This is a (long) letter I wrote to Senator Lankford in response to his reply to one of my letters to him about health care.
July 26, 2017
I received your email response to my letter and, with all due respect, it is filled with half-truths, hyperbole, and outright lies. Allow me to enlighten you.
You said, “While I celebrate with those families who now have health care coverage, I am very concerned about the growing number of Americans who have been priced out of the market…:”
While there are a number of Americans who have been “priced out of the market,” the blame for that fiasco lies firmly on the shoulders of Republicans, who have passed many laws intended to hobble the ACA and on the Republican governor of Oklahoma, who spitefully refused to expand Medicaid in our state, proving that states—at least our state—are entirely incapable of managing the implementation of healthcare at the state level. We can’t even keep our schools open five days a week!
You write, “It is vital that we work toward a better healthcare alternative that is more affordable, market-driven…”
When was the last time you had a heart-attack and thought, “I’m going to call around and find the cheapest hospital before I get in the ambulance?” Or, “I’m going to have plastic surgery to repair the damage from this severe facial burn—I’m going to call around and find the cheapest plastic surgeon.” Or, “I have cancer, I’m going to call around and find the cheapest oncologist to treat me.” Or, “My child was born with a heart defect, I need to find the cheapest heart surgeon to repair it.” The answer in all cases: NEVER. Because the market does not drive healthcare decisions. Cost ends up being a factor only in whether or not a person gets any care at all—not in the cost of that care. In addition, even if you were to somehow contort some examples in which this might be true, it would not apply to most Oklahomans who live in rural areas (like myself) and whose healthcare options are already severely limited.
You said, “In Oklahoma, Blue Cross Blue Shield (BCBS) is currently the only provider of Obamacare plans.”
See paragraph three and reference Mary Fallin. You really need to get a different argument—this FAKE one is getting old.
You said, “Over the last few months, several Oklahomans received notice that network negotiations have been difficult between their hospital and BCBS. If an agreement is not reached, that hospital will be considered out of the BCBS network and patients will either see another significant increase in out-of-pocket payments or be forced to choose another physician.”
Hospital emergency rooms cannot legally turn people away. In my rural area, people without insurance rely on E.R. care for their primary healthcare for this reason. That means that without ANY insurance, hospitals are forced to provide care for more and more people who cannot pay their bills at all. In rural areas, specifically, this is an insurmountable burden—crippling them beyond their financial constraints. That means that people living in rural areas—who already have to drive a long distance to a hospital—may now lose their closest hospital and have to drive two or more hours to the nearest hospital! That means almost certain death in the case of heart attack and increased risk of death for accident victims. “…forced to choose another physician” hardly seems like a hardship when viewed through this lens.
We require EVERYONE to carry car insurance so that if they hit another vehicle, and they are to blame, they can be responsible and pay for it. In the same way, EVERYONE should have health insurance so that those who DO have insurance aren’t financially supporting everyone else who does not.
You said, “It is imperative that policy makers come together in Washington to fix our healthcare delivery system.”
This is the one true statement in your otherwise-bullshit letter.
You said, “As you may know, on July 25, 2017, Senate Republicans agreed on the motion to proceed to debate on how to repeal and replace Obamacare. The key goals of the healthcare debate in the Senate are to protect people in the safety net who need access to health care and to lower costs for individuals who pay for their health insurance.”
NONE of the options on the table that Republicans have proposed do ANY of these things—much less ALL of those things.
You wrote, “There is also a significant focus on returning insurance regulations to each state, where innovation and regional needs can be met with greater attention. Healthcare priorities are different in Alaska, Oklahoma, and New York. A one-size-fits-all approach does not honor those differences and prevents each state from best serving its citizens.”
Have you heard of “economies of scale”? You can Google it. And, really—how different are an Oklahoman’s healthcare needs from those in Alaska and New York? Repeating talking points ad nauseam doesn’t make them true. I can’t think of a single way they are different. The human body works the same all over the world. We are the same species. If there ARE ways they are different (for example, if Oklahomans are more obese or have more heart disease or diabetes than New Yorkers), then it is because Oklahomans have received substandard healthcare until now….likely because Mary Fallin refused the Medicaid expansion.
