January 14, 2010
Host: Ted Simons
Health Care Reform
- Representative Kyrsten Sinema, assistant leader of the House Democrats, and Kim Van Pelt, Associate Director of St. Luke’s Health Initiatives, share their views on efforts to reform the nation’s health care system.
- Kyrsten Sinema - Assistant Leader House Democrats
- Kim Van Pelt - Associate Director of St. Luke's Health Initiatives
Ted Simons: Last Tuesday Congressman John Shadegg and Steve Forbes held a press conference in support of the Arizona Health Care ? Act that’s on November’s general election ballet. That same day, Forbes and Shadegg appeared on "Horizon” to explain their criticism of efforts in congress to reform health care.
Steve Forbes: People should have the right to say I don't want to buy this kind of insurance, or if I do I want to buy what I want, not what the government dictates to me. People should have the right if an if a health service is legal to be able to buy that health service. Providers should be able to provide that health service and not be punished by the government for it. Because where we're headed now is the government is going to be telling providers what they can and cannot do and that's wrong.
John Shadegg: There's a huge disconnect between the service provider today and the consumer of that service. That disconnect is we’ve put employers and plans in between. Now, what we're going to do is put the government in between. What Steve and I are saying is, let's get everybody out, lets have you and I as individuals be able to pick our own plan with the doctors we want or the services we want or the hospitals we want and get both employers out of middle and the government out.
Steve Forbes: If you allow nationwide competition, you're going to get literally hundreds of companies trying to figure out how to win your business. On TV every night, you have Geicos ads, you got the progressive ads, All state ads, other kinds of ads -- that's the kind of competition you want. So somebody is going to want you because they'll figure out to make money. And the other thing is when you get with true entrepreneurship, people will provide healthcare services at a more affordable cost like we do with the rest of the economy.
Ted Simons: Here now with another perspective on health care reform is democratic state representative Kyrsten Sinema, a member of President Obama's White House healthcare reform taskforce and Kim VanPelt, associate director of St. Luke's Health Initiative. Good to have you both on “Horizon” thanks for joining us.
Kim VanPelt: Good to be here.
Ted Simons: All right Kyrsten, compare and contrast the two bills right now, trying to be reconciled.
Kyrsten Sinema: Well in many respects, the two bills are identical and in many other respects they are largely similar. There are a few key differences and a couple of those are important for us here in Arizona. One version we've heard a lot about is the senate version of the bill which basically punishes Arizona for having done the right thing through a voter initiative years ago, by expanding Medicaid or as we call it in Arizona, AHCCCS, to more people. That bill, if it stays in that form will cost Arizona more money in the long run to continue to provide healthcare for those individuals. Under the house version though, Arizona actually gets a benefit of $7 billion over the course of ten years. So we’re acrually rewarded for increasing insurance for individuals who are low income.
Ted Simons: When you talk about AHCCCS, there are interesting aspects as far as federal version but we've got the governor afternoon lawmakers saying we can't afford the funding source is not there anymore. What do we do with these folks? What happens to the program?
Kim VanPelt: The governor is proposing to essentially have the legislature refer back proposition 204 to the voters. This is again, the ballot initiative that was passed in 2001 which extended eligibility for AHCCCS up to 100% of the federal poverty level. If that's indeed rolled back, about 350,000 Arizonans would lose health coverage and these are folks who really don't make much money and they could go uninsured. I mean that could have profound impact on those people and our overall health care costs. So it's a significant proposal in terms of the impact on Arizona and the number of uninsured we might have in our state.
Ted Simons: And yet Kyrsten, these are lawmakers who say again the funding source simply is not there for this program as it stands or as it may stand even with reform.
