If there is one thing we all hoped Congress had learned with the latest failed attempt at health care repeal, it is that people want bipartisan solutions. And yet, even with the 24-hour news cycle, it is nearly impossible to find any instances of bipartisanship or progress. While current congressional approval ratings would indicate that the public isn't surprised, history tells us it doesn't have to be this way.
Consider the modern day health care system for veterans, which was first established in 1929. Year after year, Democrats and Republicans come together to make improvements to the program. Working together, Congress has shown it is possible to provide a working model of health care in this country. Republicans and Democrats may not always have the exact same vision for moving forward, but because both parties agree that our commitment to veterans should rise above politics, they find a way to compromise.
In 2014, after the devastating discoveries of inadequate care in VA centers across the country, Republicans and Democrats stepped up and put forward various solutions to address the problem. Outrage in Washington was abundant, but at no point did either party suggest we should just scrap the program altogether and eliminate this essential network of care that our veterans rely on.
There is no reason that providing access to quality, affordable health care to hard-working families and children has to be any different. The Affordable Care Act needs to be improved. This is something I have said since the initial bill passed and I do believe there are common-sense solutions that can help improve the current system if there is political will to see them through.
Insure across state lines
I have long advocated for opening the health care exchange across state lines. Alaska's small population means insurance companies view us as a "higher risk pool" and as a result we pay higher premiums. If, however, Alaska could share an exchange with other similarly sized states – Montana, Idaho, Wyoming – then we could expand our pool, lower the risk and drive down costs.
Provide a catastrophic coverage option – Copper Plan
I have also advocated, and while in the Senate introduced a bill for, creating a lower cost option on the exchange, which I called the Copper Plan. The Copper Plan would mirror what is known as "catastrophic coverage," but would also include all the core consumer protection benefits that are a part of the Affordable Care Act – lifetime limits, pre-existing conditions, children can stay on your plan until they are 26, etc. The Copper Plan along with the Alaska Native Health Care Clinics, Planned Parenthood and our community health centers would provide a great network of preventive care for Alaskans.
I believe the Cadillac tax should be eliminated. This is a tax on high-cost health care plans offered by the general business community, including the oil and gas industry, mining industry and local and state governments. Alaska, due to our state's unique geography, has one of the highest-cost health care delivery systems in the country. So states like Alaska are disproportionately penalized by the Cadillac tax because of our unique needs. If this tax is not eliminated, local governments will continue to have increased costs, which are ultimately paid by local taxpayers. This is unfair and unacceptable.
Last, I would expand the tuition reimbursement that I was able to get in the Affordable Care Act. I would allow a full 100 percent scholarship for those who want to work as primary or senior care doctors, nurses and physician assistants. In exchange, they would work for a period of time in either community health centers, VA clinics or Indian Health Service establishments. This is basic supply and demand. By increasing the supply of qualified professionals, we could help stabilize the cost of providing care and therefore the lower the cost of care to patients.
Without these additional reforms, Alaska's individual insurance market will continue to falter and create a ripple of negative impacts across Alaska communities. We must stabilize the private insurance market, which will in turn help our small business community. Given Alaska's ongoing economic situation, the greatest thing we can do for families and businesses is to create some certainty.
Change is always hard, but it is doable. When I was in the Senate, I crafted an initiative to create a program that now delivers health care to veterans in Alaska utilizing the Alaska Native health care system in their local (or nearby) community when no veterans care is available at home. People — including many from within my own party — told me it would be impossible, but I knew it was a better way to provide care for our veterans so I refused to take no for an answer. Alaska now serves as a model for the rest of the country when it comes to providing health care to our veterans.
As mayor of Anchorage, I also revamped our health care self-insurance fund for the city's 3,000 employees. As a result, our costs went from an annual 10 percent to 12 percent increase all the way down to less than 1 percent per year.
I will say it again – the current law needs to be improved. But we can't simply rip the rug out from under hard-working families for the sake of short-term political agendas. Nearly 25 percent of Alaskans are currently covered by Medicaid and stand to face devastating impacts if they are forced off the program. Thousands of Alaskans would be left without access to the critical care they receive at Planned Parenthood. All Alaskans risk facing devastatingly high premiums and reduced access to care. Moreover, it is impossible to quantify the peace of mind that is brought to individuals and families knowing they are protected by the core consumer protections that were implemented in the Affordable Care Act.
There is reason to have hope, given the inability of Republicans in Congress to pass their risky "repeal and replace" plan. Moreover, Alaskans should be grateful that our own Sen. Lisa Murkowski was willing to stand up to her party leadership and protect the pieces of health care that are working. Now, we need Congress to fix the pieces that are broken. What happens next, however, will depend on Congress' willingness to put politics aside and find the middle ground as they have done time and time again for improving veterans health care. It isn't an easy challenge but it is a worthy one.
In Alaska, the health and well-being of not only our families and communities but also our economy depend on common sense, balanced solutions that improve access and affordability without undermining consumer protections and personal rights.
Mark Begich is a former mayor of Anchorage and former Alaska U.S. senator.
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