Quality healthcare is a fundamental human right
When I was 16, I was diagnosed with type 1 diabetes and quickly learned what it meant to worry about health coverage and costs. All that time in doctors’ offices inspired me to become a pediatrician so that I could treat children and help their families navigate the healthcare system.
As a practicing pediatrician, I know firsthand what is wrong in our current system. I have comforted mothers crying in my office because their costs and deductibles are skyrocketing. I can’t tell you how many times I’ve had to work with patients to help them find ways to afford vital prescription drugs and access specialists for treatments their children need. One family last fall explained that they had to simply opt out of health insurance and roll the dice. In the most wealthy and powerful nation in the world, no parent should ever have to make a trade-off between their child’s well-being and paying their rent or mortgage. It is inexcusable that our country spends far more on healthcare than every other country, yet our health outcomes fall further and further behind.
America has many of the world’s most advanced medical facilities, the smartest researchers and scientists, and cutting-edge technologies and medicines. We support these advances with our tax dollars. Yet our delivery system fails to offer the highest-quality health services to too many Americans. Washington state individuals and businesses deserve access to quality, affordable health coverage that gives them peace of mind and protects them from going bankrupt when unexpected medical emergencies arise. Too many Washingtonians face skyrocketing healthcare costs, and we need to take immediate steps to help them get the coverage they need and deserve.
That’s why I am committed to moving us toward a Medicare for All system that guarantees affordable, high-quality care for every American. Medicare has proven to be the most cost-efficient way to deliver high-quality care. But we cannot simply wait for a Democratic president and Democratic majorities in Congress to pass a bill that will take years to implement. In the meantime, we need to take immediate action to stabilize our insurance market and build on the ACA in the short term and implement a Medicare public option immediately, as we work toward a universal system. Parents of my patients who confide that they don’t know if they can afford health insurance anymore need immediate relief from skyrocketing premiums and out of pocket expenses like prescription prices. We must address costs and deliver higher quality healthcare to every American while simultaneously moving toward a more efficient, long-term solution. Here’s how we do it.
Expanding Medicare to All through An Immediate Public Option
My goal is affordable, accessible care for everyone in this country. As a major step to lowering costs and making our healthcare system more efficient, I propose allowing every citizen and employer to participate in Medicare as a public option on their state’s health exchange, on a sliding scale based on ability to pay, with subsidies available to help cover the neediest. This Medicare public option would be offered alongside private insurance plans in the individual and small group markets through the Federal and State Exchanges and the Small Business Health Options Program (SHOP) Exchanges.
Not only will this provide employers and individuals with more choices, but it will use market forces to drive efficiency and spur competition among insurers. Average insurance company overhead is currently estimated to be a staggering 20 percent, while Medicare overhead is estimated to be an incredibly-efficient 1.8 percent. The competition will encourage private insurance companies to offer plans as efficient and beneficial to consumers as Medicare, so more of your money goes toward healthcare services, not bloated insurance company bureaucracies and executive salaries. If they choose to not compete, more and more Americans will opt-in to Medicare as their preferred choice. It’s a way to evolve toward the cost-efficiencies of a Medicare for All system while still providing consumer choice.
Ensure Everyone Has Access to Affordable Health Coverage
- Provide a high-quality, affordable public option to all Americans, without requiring the immediate replacement of employment-based health insurance.
- Allow Americans of all ages and private employers to benefit from Medicare’s bargaining power.
- Increase premium tax credits and extend eligibility for subsidies to middle-income earners to lower the cost of healthcare premiums.
Provide Comprehensive Care
- Expand Medicare coverage to include pediatric care, reproductive care, and family planning services.
- Preserve protections for pre-existing conditions.
- Promote preventive care and screenings to keep patients healthier, diagnose problems before they become emergencies, and lower long-term costs.
- Provide immunizations free of charge to ensure that every child and adult is vaccinated, protecting all of us from vaccine-preventable illnesses.
Increase Competition and Lower Prices
- Offer a low-cost option for consumers and employers, improving consumer choice in underserved regions.
- Enhance market competition by allowing consumers to choose a public option over their employer coverage if preferred, driving down private insurance prices.
- Allow the federal government to negotiate prescription drug prices.
Restoring the Affordable Care Act
The Affordable Care Act was a monumental first step in expanding access to affordable healthcare and ensuring quality protections. It has its faults, but in the 8th District, the Affordable Care Act provides insurance for 70,000 people who otherwise would not have care. In the 8th District, the uninsured rate went from 12.8 in 2013 to 5.0 in 2016. Despite dozens of failed attempts to repeal it, it continues to provide a vital lifeline of coverage. However, we need to undo the purposeful damage done by Congressional Republicans and the Trump administration, and improve some aspects to make it work more efficiently.
