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What Will This Multimillion Dollar North Carolina Hospital Merger Mean for Rural Health Care?

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Highlands-Cashiers Hospital in Highlands, North Carolina. Photo: Taylor Sisk/100 Days in Appalachia

On December 13, a full page ad in the Highlands Newspaper, in Highlands, North Carolina, was headlined: “Bringing a new state-of-the-art Angel Medical Center. Investing in the future of healthcare in western North Carolina.”

The ad was purchased by Nashville, Tennessee-based HCA Healthcare, a for-profit hospital system that owns 178 hospitals in 20 states.

While heartened by the prospect of such an investment in health care services in Macon County – a rural county with a population of about 34,000 situated in the southwest corner of the state  – a discerning reader might have found this assertion a little premature. A multimillion dollar deal for HCA to buy a health care system that includes six hospitals in Western North Carolina, including Highlands-Cashiers Hospital in Highlands and Angel Medical Center in nearby Franklin, has yet to be approved by the state’s attorney general.

For communities in rural counties such as Macon, investment by a large hospital system could mean expanded access to next-generation health care. But some worry that given the pressures of the industry, that large corporation may see no future in providing services in their community, and pull out. They worry that decisions will be made without their input.

‘We built it’

It takes a good while to get anywhere from Highlands.

The town rests on a plateau within the Nantahala National Forest, and though the county seat of Franklin is just 20 miles away, the first leg of that journey is down a serpentine two-lane through the Cullasaja Gorge. Highlands is home to less than a thousand residents in the winter; quite a few more in the summer.

Highlands, North Carolina, Mayor Patrick Taylor. Photo: Taylor Sisk/100 Days in Appalachia

Ask Mayor Patrick Taylor what Highlands-Cashier Hospital means to his community. His reply: “Everything.”

The hospital opened in 1951, expanded in 1966, and expanded again and relocated in 1993, all with considerable community investment.

“It’s our hospital,” Taylor asserts. “We built it.”

Six years ago, succumbing to the pressures of a changing health care landscape in the U.S. – to rising costs and the push to consolidate – the hospital’s board elected to affiliate with Mission Health, an Asheville-based not-for-profit health care system – the only one managed in Western North Carolina. Mission administrators say the same pressures have pushed them to look for a larger health system to take over operations, most particularly the challenges of providing services in remote areas.

“I understand; we’re a small market,” Taylor says. “I understand the dynamics of what’s going on, the market forces.” He just doesn’t want to lose his hospital.

The Deal

It was announced in August that HCA had come to terms to purchase Mission Health, which owns and operates a large hospital in Asheville and five smaller ones throughout mostly rural Western North Carolina. But the deal must first be approved by North Carolina Attorney General Josh Stein.

The agreement calls for a $430 million commitment from HCA in capital expenditures.

Such investment comes as good news for Western North Carolinians, as does, at least in theory, the announcement of a $1.5 billion foundation called the Dogwood Health Trust that will manage the proceeds of the sale. The foundation will include a governing board made up of members appointed by Mission, with the goal to improve the health and well-being of the communities Mission Health now serves.

But a number of rural residents throughout the region are intent on seeing to it that the deal doesn’t shape up to be Asheville-centric. Asheville, with a population of 90,000, is the hub of Western North Carolina and home to Mission’s flagship medical center, Mission Hospital. None of the counties that are home to Mission’s regional hospitals have a town of more than 10,000.

Rural residents are asking that this deal be of benefit for years to come for the whole of the region – that health care services in their more remote communities don’t get lost in a megadollar transaction.

On its website, Mission offers this assurance: “Understanding the unique, special needs of our patients, particularly those in remote and rural areas, we look forward to the possibility of expanding access and accelerating improvements while gaining efficiencies.”

“I know my friends at Mission think I’m against this,” Taylor says. “I’m really not against it; I just want to be sure it’s done right. And as soon as this is approved, I will certainly want to support everything we can do to make sure it’s successful.”

“I just think it’s healthy for the public to have a discussion about these issues,” issues that include assurances for access to care in his community, Taylor says.