You said, “It is important to know that none of the Senate proposals affect Medicare, VA benefits, or employer-based care.”
EVERY one of these statements is an outright LIE or a not-so-clever misdirection. Millions of people who are on MediCAID will be kicked off and left with NO insurance. Those on MediCARE, but who have supplemental plans (a large percentage of them) will also be affected. Employer-based care will ABSOLUTELY be affected…your bills will ELIMINATE the employer mandate for smaller companies, which will ELIMINATE coverage offered by some employers, leaving many people without any coverage. It also allows lifetime CAPS for everyone, which affects both employer-based care as well as privately accessed care. VA benefits are also affected IF they also get health insurance on the private market.
You said, “The focus of the debate is how to stabilize the individual insurance market and Medicaid.”
Your focus SHOULD be on how to make sure that ALL Americans have basic healthcare as a fundamental human right, as the World Health Organization has declared it is and as hundreds of countries around the world guarantee to their citizens. HEALTHCARE—that should be your focus. Human beings. Your constituents. Men, women, children.
You wrote, “The individual mandate tax hits the middle class and those in poverty the hardest.”
You know what else hits the middle class and those in poverty the hardest? A personal healthcare crisis. Cancer. Diabetes. Heart disease. Birth injury or congenital anomaly. An accident. And bankruptcy that comes after that due to an inability to pay the resulting bills.
You wrote, “A few years ago, people on the individual market could purchase inexpensive health insurance from multiple competing companies in Oklahoma, but now those policies are illegal. It would help many families if cheaper health insurance was legal again.”
Those policies became illegal because they take people’s money without providing a basic level of coverage necessary to prevent bankruptcy or cover services owed for emergency care, hospitalization, etc. They are predatory policies in the same way that loan sharks are predatory lenders.
You wrote, “We are also working to provide options for families who have chronic and serious illness by significantly decreasing their tax burden. Families should be able to choose what coverage options they need at a price they can afford.”
How nice for you to live in such privilege as to assume that everyone HAS a “tax burden”—much less that it could be sufficient enough to be used to solve a major health crisis. People living in poverty and the middle class who you claimed to care about earlier in this letter can NOT divert enough of their taxes to pay for sufficient health insurance or healthcare. Most pay very little in taxes. And refer to the predatory policy information I described earlier. Prior to the ACA’s passing, 75% of personal bankruptcies were due to a healthcare crisis. After the ACA was passed, that number decreased tremendously. THAT is how well those “illegal” policies work. In other words, they do not work at all.
You wrote, “Medicaid used to focus on people with the greatest need in our society, but in the past five years, it has expanded to include able-bodied adults without children.”
Yes—that is what we now call “the working poor.” They are those that you on the Christian Right like to pretend are not working as hard as you are or praying as well as you are and are, therefore, responsible for their own poverty. I guess you and I will have to differ on that point. For the record, Jesus Christ would side with me.
You wrote, “There is no ‘cut’ in Medicaid, only a decrease in the rate of increase.”
PolitiFact rated that as “Mostly False” when Kellyanne Conway said it. I don’t think your saying it makes it anymore true. I’m certain you know as well as she did that it’s false, though, and said it anyway. The nonpartisan Congressional Budget Office estimated that the Better Care Reconciliation Act–the first bill the Senate considered and one that most closely matches the bill that has already passed in the House–would result in 22 million fewer people insured by 2026 than the current healthcare system. Cuts to Medicaid would reach $772 billion by 2026.
You wrote, “The Affordable Care Act was designed to offer benefits as early as possible and delay the increased costs and burdens for years later. Unfortunately, we are now approaching the time when the highest costs and burdens kick in.”
This is just not true. Again—see my response about Republicans hobbling the ACA through numerous pieces of legislation attacking small pieces of it—death by a thousand cuts. It was the only way you could react when you didn’t hold the White House, I realize, but YOU made this mess, so don’t blame it on the ACA, Democrats, or President Obama. Burdens and costs would not have increased to this degree had Republicans not passed crippling legislation.