Kyrsten Sinema: Well, with reform the house version of the reform actually helps us so we'll get a great infusion of cash to help bury that burden and provide that healthcare for those Arizonans. I think it’s important to note that if we were to take that healthcare away from those 320,000 Arizonans, most of whom are working families that we're still going to provide care for those people through emergency rooms and that's what we call uncompensated care. So all of us pay for that in our taxes each year. It's much more expensive than providing health coverage and it provides for worse outcomes for all Arizonans. So I don’t think it’s a good idea, not a good proposal.
Ted Simons: As far as the federal versions are concerned again we had Congress man Shadegg and Steve Forbes in studio last week. Congress man Shadegg saying that these bills do nothing to control costs because the market is further afield and the government is right there in the middle of everything. You're thoughts?
Kim VanPelt: Well, the federal proposals really do have an impact in terms of coverage. They make significant increases in terms of the number of people to be covered nationally to the tune of 30 million Americans who will have coverage. That's a big deal for states like Arizona where one in five Arizonans are without health insurance. So that will definitely have an impact on cost. But there are certainly reasons to be concerned about how well the federal proposals will control costs over time. There are a lot of ideas in there, a lot of sort of nipping at the edges in terms of controlling costs, but there's some truth to say that without further reforms, the overall healthcare costs may have continue to rise.
Ted Simons: We had senator KYL speak to this as well. Congress man Shadegg certainly mentioned this as did Steve Forbes the idea of Medicare advantage, the idea that senior’s choice for seniors will be limited. Something simply will not be there anymore. These are concerns people have. How do you respond?
Kyrsten Sinema: Well, right now we do have a lot of choice in the market. The problem is that you're ability to choose among the choices in the market is incredibly dependent on your own personal wealth or the type of job that you have. The nice thing about both packages, the health and senate versions, is that that choice remains for Americans but subsidies put in place for individuals who don't have the power to make the choices they want to make today. So the truth is this legislation actually increases choice for most Americans.
Ted Simons: The Republican idea of tax credits for folks, they can have the money and go ahead and choose what they want without anyone telling them what to do or where to go. Why is that a bad idea?
Kyrsten Sinema: It's a great idea if you're young and healthy and will never get into an accident at all. But if you have a pre existing health condition, if you develop a disease or disorder or if something happens in your life that you're not expecting, than those tax credits won't cover the cost of your care.
Ted Simons: Is that how you see it as well?
Kim VanPelt: I would just add too that, tax credits don't really mean much if you're not paying taxes to begin with and certainly if you are low-income and can't afford to buy coverage, they're meaningless.
Ted Simons: So if there is a program set for those folks who can’t afford it, to get on a different exchange or covered in different ways, that still doesn't cut it?
Kim VanPelt: The tax credits aren't really significant enough to really have an impact on health coverage for low-income people.
Kyrsten Sinema: There’s not even enough for most middle income people to be honest. We're talking about tax credits that cost less than the cost of giving birth to a baby in a hospital. If you plan to get pregnant, your tax credit is not enough.
Ted Simons: We heard Steve Forbes comparing health insurance to auto insurance to comparing it to food stamps, these sorts of things. Apt to comparison?
Kyrsten Sinema: I think there are some key differences. When one goes without health insurance, it affects all of us. Not only do they receive coverage solely through hospitals, which you and I pay for through the emergency rooms, but they also increase the risk for public health concerns. Spread of communicable diseases is increased when we have lower levels of health care coverage. And that's a key difference from auto insurance.
Ted Simons: And yet the free market folks are saying that these health insurance companies don't have to compete. There are so many middle players that most of us don't know what the procedures we're getting cost. By way of this and that and the other, everything clogs in the middle. Make it an open market, prices will come down and they will give you better service. Again?
Kim VanPelt: Well there certainly are problems with transparency in the system right now. We really don't know what things cost and that does contributes to overall healthcare costs. But I think part of Steve Forbes argument was that ultimately the government shouldn't be involved in the free market. I think most people really don’t think that there's a need for more freedom with health insurance companies, they think that there’s a need for oversight.
Ted Simons: Is there enough transparency in what you're hearing coming out of the federal bill?