Attorney General Stein has assured Taylor and his neighbors that he has their best interests in mind. Before approving the deal, Stein told the Asheville Citizen-Times, “I want to clarify and strengthen HCA’s commitment in terms of its delivery of medical services and…keeping the rural hospitals open.”

The Pressures

Taylor’s concerns over access aren’t unfounded. These are tenuous times for health care services in rural America. In September, the U.S. Government Accountability Office reported that between 2013 and 2017, 64 rural hospitals closed, more than double the rate of the previous five years.

Making it as an independent is increasingly difficult. Researchers at the North Carolina Rural Health Research and Policy Analysis Center write that rural hospitals face Medicare reimbursement cuts if they’re unable to meet quality and technological standards, but often don’t have the capital to make the necessary improvements.

The researchers also point out that patients at small, rural hospitals tend to be relatively older, poorer and sicker, with a higher percentage covered by Medicare or Medicaid or who have no insurance at all.

Merging with a larger hospital or system is often the only alternative to closure.

Further, a recent study from the Colorado School of Public Health found that hospitals in states that haven’t expanded Medicaid, as allowed for under the Affordable Care Act, are six times more likely to close than those in states that have. The North Carolina Legislature has thus far elected not to expand Medicaid.

One more source of concern for Western North Carolina’s rural residents: The Government Accountability Office found that while only 11 percent of rural hospitals in the country are owned by for-profits, 36 percent of those that closed in that five-year period were for-profit owned.

HCA is a for-profit corporation.

The Potential

Rowena Buffett Timms, Mission’s senior vice president for government and community relations, is sensitive to these concerns, but says she firmly believes that HCA has no desire to come into the region and close rural hospitals. HCA, she says, is “very excited about this hub-and-spoke of a very healthy health system in Western North Carolina.”

Historically, HCA is “used to going in and buying hospitals that are very close to being closed.”

“This is a new business model for them,” Timms says. “To come in and dismantle would not really be supportive of what I believe they are trying to achieve in this very exciting new business model.”

HCA, she says, sees “the work that we do in quality, the outcomes, how we drive those concepts into rural communities…They see that potential.”

Taylor and others feel that Mission has a responsibility for how that potential unfolds.

Jay Nixon, a former governor and attorney general of Missouri, has been brought in as a consultant by citizen groups. Nixon previously challenged HCA in the courts, claiming the corporation did not live up to the terms of its contractual agreement to make capital improvements at hospitals the company purchased in the Kansas City area. Last year, the state won that lawsuit.  

“Mission is a nonprofit, and has built up a significant value, obviously, as laid out by the transaction that’s on the table now,” Nixon says. It has “an ongoing responsibility for health care in that region.”

That responsibility, he says, “has been vested in them through their nonprofit status with the state.”

“I just think these hospitals are extremely important in these smaller communities,” Nixon attests. “They are not only an employer, they are also an asset that makes it easier to attract and keep businesses and families. So, I get very concerned about transactions of this nature where you don’t have long-term ironclad guarantees that the facilities and services will remain open.”

The AG’s Concerns

Attorney General Stein has expressed three fundamental concerns with the agreement as it stands: Are there sufficient provisions to ensure the continuation of certain services, is the $1.5 billion price tag enough and will the board tasked with managing the money represent the diversity of the region?

“The people of Western North Carolina have been investing in these hospitals for decades and they should benefit from all the value that has been accrued over time,” Stein said.

Highlands Mayor Patrick Taylor traveled to Raleigh to meet with Stein’s office, and he’s confident that his neighbors’ concerns are being heard. One provision in particular that Taylor would like to see included in the final agreement is that if HCA should decide to close a hospital, the attorney general’s office must be informed, must be given a justification and would have oversight to review why HCA believes it’s necessary.

The town of Highlands passed a resolution in September asking that the agreement stipulate that if HCA should undertake to sell Highlands-Cashiers Hospital, the community would be given notice and a local entity would be offered the first opportunity to buy it back. Taylor and his colleagues recognize that they wouldn’t be able to make a go of it as an independent. They’d have to then find another partner.

