Congresswoman DeGette holds town meeting for health care insurance reform

Flat Earth/Denver State Capitol

An estimated 1200 attended the town hall meeting hosted by Congresswoman Diana DeGette, Dem. – CO, at her alma mater, Denver’s South High School earlier this Saturday morning. The meeting was designed to explain legislation currently winding its way through Congress and answer questions raised by constituents regarding issues that have entered the public debate over the health insurance reforms that represent the cornerstone of President Obama’s plan to revive the faltering American economy and reign in an industry where costs are spiraling out of control. 

The congresswoman, with 13 years in office, is the deputy majority whip, responsible for assembling the votes her party needs to pass legislation and is vice chair of the powerful Energy and Commerce Committee, one of three House committees crafting legislation on this matter. She began by setting the stage for her report on her committee’s progress. It was clear the congresswoman was very focused on delivering a clear message to her constituents on what was possible and why.

Why Reform/Why Now?

She began by explaining reform was necessary because the United States spends more than twice as much on healthcare than any other developed country and ranks just ahead of Slovenia in measurable health care results, a strong indicator that the nation’s resources are not being used effectively in this area.

She suggested that continuing on this trajectory, the United States would be spending nearly 40% of its GDP on healthcare. “The system is untenable,” she said, “from either a healthcare or financial standpoint.” She cast the issue in the broader light of President Obama’s plan to get the nation back on its feet and competitive with the rest of the world. “We need to remodel our economy,” she said.

To a show of hands in answer to her questions as to how many present were covered by health insurance (90%), how many were satisfied with their coverage (70%), how many had come up against a cap on their benefits (about ¼) and how many were denied coverage due to pre-existing conditions (about 1/3), she said those statistics were fairly typical of Americans in general.

Market Competition and Socialism

The legislation the House was crafting is designed to prevent discrimination by private insurers against pre-existing conditions, eliminate lifetime caps on coverage and prevent loss of coverage due to loss of employment. In answer to questions about socializing a system that several in the audience thought works best when left to free enterprise and capitalism, Ms. DeGette replied that all of the legislation, from her viewpoint was motivated to return competition to an industry she said was protected against anti-trust laws, particularly by the McCarron Act which remanded control of insurance companies to the states.

The ghost of Ronald Reagan was invoked by at least one woman who, by quoting him, warned the audience the legislation was leading Americans toward more government control over their lives. [Apparently, she has not traveled through an airport security line recently, undertaken a foreign adoption nor tried to obtain a new driver’s license, although this reporter did not ask her those questions.]

Rep. DeGette observed the status quo no longer served the nation’s interests. She said federal reform legislation was now needed to prevent insurers from registering in states that had minimal requirements for policies, thus providing watered down, ineffectual but expensive coverage. For example, in Colorado, she noted, health insurance policies must cover health screenings before they can be offered to the public.

The Public Option

She reiterated that if someone liked their insurance they could elect to stay with their plan. But she stressed the importance of setting up an insurance exchange that included the public option. Here in Colorado, she noted, in Pueblo, one company controls 70% of that healthcare insurance market. “We’ve got to get actual competition,” she said. “In Massachusetts, the state succeeded in enrolling nearly all of its citizens. But a problem arose regarding cost containment because the state had not mandated price competition.”

She stressed the public option will not be paid for by taxes but by premiums. Projections by the Congressional Budget Office put the cost at $900 billion over 10 years. That’s an average of $100 billion per year, about the cost of the previous president’s estimate for the first year cost of the war in Iraq. The public option, the Congresswoman said, is designed to be deficit neutral. And, she reminded those present, the President’s pledge to insert a provision that says, if it is found down the road to not be so, it must be adjusted so it is. “Competition is the key to reform,” she said. “If there is an alternative to the public option, I’d like to hear about it. I am open to ideas. I will consider a real alternative. But I will not consider some ‘fig leaf’ option.”

Tax Penalty for Those Declining Coverage

Asked to comment on the penalties for not having health insurance coverage, Rep. DeGette observed that automobile insurance coverage is mandatory in nearly every state. She also reminded the questioner that the penalties were necessary to pay for those who declined coverage, but still might find themselves in an emergency room.