Kim VanPelt: I think there's efforts to tinker at controlling costs in the healthcare system but over time, we're going to have to readdress that issue.
Kyrsten Sinema: The establishment of the commission is I think one of the key ways to get to that transparency. But, you know, back in terms of the idea of competition, one of the nice things about the exchange, and this exists in both bills, it that there are opportunities for companies that operate in the private market today and our private corporations to form nonprofits to provide this care and the fact that you're utilizing a nonprofit helps to drive down the cost. Because there's no inducement to have a profit margin. And so that provides some more competition within the exchange and it also helps keep the cost down.
Ted Simons: I know that senator KYL and we've heard from the Republicans, one of the things they mention is tort reform. Is it time to address tort reform?
Kyrsten Sinema: The president already did. Last year in September when he made his address to congress, he announced he was starting a pilot project in numerous states throughout the country to try out various types of medical malpractice reforms. Those pilots are in process right now and the federal government will have a report sometime this year. To talk about which ones are the most effective.
Ted Simons: Pilot project is one thing, actual hard tort reform is another. Is that something that could be considered a compromise with Republicans?
Kim VanPelt: I believe it could be considered a compromise. And I think there probably is need for tort reform but we'll see how it rolls out in what's being proposed by the president.
Ted Simons: I want to get back to AHCCCS and the future of AHCCCS here in Arizona. President Burns had a quote regarding people not being qualified anymore. His quote was they need to make choices as to how they spend the money they earn. The idea there may be sacrifices that need to be made among folks who right now aren't making them. How do you respond to that statement?
Kim VanPelt: Health insurance is not cheap. The idea of low income people buying it in the free market is hard to understand. It’s clearly a problem that has to be addressed systematically, this isn't a free market problem.
Ted Simons: When you have heard senator Burns say that?
Kyrsten Sinema: I think it's important to remember who is on AHCCCS in Arizona. To qualify for AHCCCS you have to live at $18,000 a year for a family of four or less. There are single person healthcare plans in this state that cost that much money. So there's no ability for a family of four people that makes $18,000 a year to go purchase healthcare on the open market. I think there's a misunderstanding or lack of understanding about who these folks are on AHCCCS. Over the last year and a half, we've seen a great surge in enrollment in the AHCCCS program because middle class families, when one partner loses a job, in that family, boom, within two weeks they're eligible for AHCCCS.
Ted Simons: Last question someone watching right now is afraid and concerned that if one of these bills passes, they're going to lose options and coverage. What do you say to them?
Kim VanPelt: I think that the healthcare proposals being discussed in Washington actually offer Americans more choices. They certainly offer you more choices for example if you have a healthcare problem. Choices that don't exist today. They offer more protection for consumers in general, in terms of making sure that insurance companies actually live up to their obligations. You're going to have more choices over the long term, not fewer.
Ted Simons: All right we’ll stop it right there. Thank you both for joining us.
Kim VanPelt/ Kyrsten Sinema: Thank you.
Senator Jon Kyl
- United States Senator Jon Kyl of Arizona will discuss national issues including health care reform, immigration and security.
- Jon Kyl - United States Senator
Ted Simons:> Healthcare and national security -- two big issues before congress right now. And here to talk about those concerns and other topics is Arizona Senator Jon Kyl.
Jon Kyl: Good to be back.
Ted Simons: Let's get to healthcare because we're going to talk about that later on in the program as well. Before we get to the wherefores and whatnots, at its core, why does healthcare cost so much right now?
Jon Kyl: There are a lot of different reasons and that's why there's no silver bullets to reduce the costs. You can start with physicians who practice defensive medicine for fear of being sued in court. One of the first reforms would be tort reform. You could save billions of dollars every year and physicians wouldn't order those extra tests or procedures so they wouldn't be reflected in your insurance bill and insurance would cost less money. There are new devices, new pharmaceutical products, new techniques that are developed every year that make our medicine better and the quality of medicine, advances, but that costs money and sometimes at least at first, those things cost quite a bit of money and when mass produced cost less. I don't think we want to give up the care simply because it costs more. And there are variety of other reasons congress is trying to identify those reasons and tackle them and that's where a lot of differences of opinion are in how to accomplish healthcare reform.