“But if we don’t have that option,” he says, “we have a real clear danger of not having any health care access here after all that money and everything has been put into it.”

Taylor’s best-case scenario is that HCA “would come in and invest in services and be creative in remaking the hospital.” He notes that HCA has hospitals in Florida where they could provide reciprocal services for many of Highland’s seasonal residents.

That full-page ad in the Highlands Newspaper states that HCA plans to “invest region-wide to meet the future health needs of western North Carolina. Our promise: the best healthcare for your family – sooner and closer to home.”

Taylor hopes very much that this ideal scenario is realized, “and I hope that people will look at this old mayor…they’ll look at him and say, ‘What was he worried about? This turned out great.’

“I hope that’s the case.”

This is the first story  in a two-part series about the sale of North Carolina’s Mission Health to the national HCA Healthcare. Read the second part of the series here.

Rural Health Care

After Adding Telehealth in VFW Posts, Veterans Health Administration Now Puts Sites at Walmarts

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Photo: Kathy Swendiman/ Flickr. Creative Common

The Veterans Administration is still on shaky ground with medical appointment wait times. Officials say new telehealth facilities will help improve veterans’ access to healthcare.

First came VFW posts. Now the Veterans Administration is adding telehealth facilities at selected Walmarts.

The VA cut the ribbon on an appointment space in a Walmart in Asheboro, North Carolina, in December. Walmart donated the equipment and space at five sites across the country, which are part of the Accessing Telehealth through Local Area Stations program, or ATLAS. Other locations are slated for Wisconsin, Michigan and Iowa.

In August, the VA announced that it was teaming up with Philips, a health technology corporation, to create diagnostics rooms for rural VFW posts to provide similar telehealth meeting rooms. Those rooms, located in Linesville, Pennsylvania; Los Banos, California; and Eureka, Montana, were created with the help of veterans at those posts.

“There are no masses of population out here,” said Ray Andel with the Veterans of Foreign Wars Post 7842 in Linesville. “We’re out in the middle of nowhere.”

Linesville had a population of 997 in 2017 and is in the northwestern corner of the state, just miles away from the Ohio border, an hour and a half drive to Cleveland.

Members of the VFW post were part of the design phase of the project when representatives from Philips brought a mock-up of the proposed telehealth room to the post for veterans to use and give feedback. Similar sessions were set up in Los Banos and Eureka.

Andel said Linesville was chosen because of the lack of internet access in the area, as well as the weather in the area that can affect people’s ability to travel.

Veterans were at first skeptical of the program.

“Those here who started this were really resistant to change, but after they saw its capabilities, they really got on board fast,” he said.

In fact, he said, many of his colleagues at other VFWs were hesitant to join the program.

“The VA mentioned that there was this program and that it needed volunteer posts to be pilot sites,” he said. “Not a whole lot of people thought this was really going to take off. But I thought it would be a great thing to be a part of.”

The facility includes a room where veterans can communicate via a video hookup to a healthcare provider in another locations.

“There’s a camera in the room with a high-resolution lens,” Andel said. “It can look at the blood vessels in your head and tell you some of your health statistics. It can tell you your breathing rate by watching your chest move. It’s really amazing stuff.”

Andel said he envisions the technology progressing further.

“We’re in the age of the Internet of Things,” he said. “I can envision a time when if you need your blood pressure taken, you’d open up a door and there’d be a cuff right there that you could put on,” he said. “This is just the beginning.”

The VA estimates that nearly 5.2 million veterans, or about a third, live in rural areas and have to travel long distances to access care at a VA hospital. That’s up from 5 million veterans living in rural areas in 2017, according to the U. S. Census Bureau.

The Veterans Administration has faced harsh congressional criticism for wait times for veterans to get in to see VA healthcare providers. A controversy erupted in 2014 when information from a whistleblower revealed systematic lying about appointment wait times at some Veterans Health Administration facilities. In 2019 a representative of the General Accounting Office said record-keeping on wait times had improved but was still unreliable.

