or greater than that which beneficiaries receive now. An independent assessment panel, made up of health care experts and officials, would evaluate for the Secretary of Health and Human Services (HHS) whether a particular state’s proposal meets the requirement of providing as much as or more coverage than the individual streams. Also, the state would have to provide an assurance that it has the legal authority to implement its universal health care plan.

In order to combine streams of funding, provide flexibility, and allow for states to offer comprehensive universal health care, provisions in law that are waived pursuant to this bill include: (1) the requirements for the establishment, creation and maintenance of health benefit exchanges; (2) cost-sharing reductions under the ACA; (3) premium tax credits and employer mandates under the ACA; (4) Medicare; (5) Medicaid; (6) CHIP; (7) FEHBP; (8) TRICARE; and (9) ERISA pre-emption provision.

Waiver consideration and transparency. Not later than six months after enactment, HHS will issue regulations that provide for public notification and comment, a process for the waiver application process and reporting on the implementation and evaluation process. The HHS secretary will provide Congress an annual report on the applications received and programs conducted through the waivers granted.

Regional waiver request. Allows two or more states the option of submitting a waiver application together.

Granting of Waivers. Underscores that state coverage, among other things, would:

• be no less and cost no more than what residents would have received under the federal program;
  
• provide coverage and cost-sharing protections against excessive out-of-pocket spending;
  
• include all state residents, including DACA recipients, but exempts from these requirements those eligible for benefits through the Indian Health Service, the VA, ​and military treatment facilities.

Coordination between HHS, Treasury, Office of Personnel Management, Defense, and Labor is required though an interagency MOU to ensure that all regulations are administered to have the same effect absent a waiver.

Frequently Asked Questions

1. Why is this legislation needed?
   The State-Based Universal Health Care Act responds to the calls for complete access and greater affordability of health care for all Americans coupled with a uniquely American tradition–namely, capitalizing on the role of states as incubators of policy from our founding. As such, states should be able to provide health care for all.
   
2. Previous iterations of this bill supplanted ACA Sec. 1332 State Innovation Waivers, but this is a new waiver. Why did you make this change?
   Unlike Sec. 1115 waivers, which some states have used to implement harmful Medicaid work requirements, Sec. 1332 waivers have been used by states across the political spectrum to reduce health care costs for residents. In order to prevent perfect from being the enemy of good, this bill leaves 1332 waivers in place, while creating a new waiver option for bold states that wish to implement true universal health care programs.
   
3. Why did you select these funding streams to be the basis of the state-based universal health care program?
   These are the streams of federal dollars that cover the greatest number of people and will be most important for states’ ability to properly fund the ambitious programs necessary to achieve universal health care coverage.
   
4. How will this bill affect the cost of health care for individuals, employers, states and the federal government?
   This bill enables states to bring health care costs under control for the first time with several tools: (1) greatly expanding the risk pool; (2) eliminating much of the administrative and profit-oriented cost of private insurance plans, estimated to represent 15-30 percent of American dollars spent on health care; (3) allowing the creation of global health care budgets with negotiated reimbursement rates for all providers; and (4) reorienting health care towards prevention and primary care.
   
5. I am satisfied with my current healthcare coverage. Am I able to keep it?
   Under this proposal, the coverage you receive for health care will be either equal to what you currently receive or more expansive. You will have a free-choice of providers. Everyone in your community will have health care.
   
6. How much will this cost me?
   Combining streams, negotiating discounts with providers and eliminating inefficiencies will help drive your out-of-pocket costs down. In the end, your costs will depend on how each state devises its own individual state-based universal health care program.

Background

In June 2018, Representative Pramila Jayapal (WA-07) introduced the State-Based Universal Health Care Act of 2018 (SBUHCA-HR 6097). HCFA and other advocates worked with Rep. Jayapal to develop this proposal.

In Rep. Jayapal’s words:

“At the federal level, as we work towards ensuring a Medicare-for-All-type single payer​ system, we should also be building on the expertise and energy that resides at the state level. In fact, throughout our nation’s history, our states have served as the incubator of democratic ideas and ideals.”

Click here for a PDF of this information and a FAQ Sheet.

Many thanks to One Payer States for providing the Bill Summary and FAQs.

Health Equity, the Underinsured, and Advantages of Single-Payer

Takeaways from First Universal Health Care Work Group

What You Can Do: Watch the TVW recording of the first UHC Work Group meeting. Read the Budget Proviso that funded the Work Group, and posted meeting materials. 

Provide public comment by Friday, September 27 at 5 pm.

Next meeting: November 1, 2019 in Olympia.  More Meetings here.

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We are excited to report that the first Universal Health Care Work Group met last Friday in Olympia. Health Care is a Human Right-WA has three Steering Committee members on the 33 member UHC Work Group: Sybill Hyppolite (SEIU 1199), Bevin McLeod (Alliance for a Healthy Washington) and Kelly Powers (Exchange Consumer). It was energizing to see so many medical, community and labor allies from around the state on the committee and in the audience.

Rep. Nicole Macri (LD-43) , Senators John Braun (LD-20) and Emily Randall (LD -26) attended the meeting. Rep. Schmick (LD-9) was not in attendance.

After discussing the Work Group’s directive from the legislature in the Budget Proviso, there were two presentations: Health Coverage in Washington State and the Washington State Institute of Public Policy (WSIPP) Studies, Single-Payer & Universal Health Care Systems.

Here are key takeaways from Kelly Powers, Washington Health Benefits Exchange Consumer (the ACA) serving on the Universal Health Care Work Group & representing Health Care for All – WA on the HCHR-WA Steering Committee:

1) Work Group members offered the following additional Single-Payer advantages that were not presented during the WSIPP presentation:

• Controls costs by negotiating reimbursement rates and drug prices
• Alleviates the high costs of delayed health care
• Reduces the need for expensive legal action to recover medical costs
• Ends medical debt
• Ends job lock

2) Information about underinsured Washingtonians, and the impact of health care expenses on the family budget was lacking. We believe the Work Group members need this information to inform our work.

3) There are important things to learn from initiatives around the state, such as Accountable Communities of Health and tribal health systems.

4) Several Work Group members brought up health equity and affordability. Note: The Robert Wood Johnson Foundation says, “Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”

Members encouraged the Work Group to be culturally attuned.

5) Public testimony urged the Work Group to look at the Basic Health Plan work in the 1990s to see what could be learned and used.

An oncologist from Spokane also gave public testimony that patients and doctors agree our health care system is broken.

6) The Work Group needs to hear from you! We need more voices of people struggling with current health care system

All in all, it was a solid start at laying out the issues and coming together to work through the challenges.

updated Sept 27, 2019