Health reform and the underserved

Health care reform could have been about lifting up the health of Americans. Instead, the process became the equivalent of a wolf pack stalking, attacking and killing its prey. Special interests consumed all that could have been good or possible, leaving us with a carcass stripped clean.

Still, members of Congress and the White House are trying to tell us it is really an endless supply of filet mignon.

Americans, however, are not being fooled — the polls clearly show that. If you don’t believe the polls then look at what happened in the New Jersey and Virginia gubernatorial races and — my goodness — the Senate race this week in the bluest of the blue states, Massachusetts. All losses for the Democrats in the past 11 weeks with the current health care bill playing a critical role.

Low-income and minority groups, supposedly the main focus of reform, will have the least to look forward to. The bills passed by the House and Senate will effectively segregate low-income Americans into a second-class health care system from which they will find it increasingly hard to escape.

Medicaid will be vastly expanded — with an additional 15 million Americans being added to the rolls.

But coverage does not equal care. When the controversy over mammograms for women under 50 erupted, the Senate acted to improve the likelihood that coverage for at least this preventative service would remain — for everyone except those on Medicaid.

The Senate bill bent over backward to increase subsidies and decrease financial risk to those making between $60,000 and $80,000 per year — but at the expense of features that will limit access for those most likely to find themselves on Medicaid. By not mandating payment parity with Medicare, Medicaid recipients will increasingly find that not only are doctors and clinics not accepting them, but that the disincentives for even offering services in places like inner city neighborhoods will force them out.

Medicare Advantage, admittedly a flawed program, nonetheless has become an invaluable health care subsidy program for minority seniors. Data from 2007 show, for example, that more than 80 percent of Hispanic/Latino seniors eligible for Medicare who make less than $20,000 per year currently have a Medicare Advantage plan. Except for the chosen ones who live in a state that was able to cut a special deal, those seniors will now be faced with higher payments, fewer benefits and the real possibility of losing their plan altogether.

At-risk families will need to get services that will be harder to find at hospitals and at home — because payments to hospitals serving the poorest areas are being cut along with almost $43 billion in home health care. These same folks, with the poorest support systems at home, are also at high risk for readmission — and penalties are being developed to further discourage hospitals from even locating anywhere near these communities.

Yet if Americans do not sign up for one of these plans — no matter how restrictive or full of fine print that even its authors cannot or will not understand — they face fines or other penalties. Massachusetts has had this since 2006. In a 2008 survey, fully 50 percent of respondents who had been impacted by this “individual mandate” believed they were worse off than before.

The health insurance industry has been scurrying in and out of the White House for months, holding fundraisers for candidates who have promised fealty to any bill, no matter how bad for constituents. One senior insurance company lobbyist even announced in December, “We won!” It is not hard to understand why Americans, especially low income minority groups, are left outside, forced to simply stare through the glass into where the real power, money, and benefits get shared.

But Washington has shared one large piece of this health insurance company bailout bill with outsiders — the cost. States — both directly and indirectly — are expected to shoulder tens of billions in new costs. State budgets are in crisis already, and when that bill comes due, it will come right out of education, public safety and public works budgets, at the disproportionate expense of at-risk communities. And the new federal taxes and the necessary state taxes will make everything less affordable and jobs harder to find.

We need reform. But the process has been hijacked, and it is not weakness to admit a new strategy that puts patients first must be put forth and promoted. The dialogue that for too long has only included Washington’s elected elite and entrenched special interests, must be expanded to place patients at the center of reform.

There is an effort in Arizona being led by Dr. Eric Novack called the Health Care Freedom Act. It places health care in the underserved community as a top priority. His initiative and efforts ensure that health care reform can proudly lead us down the road together, to more accessible, more affordable, higher quality health care.

J.C. Watts (JCWatts01@jcwatts.com) is chairman of J.C. Watts Companies, a business consulting group. He is former chairman of the Republican Conference of the U.S. House, where he served as an Oklahoma representative from 1995 to 2002. He writes every other Sunday for the Las Vegas Review-Journal.