The Politics of Reform

After the meeting, Mrs. DeGette was asked about the political obstacles to the legislation. She noted when the Republicans were in control of Congress and the White House, her own party sometimes instructed her and others not to negotiate. It was clear, she said regretfully, the Republicans were not about to share in the crafting of this legislation. That left it for the Democratic Party’s leadership to negotiate among three distinct Democratic factions: liberals, moderates and the so-called “Blue Dog Democrats.” Some of the Blue Dogs represent very conservative rural constituents. The Democratic Party, she noted, is far reaching and widely encompasses many political views. She noted one Blue Dog from Iowa had, at first, refused to accept the idea of a public option. But when pressed for a workable alternative and after he had gone home in August, returned to Washington open to the idea of increasing competition with the public option. “In finding common ground,” she said, “you can’t give up your core principles.”

House Bill 3200 and the Senate

“The bill is 1100 pages long,” said DeGette, “and, yes, I’ve read it.” She showed her political acumen when asked about other versions of legislation winding their way through two other House committees and two Senate committees, the Senate Health Committee and the Senate Finance Committee, the latter coming into notoriety by the negotiations that have taken place between Chairman Max Baucus, the Democratic senator from Montana and the Republican “Gang of Six,” including Charles Grassley, the Republican senator from Iowa who earlier this summer admitted his insincerity in negotiating with the Democrats.

“I can’t control what happens in the Senate. But, we can decide what comes out of the House,” Rep. DeGette said. Recognizing the need for compromise within the three distinct factions within her own party while acknowledging her willingness to be open to ideas and the complexity of the task at hand, she said, “I am not going to make the perfect the enemy of the good.”

The three house committees will present their bills to the Rules Committee that will then put the three versions together and craft them into legislation on which the full House will vote. The congresswoman acknowledged her role in helping to gather the 218 votes needed to pass the legislation in the House.  Once the House reform bill passes, it then goes to a joint conference committee for final negotiations with the Senate version later this autumn.

Colorado District 1 Concerns

One man noted a recent Denver Post article questioning how many of the reported 45.6 million who were uninsured were in fact illegal immigrants. Mrs. DeGette said even if the actual number were 10 million uninsured American citizens, wouldn’t that still be too many? The assembly seemed to agree. The man suggested that 70% of the babies born in one Dallas, Texas hospital are children of illegal immigrants. The congresswoman called his attention to Section 246 of the House bill that prohibits insurance coverage to those who are illegally in the country. But, it does not deny them medical attention. The man questioned how those costs would be addressed? The answer was not clear. “This is a complicated bill because it’s a complicated topic,” she said.

An emergency room physician said the reform legislation needed to contain two provisions, universal coverage and portability. Several others who came to the microphone seemed to agree. A woman who’s doctor prescribed a test for her observed it only cost her $15.00. She reminded him he made $300.00 from the same test. “Multiply that by thousands,” she said. Another woman, clearly anti-abortion, questioned if public funds would be used to perform abortions. The congresswoman answered that it would be up to an individual to buy coverage in the competitive market that either provides coverage for such procedures or did not. Currently, federal legislation prohibits most public funds from being used to pay for abortions. That legislation, the congresswoman suggested, would stay in place. A man with AIDS said the "public insurance option is not an option. It is essential" for the chronically ill, noting the high cost of coverage from the current public Cover Colorado plan. No one seemed enthused by health coops.

The Tone of Civility

Hecklers erupted only when questions of dogma arose such as Republican tax cuts and the federal deficits some suggested they caused. They were quickly quieted by the crowd which clearly had a greater appetite for trying to understand the complexities of the issues than it did for dogmatically based political debate.

The congresswoman set the tone for the meeting when she reminded her constituents, “I actually live here. I come back the moment I can. Wouldn’t you?” and the crowd showed its appreciation with chuckles and applause. Those present represented a broad mix of age groups, couples, young and old, a few who had brought along their babies and small children. One woman, toting a covered baby carrier, busied herself waiting to enter the meeting on her cell phone talking to her nineteen-year old sister in law who’d just given birth at home with the help of a midwife after 23 hours of labor. By and large it consisted of affluent, mostly white voters from Colorado’s 1st Congressional District and with the rare exception of those few catcalls, was devoid of the incivility the media has reported at other meetings across the country dealing with the same issue.

Where to from Here?

If Colorado’s 1st Congressional District is an indicator, Americans want reform. And, they are very specific about what they want the legislation to look like. They want spiraling costs contained and waste cut. They want to choose their own plan, including having a public option. They want portability. They want no discrimination against pre-existing conditions. They prefer no lifetime caps on coverage. They are willing to accept that the Republicans will not be part of crafting this legislation, at least in the House.