Ted Simons: I know Republicans like the idea of giving folks the incentives to take care of themselves by way of tax credits and these sorts of things. How does that work though for those who simply can't afford healthcare as it is right now?
Jon Kyl: To give you another example, states passed laws that tell you what has to be in insurance policies. These mandates add to the cost of insurance. Because every time a special interest lobbies the state legislature to add their particular type of care -- and, of course, this adds to the cost of insurance. People talk about hair transplants and Botox, and all the rest of it. That increases cost and it doesn't help anybody who can't afford the care to get it. What we've said is let's try to eliminate those mandates and get malpractice reform, lets have competition across state lines so that you can literally-- I know the insurance companies don't like it, they’ll have more competition, but they’ll have to reduce their premiums. Small businesses and associations should be able to aggregate their employee groups into large risk pools so they have the ability to negotiate with insurance companies just like big business does. There are a variety of ways in which you can draw down -- cause the cost to go down without upsetting the system for all those people who have insurance and frankly, think their insurance is just fine.
Ted Simons: With that in mind, you've got the house version, the senate version, the reconciliation right now. Something is going to come out of this. Are there any aspects of either bill that you are somewhat positive about or it sounds like Republicans just don't like anything they're seeing right now?
Jon Kyl: No, it's not that. The deals with preexisting conditions. Everybody wants to do that. The problem is the bills are so balled up and part of the reason for -- let me finish my sentence. There so balled up that it's hard to pick one thing out and say we'll take that. Everything is connected to something else. What they've done in order to get the votes is to have so many exceptions to the exception going back to subsection such and such. For example you have all of these great ideas and than because they're going to be harmful to states senators exempt their own constituents. Medicare advantage, many Arizonans are on Medicare advantage. If they have Medicare, there’s going to be a big cut in your benefits under Medicare advantage. Senator Nelson from Florida, not the Senator Nelson from Nebraska says, “Well that’s going to hurt my constituents, I’ll grandfather them”. So he grandfathers them in. The rest of them are on the hook. The other senator Nelson got a special deal for Nebraska and so on. All of those things are interconnected, so I don't think you can say we'll take A, C and F. You have to unravel it and I would suggest start from scratch, identify the specific problems, target the solutions to those problems, and don't try to undo what works for people today and try to get a large government intrusion into literally the care and decisions between the doctor and patient.
Ted Simons: Last question on healthcare. Will Republicans have any say in what comes out?
Jon Kyl: Not unless Democrats don't have 60 votes in the senate. In other words, if they can just do it within their own party, they'll do it and won't pay attention to Republicans. That's why I’ve been trying to get some democrats to say no, so that at least the Democrats will have to sit down with Republicans and say, now let's see if we can work out some kind of compromise. But as of right now it's being done behind closed doors with democratic leadership.
Ted Simons: Let’s talk about the economy really quickly here. Administration saying by way of the president's council and economic advisers that the stimulus has worked added two points to the fourth quarter GDP. Your thoughts on that.
Jon Kyl: I think that's baloney, if you want to know the technical term. We lost 85,000 jobs last month. Unemployment now is over 10%. If you take the systemic unemployment, people have stopped looking for work, it's 17.3%. I was in Tucson all day yesterday, I’ve been here today, people are hurting and to suggest that somehow the stimulus has made things better I think is a real stretch. It's true you can't spend that much money and not have it do some good. And frankly, it has helped the state, the state of Arizona somewhat, but I don't think it's an economical way to create jobs. And that’s what should be job one, put people back to work.
