Senator Heitkamp held a town hall yesterday in Fargo that was largely focused on health care. She was joined by Pat Gulbranson, CEO of Family HealthCare, Dr. Josh Wynne, Dean of UND Medical School, and Dr. Greg Glasner, CEO of Essentia, who were there to answer questions and share their perspectives. It was a helpful and informative conversation, and we thank Sen. Heitkamp for taking the time to talk to her constituents about this issue.
On the state of the ACA
Sen. Heitkamp said that the Medicaid expansion is working well. Concerns about the ACA are most often about exchanges. Because older people cannot be charged more than three times more than a younger person, the costs of getting insurance have been prohibitive for younger people.
On the Republican “Repeal and Replace” plan (the AHCA)
The Republican plan would phase out the Medicaid expansion. It would also change the funding of traditional Medicaid from mandated payments from the federal government to a lump sum that the states can decide how to use. Over 10 years, federal government spending on Medicaid would be reduced by $880 billion. The North Dakota legislature would have to allocate $250 million to make up for that shortfall.
According to Sen. Heitkamp, older Americans who do not qualify for Medicare will be hurt the most if the AHCA passes.
On what’s happening in North Dakota
Pat Gulbranson of Family HealthCare said that his organization serves low income and homeless people, and they are seeing increasing demand. They just built a West Fargo clinic and it is already too small. They have 15 dental chairs going every day and several hundred people on the waiting list. Their biggest challenge is workforce recruitment and retention. Family physicians, nurses, and support staff are hard to get.
Dr. Wynne of UND said that workforce recruitment is a big issue in health care in North Dakota. From a national perspective, we spend 50% more per person than any other country in the world. We spend more than $10,000 on each person in the US per year–18% of our GDP. The average person on Medicare puts $1 in and gets $3 out, which raises the national debt. In 10 years, we are going to spend 20% of all dollars on health care in US. We have a problem with how we are going to pay for health care.
Dr. Glasner of Essentia said that for him, uncertainty is the biggest problem with trying to deliver care. 60% of their patients are on Medicare or Medicaid. Not knowing what the law might be in a year or two makes it hard for them to plan. He also said that there are not enough doctors for everybody to have a primary care provider anymore.
On Medicare for All
Responding to a question on a single-payer system, Sen. Heitkamp said that everybody believes that a lot of the cost problems you see in health care costs are inefficiencies from not having single-payer, but Medicare and Medicaid are costs are expanding, too. The decision was made in 2010 to go with a market-based system–the question is how to we fix the system we have.
She would like to lower the Medicare eligibility age to 60. That would help lower costs on the exchanges, because older people are more expensive to insure.
On how to stop the AHCA
Sen. Heitkamp said to write our congressman and senators and state legislature to let them know about our opposition to the AHCA and our support for the Medicaid expansion.
On Medicaid funding
Sen. Heitkamp said that she will never support block-granting or per-capita cap funding for Medicaid, which is what the AHCA would have done.
On global health funding
Sen. Heitkamp supports funding for global health as a way to protect the US from future pandemics.
On reducing the costs of care
Dr. Glasner said that 50% of health care dollars are consumed 5% of the population, and that half of health care costs can be attributed to lifestyle choices. Diet and exercise can dramatically lower the cost of health care.
Dr. Glassner also said that if you want to see what’s blowing up hospital budgets, it’s drugs. A single course of treatment for Hepatitis C is $100,000+. Drugs for cancer can be $5,000 to $8,000 per month. It’s very difficult to tell people they are not going to get the best drugs, and the best drugs are often very expensive.
Sen. Heitkamp agreed that we have to find a way to reduce the costs of prescription drugs, but she said that it’s complicated. She does not support importation from Canada due to quality control issues.