Stabilizing insurance markets
The Trump administration and House Republicans have taken every opportunity to undermine state health insurance exchanges. From allowing plans to cancel coverage for essential health benefits, to repealing the individual mandate, Republican policies have sent insurance markets into chaos, provoking skyrocketing premiums that have caused insurers to leave our state and left many of my patients facing skyrocketing premiums and deductibles. No family in the United States should be put in a position of having to decide whether to provide health insurance for their children or putting food on the table. As a nation, we must do better, and stabilizing insurance markets is the first step we need to take to begin bringing costs down.
- Reinstate individual responsibility for health coverage – if we can mandate auto insurance for drivers, we certainly can reinstate the requirement that people have health coverage if we provide affordable options.
- Implement a permanent reinsurance program onto healthcare exchanges.
- Restore cost-sharing reduction payments to health insurers to bring insurance premiums down, while increasing premium subsidies to help consumers afford insurance.
Protecting People with Pre-Existing Conditions
As a person with my own pre-existing condition, I understand on a personal level what it means to worry about getting health insurance. Every decision from which job I could take to where I could live depended on whether I would have access to health insurance and high-quality care. In the 8th District, 300,000 people with pre-existing conditions must worry about health insurance.
Women, people with pre-existing conditions, and older Americans shouldn’t pay more or be denied coverage altogether just because they’re female, sick, or above a certain age. Consumers need to know that they can buy health insurance coverage and that it will be there when they need it.
- Reinstate rules outlawing discrimination against women, older Americans, and people with pre-existing conditions.
- Protect consumers from sham insurance by eliminating proposed federal rules that undermine guarantees consumers need to get coverage.
- Restore individual responsibility for coverage to nullify the lawsuit brought by Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimel that the Trump administration is using to undermine pre-existing protections.
Lowering the Costs of Care
The fact is, for too many 8th District families and businesses, healthcare has become too expensive, inefficient, and unaffordable. As a pediatrician, I’ve devoted my career to providing care to families in my district. I can’t do my job when my patients can’t afford the medication they need. As a patient with Type 1 diabetes, I know what it’s like to depend on medication and have to worry about rising costs. One of the most egregious cost issues facing our healthcare non-system is inflated prescription drug prices. And compounding that is the lack of transparency in pricing throughout our medical system.
Prescription drug prices
I know what it’s like to worry about the cost of medications. The price of the insulin that I use rose from $40 per bottle 20 years ago to $260 now. It’s the exact same bottle. Nothing has changed, but our healthcare system has allowed the price to increase by more than 600%. This hits all of us. Thirty of the most prescribed prescription drugs have more than doubled in cost over the past five years.
The pharmaceutical industry is one of the most profitable in the world, largely because of the already-high and rising prices they charge for prescription drugs. The federal government uses our tax dollars to support around 30 percent of prescription drug R&D. In a country where our tax dollars are going to help these companies create drugs, no taxpayer should be unable to access these drugs because of prohibitively high prices. Instead, patients are being left untreated, while our tax dollars are boosting big pharma’s bottom line. There needs to be more transparency in pharmaceutical pricing, the cost of research, and the overall net company profits. And we need to end the pay-to-play culture in the nation’s capital, where drug companies shower millions of dollars on members of Congress to keep them right where they want them – voting for loopholes and special deals for big pharma instead of holding them accountable.
- Break the monopoly power of drug companies by allowing Medicare and Medicaid to negotiate lower drug costs for patients.
- Require drug companies to provide the same drugs at the same prices negotiated by Medicare, Medicaid, and the VA to all Americans covered by public programs and private insurance.
- Expand access to generics, including speeding generics to market, accelerating the generic review systems by the FDA, and allowing pharmacists to fill prescriptions with biosimilar generics.
- Require drug corporations to disclose how they set prices if a drug is invented using taxpayer funding.
- Disclose secret deals made by pharmacy benefit managers who run prescription drug insurance programs.
- Create pricing guidelines for drugs developed using taxpayer-funded research.
- End direct to consumer pharmaceutical advertising.
- End prescription discount cards that incentivize the use of name brand pharmaceuticals over generics, and escalate costs for consumers.
Improving Price Transparency
As consumers, we would never make a large purchase without reading reviews and comparing costs. Healthcare should be no different. A knee surgery in one hospital can cost thousands of dollars more than the same operation at a hospital five miles away. Patients need to understand the full costs of operations and treatments. Healthcare is the number one cause of bankruptcy in the U.S., and this trend will continue as long as we don’t improve transparency into costs for consumers.
