Alaska Sens. Lisa Murkowski and Mark Begich are home from Congress for the August recess, and both are meeting with business and community groups, attempting to explain what's in various health care bills now before Congress.
They're also responding to rising public concerns for the urgent need for some kind of health care reform, how a reform package might work and how it will be paid for.
Murkowski was blunt in her criticism of groups that stir up fear.
"Health care is very personal and people get extremely emotional about their concerns," she said, and people who are stirring up things with false claims, such as that the legislation would limit access to health care for the elderly and the so-called death panels, are doing a real disservice.
Murkowski spoke at a Commonwealth North luncheon in Anchorage Aug. 11.
In his talk Aug. 10 to the Anchorage Chamber of Commerce, Begich said, "We've got a huge problem on our hands -- health care costs spiraling out of control and our economy suffering because of it. There are 46 million uninsured Americans today, and it's going to get worse if reform does not pass."
In Alaska, about 116,000 people don't have health coverage.
"That's 18 percent of our population," Begich said.
Murkowski agreed something has to be done, although she disagrees with what is being proposed so far.
"We can't afford to ignore exponentially rising costs of health care that are pricing American families and businesses out of the market. This is unsustainable and will only further drive more Americans away from being able to afford health insurance," Murkowski said.
Begich told the Anchorage chamber that Congress is close to information overload on health care.
"There are wheelbarrows of reports available to Congress, and just as many opinions," he said. "But here's my take-away from the debate so far: A broken health care system leads to lost jobs, reduced productivity, less investment capital and -- ultimately -- stalled business growth."
Murkowski said her major criticism is that reform is being pushed too fast, that its cost estimated at more than $1 trillion will be added to the estimated $3 trillion already spent by Congress so far this year in various economic stimulus efforts, and that it will be ineffective, particularly if a model similar to the Medicare system is used for a public insurance option.
Begich ticked off some sobering statistics:
"In 2009, health care expenditures are approximately 18 percent of GDP (Gross Domestic Product). Without major reform, health care's share of GDP will rise to 34 percent within 30 years. That's one-third of our economy going just to health care. I don't need to tell you as business people or as heads of households that an ever-growing percentage of your business expenses or your own paycheck is going to health care," he said.
"This affects all of us. In just 10 years, family insurance premiums have doubled in Alaska. The average employer-provided premium was about $6,000 in 1997. In 2006 -- the most recent year we have state data -- the same coverage averaged $12,200. Of course wages didn't come close to keeping pace," Begich said.
Begich presented information from a report from Small Business Majority, a nonpartisan group he is working with in Washington, D.C.
The research was done by a health economist from the Massachusetts Institute of Technology, and it shows that without reform, small businesses in America will spend more than $2 trillion on health benefits for their workers over the next 10 years.
With no reform, the report indicated an estimated 178,000 small business workers will lose their jobs over the next decade because of dollars diverted to health care.
The costs of avoiding preventative health care because of lack of insurance or high deductibles amounts to a hidden tax on everyone else, Begich said.
"Thousands of Alaskans report avoiding the doctor because of high costs. When this basic care is delayed, it usually becomes more expensive later. People end up getting sicker and going to clinics or the emergency room," he said.
"Hospitals don't turn people away -- and they don't just absorb the cost of this uncompensated care," he added. "It is passed to the rest of us in the form of higher medical charges, which in turn lead to higher premiums for those of us who are covered. Nationally the average family pays a hidden tax of $1,100 to help cover the uninsured. In Alaska, the average hidden tax is $1,900 per family."
Out-of-control health care costs are also having a dramatic effect on many Americans. Nationally, 62 percent of personal bankruptcies and 50 percent of home foreclosures are the result of unaffordable medical bills, Begich said.
"The question keeps coming up, 'What's in this for the average person?' The answer, in one word, is 'stability.' Besides the family savings I just outlined, reform will bring stability in many ways.
"There will be no more coverage denied because of pre-existing conditions," he said. "You get to keep your doctor and your current insurance plan if you like them. No more reason to make job decisions based on fear of losing health insurance. No more lifetime caps on how much insurance companies will pay. You and your doctors make health care decisions not insurance companies. Don't let anyone tell you health reform won't benefit every single one of us."
Murkowski said another of her concerns is that tort reform is missing from the equation, at least so far. She said $1,700 to $2,000 a year in family health care costs could be eliminated if a significant tort reform measure were included in the bill.
She is also concerned with the penalties for small businesses and doesn't agree with claims that the proposals, as they exist, won't push people out of private coverage.
For example, a small business employing 50 and not providing coverage would pay a penalty of $750 per employee per year, or $20,000, under the bill now in the Senate (in the House legislation it is a percentage of payroll).
If an employer were providing insurance and the $20,000 penalty is less than the cost of the insurance, which is likely, the firm would be tempted to drop the policy and let workers get pushed into the government system, she said. If the public system is modeled on Medicare, it's all the more troubling.
Begich also criticized the myths being circulated to stir up opposition to health care reform.
"Sure, there are skeptics. I don't blame anyone for looking closely at the details -- I have questions myself and the bills are not final," he said.
However, claims that the health care proposals contain euthanasia provisions and will use federal funds for abortions are not true, he said. Equally untrue is the charge that Republicans in Congress aren't having their say in the bills being considered.
He complimented Murkowski on several amendments she added to a version of the bill in the Senate.
"I'm happy Senator Murkowski added an amendment ensuring that Native Americans and tribes are eligible for various health workforce programs. She addressed workforce shortages and will make funding available to Alaska health providers," Begich said. "Another of her fixes allows insurers to charge tobacco users more because smokers have higher medical bills -- costs that the rest of us shouldn't have to bear."
Murkowski said she was able to get some amendments into the bill, but others with more substance were defeated on party-line votes.
Begich said Congress is still mid-stream on the issue. The three House committees of jurisdiction each have amended and passed their versions of the bill. The next step, the senator said, is to merge them into one package and pass it on the House floor. That final vote is likely to occur sometime in September.
Although the Senate Health and Education Committee has passed a bill out, "we're still waiting for details (on its proposal) from Senate Finance Committee," Begich said.
Murkowski said the Senate Finance Committee bill being worked on now would probably be the final vehicle for a reform package.
Murkowski mentioned provisions she would like to see in a final bill.
"We must reform the way medical providers are reimbursed (under a public system) and ensure that we reward quality, and not quantity," she said. "We should allow nurses, dietitians and other mid-level providers to take a more active role in health care management by reimbursing their services under a medical home concept, as we have seen in the success of the Southcentral Foundation (a nonprofit based in Alaska). This will allow patients to get lower cost primary care services instead of high cost, late stage emergency room and specialty care."
Tim Bradner can be reached at firstname.lastname@example.org.
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