For veterans near Eureka, Montana, telehealth may offer one way to get to the doctor more quickly.

“We’ve got the thing called grapple – it’s not snow, it’s not ice, it’s not rain, but it’s like trying to drive on ball bearings,” said Rick Weldon, VFW Post 6786 Commander in Eureka. “There’ no taxi service. There’s no bus service, so how do you get them to their health appointments?”

Just nine miles from the Canadian border, Eureka veterans previously had to travel 256 miles to get to the closest VA Medical Center.

Telehealth centers, like the ones at VFW posts and Walmarts, will bridge that divide, said Deborah Lafer Scher, an executive advisor to the U.S. Secretary of Veterans Affairs who leads the Veterans Affairs’ Center for Strategic Partnerships.

“The VA has a mission to deliver best-in-class service to veterans everywhere,” Scher said in a press statement. “By connecting rural veterans with help from partners like Philips, we will continue to exceed the care standards for our nation’s heroes. Telehealth expansion is truly the next frontier for VA Healthcare.”

But Richard Stevenson, a Vietnam Vet and member of VFW Post 9899 Summers-Hodgins in High Point, NC, said he probably wouldn’t go to the Walmart Asheboro ATLAS site.

“I’ve heard about it. One of the boys here just passed away and he did the telehealth thing,” Stevenson said in an interview with Daily Yonder. “I’d rather just go to the doctor, but if I had to do it that way, I guess it would be OK.”

Stevenson said his house was only 9 miles away from a VA facility – closer than traveling to the Asheboro Walmart more than 20 miles away.

“I can be in the VA in 15 minutes,” he said. “Most of the people who have trouble accessing the VA are located out west in western NC, I think.”

Gina Jackson, spokesperson in the VA’s Office of Public Affairs, said the Asheboro location was chosen because of the number of veterans in that area.

“Asheboro is at the center of the state with the fourth highest number of veterans in the country—there are 10,000 Veterans in Randolph County and 1,600 Veterans in Asheboro,” she said via email.

Other Walmart ATLAS sites will be located in Boone, North Carolina; Fond du Lac, Wisconsin; Howell, Michigan; and Keokuk, Iowa.

Walmart said it welcomes the partnership. The company has set aside space for veterans to meet with providers in a private space connected by television monitors. Different services are available at different locations, but many include primary care, nutrition counselling, mental health services and social work. Asheboro is the pilot program, but the program will expand to five sites total.

“As both a veteran of the Air Force and a father whose son and son-in-law are serving, I know firsthand how important support and access is for our military, especially when it comes to health care,” Daryl Risinger, chief growth officer for Walmart U. S. Health and Wellness, said in a statement. “Walmart is committed to making quality health care affordable and accessible and is working with VA to expand its ability to serve Veterans through technology. This is another way we are helping our communities live better.”

The VA says it provided 490,000 veterans with access to providers through more than one million “video telehealth encounters” in the last fiscal year.

The article was originally published by the Daily Yonder.

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Homelessness And Health Costs: This Kentucky Mom Faced Cancer While Living In Her Car

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Kristi Reyes now spends time with her grandson in her new home. Photo: Mary Meehan/Ohio Valley ReSource

This article was originally published by Ohio Valley ReSource.

Cancer was what finally pushed Kristi Reyes into living in her car.

The mother of four had worked all her life, starting at age 7 when she helped out at her family’s furniture store. Most of her work was in retail. It was paycheck-to-paycheck but she kept her kids together and a roof over their heads.

But then in 2012, she was diagnosed with breast cancer. She started cycling through jobs because of the time she needed to take off for recovery from treatment. Soon, she was too sick to work at all and things continued to slide. She had Medicaid, what she calls a medical card, but it wasn’t enough.

“Even though I had a medical card, there were out of pocket things that medical didn’t cover,” she said. “I don’t care how much money you make,” she said. “Money is never enough when you’re sick like that.”

She and three of her children, who were ages 11, 13 and 15, all stayed in the car for a while. But soon she was forced to let her children live with other people.