You wrote, “We are faced with an additional challenge that President Obama also tasked his Treasury to send billions of dollars directly to insurance companies, even though the law did not allow it and the courts ordered him to stop.”
That’s a half-truth. The GOP sued President Obama over a piece of the legislation and happened to win. You made it sound like President Obama broke the law, which is, of course, what you wanted it to sound like.
You wrote, “These “cost sharing reductions” (known as CSRs) artificially propped up the insurance market and kept rates from rising even faster. Without those payments, the market will continue to destabilize, pricing even more Americans out of coverage and options.”
That’s true. You have the option to continue paying the CSRs. That WOULD stabilize the healthcare market. Everyone thinks so. And it would allow you more time to come up with some bipartisan solutions to FIXING the parts of the ACA that need fixing.
You wrote, “There are healthcare reforms that cannot be accomplished in this bill that must be addressed, such as Obamacare’s redefinition of the 40-hour workweek, increasing prescription drug costs, purchasing insurance across state lines, and several burdensome Obamacare regulations.”
Bullshit, bullshit, bullshit. Obama didn’t singlehandedly redefine the workweek. That is just another in a long list of GOP dog whistles. And those other reforms certainly COULD be addressed in creative ways if you work together across the aisle.
You wrote, “Under Senate rules, these legislative initiatives cannot be included in a reconciliation package and ultimately will require bipartisan support to reach the mandatory 60 votes necessary for passage.”
See? That’s what I just said!
You wrote, “The relevant House and Senate Committees of jurisdiction have already begun the public hearing process on those policy issues,…”
If only that were true…. We have differing ideas about what “public hearings” are. The GOP has had WEEKS AND WEEKS AND WEEKS to hold “public hearings” but, in fact, this bill was drafted not only in “private” but in SECRET—excluding even their own members. If hearings are now “public” then it is too little, too late. To make the cake, frost the cake, decorate the cake, cut the cake, serve the cake and then take the cake to the back room and invite others to toss a few more sprinkles on is NOT a participatory process. It’s still a shit cake.
You wrote, “My focus throughout this process has been the need to get all Senators who disagree about the best way forward on policy details into one room to hammer out the issues created in the aftermath of Obamacare’s implosion.”
Don’t act like you’re a leader on this. You’re not. You have no leadership capacity whatsoever. Leadership is John McCain’s speech on the Senate floor this week. Leadership is standing up for what is RIGHT, no matter the party. Leadership is Matthew 25:40, “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’” Leadership is making sure ALL of your constituents have healthcare as a fundamental human right.
You said, “People are at the heart of this conversation. We owe them the greatest honor and respect to get this right.”
This sentence says a lot. “We owe ‘them’”. You have set yourself apart. WE, not “them”. We are all in this together. You are supposed to be working for your fellow man (and woman). Not “them.” If this is your intention, however, then you must abandon the Senate healthcare bill because it does not do this. It does not honor “them,” it does not respect “them,” and it does not get it “right” in any way.
You said, “The debate is still ongoing, and I remain optimistic that we can agree on a plan to replace Obamacare. We owe American families who already struggle to put food on the table and gas in the car relief from the increasing costs of health insurance.”
You OWE American families relief from the increasing costs of health CARE—no matter what the solution ends up being. Insurance is the middleman and could become unnecessary in some scenarios. If all you do is decrease the cost of their premiums, while ALSO decreasing their coverage, then all you have done is set us back to where we were pre-ACA, or worse. And, in fact, it looks like “worse” is where we will end up. The Congressional Budget Office expects premiums to go up–steeply!–for almost all Americans, but especially for older people. The ACA was passed because our healthcare system DID NOT WORK! It was not “the good old days” then! Premiums were rising (fast), people were declaring bankruptcy at astronomical rates (almost exclusively due to healthcare), many millions of people could not afford ANY healthcare, nor insurance for healthcare. Those are NOT days we want to return to.
You wrote, “My staff and I will do everything we can to provide you with facts and information…”
You’re going to have to work a lot harder.