When I moved to Minnesota over a dozen years ago, two things impressed me right away. First, as someone who built a company to help the un- and underinsured access health care, was the first-class health care system and its accessibility to many lower-income people. The second was the civic-minded Minnesota politics that placed the good of the community ahead of party affiliation.
Both are at grave risk now that the U.S. House, confirmed by decisive votes from Minnesota's three Republican members, passed a radical bill to not only repeal the Affordable Care Act, but also to cut 25 percent from the 50-year-old Medicaid program.
While cutting Medicaid so deeply would have a massive budgetary and human impact on Minnesota, Rep. Erik Paulsen doesn't mention it once in justifying his vote ("My vote will put Minnesotans back in control," May 9). The $880 billion Medicaid cut is used to pay for a targeted $55,000 tax cut for millionaires and for industries that are among Paulsen's biggest donors. Paulsen's vote is not mainstream. It cuts against the views of many Republican governors, and against the unified view of the medical community and patient groups.
Forty-three percent of Minnesota kids are covered by Medicaid. The nursing home care of half the seniors in the country is only possible through Medicaid. I hear stories every day like the one from Emily from Edina. Emily's dad worked his way through college and for decades teaching high school. He saved diligently, but the combination of leukemia, Parkinson's disease and dementia has meant that he needs full-time nursing home care costing more than $11,000 per month. His savings are long spent. As Emily raises her own young family, Medicaid is the only way her family is able to afford the care her father needs.
Through Medicaid and the exchanges, the ACA has provided access to health care to 20 million Americans and added vital protections, ensuring that the more than 100 million Americans with pre-existing conditions don't get charged more than anyone else for insurance. While the ACA faces the challenges any new program does, Americans by large margins want to see our politicians work together and apply surgical fixes to make it better, not tear it down.
Caretakers of those with intensive medical needs understand our medical system better than anyone. "If this [Republican] bill became law, it would devastate us and so many families we know," Emily says. "Fixing things is one thing, but this bill is not about helping families like mine."
The main concern with the ACA that Paulsen points to is that premiums are too expensive. Yet premiums are projected to rise 15 to 20 percent higher next year should the Republican bill pass, according to an evaluation by the nonpartisan Congressional Budget Office. Paulsen also doesn't address the fact that more than 360,000 Minnesotans are projected to lose coverage and that rural and older Minnesotans are expected to lose the most.
Far from addressing health care costs, the Republican proposal aims to go after the very things that insurance protects: the requirement to cover mental health benefits, the prohibition against lifetime caps and the federal protection against being charged more because of a prior illness. Paulsen says in his article that this isn't so, but if that's true, why did the House GOP's own website remove the declaration that Americans "should never be denied coverage or charged more … because of a pre-existing condition" from its health care FAQs right after the vote?
Minnesota's reputation for putting people over politics is another casualty of this debate. When I left my private-sector job here in Minnesota to serve in the Obama administration, it was in hopes of helping more Americans get the care they need. But I was disappointed to find some working against that aim. When he points to rising rates under the ACA, what Paulsen doesn't mention is that in 2015 he voted to strip billions in ACA funding that was designed to keep rates lower. That vote, like the vote on the AHCA he made last week, made for good political fodder, but was done on the backs of everyday Minnesotans.
What do we hope for from our elected representatives? An end to the practice of politicians holding our personal health care hostage to the next political campaign. Were Trumpcare to pass, Americans would all await the next election cycle to seek relief from the pain and misery. Back and forth we would go.
There was a time when politicians from Minnesota led the way to compromise and put civic-mindedness ahead of party. But the days of Ramstad, Durenberger and Boschwitz have been replaced by the ways of Paulsen, Emmer and Lewis. Knowingly misleading constituents to justify harmful policies and toeing a party line has replaced leadership and principled compromise. We should not be satisfied with this approach any longer. If we don't demand and receive bipartisan leadership soon, we will all be paying a steep price.
Andy Slavitt (@aslavitt) was acting administrator for the Centers for Medicare & Medicaid Services under President Barack Obama, 2015-17.