She remembers recovering from surgery to remove cancerous lymph nodes, homeless and alone. Eventually, she was too sick for treatment to even continue.

“I couldn’t even walk up a flight of stairs without being out of breath, almost needing oxygen,” she said. Her diabetes was out of control. She was also having trouble with her kidneys.

But she said she knew other people who had it worse.

“At the same time, I think that was kind of something that kept me going. Right? Like knowing that somebody had it worse than I did.”

At least, she said, she had a car.

Housing and Health

In fact, her case is not unique. The National Alliance to End Homelessness estimates there are 15,000 people experiencing homelessness in Kentucky, West Virginia and Ohio. Many more are living on thin financial margins. The Robert Wood Johnson Foundation reported earlier this year that half of rural Americans say they could not afford to pay an unexpected bill of $1,000, and nearly a third say that they have had trouble paying medical bills.

Jessica N. Sucik directs homeless services for HealthFirst Bluegrass, a federally qualified health center in Fayette County, Kentucky. HealthFirst serves 25,000 patients, many of them poor. It also runs two health clinics for the homeless.

Jessica Sucik of HealthFirst Bluegrass. Credit: HealthFirst Bluegrass

She said there is a saying in public health that “housing is healthcare.”

Just the nature of chronic illnesses such as diabetes or COPD can limit how much people can work. 

“So they know they can’t work permanently, 40 hours a week,” she said. “They’re working as they can, but they also can’t afford housing or whatever treatment they need to overcome their condition.” 

Circumstances can change quickly. 

“With chronic medical conditions, something temporary can very, very quickly turn into a permanent homelessness status,” she said.

That leads to challenges paying the bills. It can be an unrelenting cycle.

“Without that, it’s like, you know, building a house on sand,” she said. ”You have to have that safety and that security blanket of safe, stable and affordable housing before you can take care of yourself and be able to meet your needs.”

In recent years, HealthFirst has adopted a team approach with all patients. There is a medical provider, a social worker, a case manager and a psychiatrist to provide medical, psychological and social support instead of leaving patients to fend for themselves.

“The magic that happens when you address not just the physical health issues, but also the things that are preventing them from getting those physical health issues addressed, is really, that’s where it’s at,” she said.

Graphic: Alexandra Kanik/Ohio Valley ReSource

Policy Solutions

But others say homelessness or personal bankruptcy due to medical costs point to a need for more systemic change.  

One policy solution gaining traction among Democratic presidential candidates is Medicare for All, a proposal that would eliminate private health insurance and replace it with a government-run system. Leading contenders Sen. Elizabeth Warren and Sen. Bernie Sanders support such a proposal. 

rural-homeless-rent-burden-map-v3
Graphic: Alexandra Kanik/Ohio Valley ReSource

Warren estimates her proposed plan would cost $20.5 trillion above expected health care costs over 10 years. She says that could be paid for largely with an increase in taxes on the top income brackets and through savings in medical costs, but that claim has met some skepticism from policy experts. Sanders has been less specific about the costs and has said his proposal would find savings through cutting administrative costs. 

The Urban Institute has estimated that a switch to a single-payer system would require $59 trillion over 10 years, about $7 trillion more than the costs under the current system.

Dr. Steffie Woolhandler is co-founder of the advocacy group Physicians For A National Health Program, which argues for a single-payer system. Her group says research shows more than 60 percent of personal bankruptcies are tied to medical bills. She says a single-payer system can reduce costs and relieve families from going into debt, which is why many other countries have such a system.

“Virtually every other developed country guarantees health care to everyone living there,” she said. “This is true in Europe, it’s true in Canada, and it’s true in Australia. The United States is an outlier.”

She said the idea is gaining appeal in the U.S.

“What I’m seeing, really since 2016, is that the idea of Medicare for all has become an issue with non physicians and a lot of people who don’t work in health systems but are users of that healthcare system are actually talking about Medicare for All,” she said.

rural-homeless-care-category
Graphic: Alexandra Kanik/Ohio Valley ReSource

A Kitchen Table

Reyes doesn’t spend a lot of time considering such policy decisions. Taking care of herself and her family is about all she can handle. 