Ted Simons: And yet the same council projects that without the stimulus 1.5 to 2 million jobs that are here now would be lost as well.
Jon Kyl: Well, no one can say that. And so I fault these people for trying to suggest to the American people they can calculate the number of jobs that have been saved. That's an impossibility. It is true there's a bunch of new government jobs. And to just give you an idea the new healthcare bill will cost between $5 billion and $10 billion for new IRS employees to enforce the bill. There are going to be government jobs created to be sure. I don't think those are the kind of jobs that Americans are really going to count on for the long term.
Ted Simons: And so, when the same council says that they look to see again another projection. That the impact on jobs this year will be greater than last year, you say?
Jon Kyl: This is the same council that predicted if we pass the stimulus bill unemployment would go no higher than 8%. As I said it's 10%. And so I cannot put a lot of confidence in their predictions. They're political predictions.
Ted Simons: I can't let you leave without talking about terrorism and concerns there. The system failed with the Christmas day attempted bombing there. What happened?
Jon Kyl: Well the president described it correctly. He said we had the intelligence, but the agencies responsible, primarily the national counter terrorism center and the CIA failed, to use the trite phrase, to connect the dots, but it's a pretty good description. They had enough pieces of evidence, if everybody had been on the ball and if the software programs had worked properly. It would have added all of these different pieces and they would have finally said wait a minute, this is a guy we have 6 or7 different indications on him, he should not get on an airplane and as a result that system did fail.
Ted Simons: I thought that was supposed to be -- I thought agencies were supposed to be working together.
Jon Kyl: This was supposed to be all done. Richard Clark, who worked in the previous administration said he was astonished that it wasn't working because he said we had those systems in place when I was there. Part of it may be illustrated by the last line a January 8th editorial by USA today, they said what's needed is a renewed sense of urgency which the president has so far failed to supply. What they meant was, we've got the things in place to do the job, but there doesn't seem to be the sense of urgency to pay attention to these things, treat every one of them as important and make sure that it all works. When they let the head of the national counter terrorism center go ahead and go on vacation after this event has occurred, that gives you the message that it's just not that urgent.
Ted Simons: It’s interesting, I was reading where a CIA analyst back in 02 to 05, a couple of analysts actually, were saying that we're safer now than we were in 2001 because al Qaeda, if the best they can do is to get some kid who sets his pants on fire in a plane, if that’s the best they can do, granted there have been other acts that have actually succeeded in taking lives, but he says because things are relatively in place, we're safer than we are in '01.
Jon Kyl: We are as a result of all of the things we did, the ? law, the patriot act, all of the different things that have been put in place since 9/11, we definitely have more capability than we did, but we're still making very stupid mistakes. When the attorney general takes this fellow, the Christmas day bomber, and indicts him, gives him a lawyer and tells him to stop talking when what we really need is intelligence, and we need timely intelligence -- were there any other people that week who were growing to try do the same thing? Who was he working with? Where did he get this kind of bomb? Why didn’t it go off? What are they doing to make sure it does go off? Instead of just having a couple of FBI agents in Detroit question him immediately, bring the professional interrogators from the CIA, question him until you have all of the intelligence you’re going to get from him, and then if you want to indict him, go ahead. But there’s no reason to indict him right than and there, reading him his Miranda Rights and cut off the intelligence. When the president says we'll use all the tools at our disposal, that includes gathering intelligence, and he just threw all that away.
Ted Simons: Last question before you go, Somalia, Yemen -- relatively newer players on the terrorist battlefield.
Jon Kyl: Back and forth.
Ted Simons: Exactly, what do we do about these folks?
Jon Kyl: It just shows you that these folks will organize and recruit wherever they can. And while we have very important business to do in Pakistan, Afghanistan and Iraq, there are a lot of other places in the world that we have to work on too and Somalia and Yemen are two of the big ones.
Ted Simons: All right. Good to see you.
Jon Kyl: Thank you, Ted.