Let states fix health care woes
What if Congress abandoned its fruitless debate on health care reform and let states do the job?
Last month, U.S. Rep. Pramila Jayapal of Washington submitted HR 6097, the "State-Based Universal Health Care Act of 2018," which does just that. This remarkable bill moves health care reform from a paralyzed Congress to states seeking better care to more people for less money.
To the dismay of families, businesses and patients suffering under our country's dismal health care system, Congress resolutely refuses to lead, follow, or get out of the way. Instead, each party simply debates the Affordable Care Act — restore it or repeal it? But neither option changes America's uniquely dysfunctional health care system: the world's most expensive with the first world's worst results. We will remain the only industrialized country to hold employers responsible for employee benefits and tolerate bankruptcies if someone gets the wrong disease at the wrong time.
To its credit, many Congress members (notably our own Sen. Ron Wyden) encourage states to seize leadership. But federal laws handcuff state healthcare reform efforts. These federal laws prevent Oregon from regulating, or even modifying, most of the $35 billion spent annually in our state on healthcare.
HR 6097 removes the handcuffs.
Most of these restrictive federal laws have admirable motives — insurance for our elderly (Medicare), care for our poor (Medicaid), protection of our pensions (ERISA, the Employee Retirement Income Security Act), and subsidies for private health insurance (ACA). Yet these federal laws unintentionally fracture our state's health care spending, and render most fragments inaccessible to state reform efforts.
Without HR 6097, states must grapple with awkward work-a-rounds. For example, Section 1332 of the ACA (thanks to Sen. Wyden) does permit the Secretary of Health and Human Services to issue ACA waivers, though he has issued none so far. Medicaid waivers allow states to use Medicaid dollars in novel ways — such as Oregon's tiered-benefit Oregon Health Plan and Coordinated Care Organizations (CCOs). Medicare waivers, on the other hand, are rare — only one has been issued and that was 40 years ago. ERISA has no waiver option whatsoever.
To bulldoze through this federal gridlock, HR 6097 allows the secretary to issue waivers not just from the ACA, but from all federal laws restricting state health care reform. This "superwaiver" not only frees states from federal interference, it preserves federal funds that states currently receive. Oregon needs such a superwaiver before we can provide everyone in Oregon with better care for less money.
Some are concerned that HR 6097 will further disturb our already-disturbed health care system. But HR 6097 changes nothing by itself. Until individual states receive a superwaiver, Medicaid will operate as inefficiently as before. Medicare will confound those who use it. Employer-sponsored health care will burden employers. ACA insurance marketplaces would risk insolvency. But with a HR 6097 waiver, motivated states like Oregon can begin the serious work of health care reform neglected by Congress.
We should encourage every member of Oregon's Congressional delegation to co-sponsor HR 6097, advocate for its passage, or at least offer no opposition. States, not the federal government, must lead health care reform. If Congress refuses to lead, it must follow or get out of the way.
Samuel Metz, M.D., lives in Southwest Portland. He is a member of Oregon Physicians for a National Health Program and founding member of Mad As Hell Doctors, both of which advocate for universal health care.