For about four years from the time she was first diagnosed with cancer, she was struggling to keep her employment, living mostly in her car, and separated from her children. 

She tried from time to time to get into a shelter but whenever she’d reach out, they were full.  One day, she said, she couldn’t take it anymore.

“I was at my wit’s end. Like I didn’t know what else to do. I was tired, worn out. My body felt like I couldn’t handle it anymore,” she said. “Honestly, I just started praying.”

Finally, she found help and a new home. 

She called the Salvation Army and was referred to the Housing and Homeless Coalition of Kentucky. Within two months, she was off the street.

Last year, she moved into a house in Frankfort, Kentucky, where she lives with her children, two grandchildren and her boyfriend. Because of her ongoing medical problems she has been approved for lifetime housing assistance and resumed her cancer treatment. 

“That made it even better. Because I know no matter the struggles of my health, or the battles that I got to fight with it. I’m always going to have that support.”

About a month ago, she was well enough to start working at a Subway sandwich shop.

A simple, second-hand dining room table is her favorite place to be.

“That’s the thing, that’s my thing,” she said with a laugh. “Because I can come in, I can cook for my children. And we can sit at the table and have a meal together.”

Looking back, she said, she realizes now that she was in denial about just how bad her health was. And she hopes other people will take some comfort in knowing things can change for the better. 

“You just have to tell yourself, ‘OK, I’m not going to give in today,” she said. “You know, people just need to know that just because you’re going through things, it doesn’t necessarily mean that you’re going to be stuck there for a lifetime.”

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Medicare for All, Most, Some? How Far Will Rural Voters Go with a Public Option?

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A Medicare for All rally in 2017. Photo: Molly Adams/ Flickr, Creative Commons

The healthcare debate among Democratic candidates highlights a fundamental question within the party about the proper role of government. Rural voters will have a hand in helping determine which direction the Democratic Party takes.

Medicare for All. Medicare for Most. Medicare for Some. Medicare at 50.

Democratic presidential candidates are offering a range of ways to structure a mandatory or optional public health insurance program. With rural voters, the challenge may be creating a policy that goes far enough without going too far.

Fifty-five percent of rural voters favor a Medicare for All plan, according to a July Harvard/Harris poll. But other rural residents, like Iowa farmer Ron Rossman, think a mandatory program would go too far for the rural voters he knows.

Rossman equated Senator Bernie Sanders’ Medicare for All proposal (also supported by Senator Elizabeth Warren and entrepreneur Andrew Yang) with socialism. “With health care and all that, socialism early in my lifetime was associated with communism, and we grew up with all that kind of thinking,” Rosmann told Senator Warren, according to the Chicago Times. “Rural people have long memories.”

Veteran political reporter David Yepsen, host of the “Iowa Press” TV, said Iowa is a good place to see how various healthcare proposals go over with rural voters.

“What you’re seeing here is a good microcosm of an argument going on in the Democratic Party all over the country,” Yepsen told the Chicago Times. “They’ve got to find candidates who can do better in rural areas. Now, do you do that with a moderate message or a more progressive message? That’s still to be determined, and Iowa is a good place for that type of testing ground.”

So what do the various public-option proposals mean?

The plans can be broken down into five different options:

  • Medicare-for-all – a single-payer program for all U.S. residents, which would move all Americans to a government-run health insurance program.
  • Medicare for America –a national health insurance program that keeps private insurance and would allow U.S. residents opt-out of the national plan with qualified private coverage.
  • Medicare-X-Choice – the existing Affordable Care Act altered to offer coverage individuals could opt into.
  • Medicare at 50 – Medicare coverage for U.S. residents starting at age 50
  • Medicare State Option – a buy-in option approved by individual states that would offer coverage through the Affordable Care Act marketplace.

Since the 2016 election, the idea of Medicare for All, or single-payer healthcare, has expanded to include several other options that would transition the country into a system that allows for expanded healthcare coverage.

