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Adventures in Government - Town Hall 2: Electric Boogaloo

May 12, 2017

Several days after Rep. Gallego's town hall at Rincon High, I attended another town hall focused on the American Health Care Act. This one featured former administrator of the Center for Medicare and Medicaid Services (CMS) Andy Slavitt, and it took place at the Sierra Vista Public Library. The town hall was hosted by Organizing for Action, and I really appreciate that they brought such a knowledgeable, high-profile guest to Cochise County. 

I was really looking forward to this one since I expected Andy, as the former head of CMS and an acknowledged authority on health care matters, to bring a deeper understanding of how the legislation is expected to impact real people. He did not disappoint.

The large library meeting room was packed, and many people ended up having to stand through the presentation. Andy's presentation was preceded by two other speakers: The first was a local resident impacted by the lack of mental health services in the area. The second was a man who was devoutly anti-ACA until, after contracting cancer, he suddenly came to rely on it. He says he's alive today because he was able to get insurance through the ACA.

Andy Slavitt's presentation covered a lot of ground, but his main point was this: that our goal should be getting as many people covered as possible. The fact is, there's no silver bullet that solves the healthcare problem in America, but our goal, as a country that cares about its citizens, should always be to cover more people and work on bringing costs down for everyone.

The discussion mostly cemented my desire to provide a comprehensive overview of what the ACA does, how it works, and why it's not as effective as it's supposed to be. It's such a complex piece of legislation that it's hard to really boil it down to something easy to digest. And, as a complex piece of legislation, it requires all of its cogs to turn in unison in order for the machine to function as intended.

Unfortunately, it's been hobbled from the beginning. While many of the important cogs (essential benefits, individual mandate, medicare expansion, etc) functioned automatically and largely succeeded in providing their intended benefits, there was one major cog that didn't: the incentive programs to keep insurance companies offering options to markets. Basically, with funding, the ACA was supposed to mitigate the risk to insurance companies, giving them a reason to provide more options and competition in each market. However, by the time the ACA's marketplace was implemented, Republicans were in control of Congress, and they were committed to seeing the ACA fail. So, those incentives were never properly funded, which caused insurance providers to withdraw from many markets. The lack of competition and options led to a rise in premiums in many markets.

In short, many of the greatest criticisms of the Affordable Care Act can be traced to intentional sabotage by the Republican-controlled Congress, and they're proud of it.

"If you wait until it impacts you, it will be too late," said Andy, responding to an audience member who gets his coverage from Medicare. According to Andy, the AHCA (as passed by the House) would take 4 years away from the Medicare trust fund.

After his presentation, Andy took questions. The audience in general seemed in favor of some sort of single-payer system, which Andy cautiously supports. He reminded people that there isn't one solution to the health care problem, though, and changing our coverage is only part of it.

And, of course, all of this left me thinking once again about how reducing coverage would severely impact rural hospitals, such as the ones that service Cochise County.

After the event ended, I spent some time standing outside the door and introducing myself to people as they left. I got over the "it's not about me" reservation between this event and the previous one, and I'm glad I did. I met some nice folks and had a conversation with a local nurse before I had to leave.

Hopefully I'll get the chance to pack that library meeting room myself sometime soon.