Provide consumers with the transparent cost of hospital visits so that patients can accurately understand and plan for the costs of treatment.
Expand healthcare patient navigator programs.
Encourage payers and providers to work together to improve transparency.
Solving the Healthcare Issues of Tomorrow
Investing in Medical Research
The United States is a leader in medical research, including right here in Washington state. But over the past decade, we have seen sustained assaults on federal funding for R&D. Our federal research agencies, which are and should continue to be world leaders in healthcare innovation, are too often targets for budget cuts. We need to recognize the important role of federal R&D to fill in gaps left by private sector research and to cure some of today’s most costly diseases.
- Provide funding to federal research agencies, including NIH, CDC, and NSF to ensure these agencies have the resources to conduct cutting-edge research to solve the problems of tomorrow.
- Support grant programs for research at universities, including our world-class research institutions here in Washington state.
- Increase federal funds for research on addiction and treatment for opioid addiction, to identify and develop evidence-based solutions.
Combating the Opioid Epidemic
The opioid epidemic is a national tragedy. Over 66,000 people died from overdoses in 2017, and we’re seeing this generation’s life expectancy shortening because of opioid overdose deaths. Central Washington Hospital now sees about ten opioid-related emergencies each day on average. This hits every corner of our society, and we see this crisis in every part of the 8th District.
- Recognize opioid addiction as a chronic disease and require that insurance companies treat it as such.
- Invest in counseling and data-driven rehabilitation policies including long-acting opioids.
- Create incentives for medical students to pursue specialties in pain management.
Empowering Women through Healthcare
I am proud to be endorsed by Planned Parenthood and EMILY’s List because they know that I will be a champion for women’s healthcare and reproductive rights. We’re seeing repeated attacks on women’s healthcare, from Donald Trump’s gag rule that prevents doctors from sharing full medical information with their patients to the expansion of fake clinics that spread misinformation and manipulate women. Now, with Justice Kennedy’s retirement, we’re likely approaching a reversal of Roe v. Wade. Donald Trump has promised to nominate judges who will overturn Roe v. Wade, putting women’s lives and health at risk. It is more critical than ever that we send pro-choice champions to Congress to stand up against these attacks and keep our country from sliding backward.
As a woman and as a doctor, I know just how dangerous attempts to restrict access to family planning care are. Women still face huge medical risks during pregnancy and childbirth. The United States has the highest maternal mortality rate of any industrialized country in the world – and that rate is rising. We need to invest in women’s healthcare and ensure that every woman has access to and coverage for comprehensive family planning services.
We need to support Planned Parenthood and allow it to expand services to women across the country. Planned Parenthood does a better job than any other medical facility in making sure that women get access to affordable, safe, effective family planning. In rural areas, Planned Parenthood is often the only medical provider. In fact, in one out of every five areas served by Planned Parenthood, there is not a local Federally Qualified Health Center to serve them.
- Ensure the privacy rights of all women to make healthcare decisions within the confines of the doctor-patient relationship without political interference.
- Reverse the Trump administration’s gag order on doctors receiving Title X funding.
- Ensure all health insurers cover all forms of contraception at zero cost to patients.
- Fully fund Planned Parenthood, and fight all attempts to undermine Planned Parenthood’s services.
- Repeal the Hyde Amendment, so that every woman in the United States has access to her full range of reproductive options.
Women’s health overall deserves special attention, and research should consider gender in all studies. Medications may work well for one gender and not the other.
Rural Healthcare Access
Here in the 8th District, we experience a shortage in rural healthcare providers on the eastern side of our district. The Association of American Medical Colleges (AAMC) predicts Washington state will face a shortage of 3,000 to 4,000 doctors and 24,000 registered nurses over the next 10 to 15 years, and most of that shortage affects rural areas in Eastern Washington. While Seattle and its suburbs have more than 11 primary-care physicians per 10,000 residents, the area covering Grant, Chelan, Okanogan, and Douglas counties has just over six. That means in these rural counties there are more than 1,500 potential patients per doctor.
- Support rural medical education programs at UW and WSU medical schools to train more students to practice in rural areas of the state.
- Create additional incentives for recent medical school graduates to practice in rural areas of our state.
- Promote telehealth services and infrastructure, including allowing telehealth services to be provided across state lines.
- Allow alternative provider types to practice in underserved rural areas, including traveling clinics and physicians.
- Support J-1A Visas and H-1B visas, allowing foreign workers to fill healthcare gaps in rural areas.