Sen. Bernie Sanders (I-Vt.) introduces the Medicare for All Act of 2017. Photo: Public Citizen/Flickr, Creative Commons

Several members of Congress have submitted bills that would reflect these options. Most notably, Sanders’ bill would create a national health care system paid for by taxes that would replace all private insurance, Medicare and Medicaid and Children’s Health Insurance Program, or CHIP benefits. Sanders pointed to the current system as broken and needing to be replaced with something that would provide health care for every American.

“It is unacceptable to me and to many Americans that 87 million people in the United States are uninsured or under-insured,” he said in a policy statement on July 17. “Americans pay twice as much per capita on healthcare than any other country while our life expectancy continues to go down and our healthcare outcomes lag behind other major countries.”

Sanders’ plan is supported by Warren and tech entrepreneur Andrew Yang. (Sanders’ proposal became a flash-point differentiating candidates’ approaches during the September 12 debate.) All three candidates say Medicare for All is the only way to ensure Americans have access to healthcare, and view healthcare as a right, as opposed to an option.

And at a town hall forum on CNN this year, Warren said it would be, and should be, the least expensive option, “What’s key is to get everyone to come to the table on this … and to figure out a way to get medical coverage for everyone at the lowest cost possible.”

For Yang, the issue is one of ensuring that the healthcare system is working for Americans and not bankrupting them even if they have insurance.

“Access to quality healthcare is one of the most important factors in overall well-being, and yet America is one of the few industrialized nations not to provide healthcare for all of its citizens,” Yang’s campaign website says. “Through a Medicare for All system, we can ensure that all Americans receive the healthcare they deserve. Not only will this raise the quality of life for all Americans, but, by increasing access to preventive care, it will also bring overall healthcare costs down.”

Other candidates support a Medicare for All option, but also would support rethinking the whole healthcare system in America. These candidates vary wildly in their support of alternative pieces of legislation, and other ideas for the system. Some advocate lowering the age for which Americans qualify for Medicare to 50. Others say individuals and companies should have the option to buy into Medicare.

At the “Linking Together: March to Save Our Care” Rally at the U.S. Capitol on June 28, 2017, Sens. Kamala Harris and Cory Book, along with other Democratic leaders, rallied to support the Affordable Care Act and criticize Republican Party efforts to repeal Obamacare. Photo: Mobilus In Mobili/Flicker, Creative Commons

Senator Cory Booker (D-NJ) and Kamala Harris (D-CA) have endorsed many different plans.

On its website, Booker’s campaign said “Cory believes that health care is a human right and that Medicare for All is the best way to safeguard that right for every American. On the path to Medicare for All, we must act with urgency for people across the country who need quality, affordable health care. This plan will immediately address one part of the broken system as we move toward guaranteed health care for all Americans.”

But his stance has also been that he supports all the legislation previously introduced, and would be willing to entertain systems that provide Medicare for Most.

Harris said on her web site a new healthcare system should be based on the current Medicare system, as it’s a system that’s accessible for all Americans.

“Kamala’s plan for Medicare for All expands on the progress made under Obamacare, immediately offers an improved Medicare buy-in, and transitions the country to a Medicare system we are all in so that we can take on insurance and drug companies. Her plan will reduce costs, keep options for public or private Medicare plans, and ensure a smooth transition,” her campaign said on its web site. “Medicare works. It’s popular. Seniors transition into it every day, and people keep their doctors and get care at a lower cost. Let’s not lose sight that we have a Medicare system that’s already working.”

South Bend, Indiana, Mayor Pete Buttigieg said he would like to see a “Medicare for All Who Want It” plan.

“The health care system we have today is both unjust and inefficient. For the first time since World War I, life expectancy is falling. If you’re uninsured, you’re paying too much for health care. If you’re insured, you’re still paying too much. This burdens hard-working families, especially in communities of color, the most. Other developed countries provide universal coverage for less than what Americans currently pay — and with better results. The American people should not have to settle for less,” Buttigieg’s campaign said on its web site. “This plan makes a Medicare-type public option available on the exchange and invites people to buy into it: if corporate insurers don’t lower costs to deliver something dramatically better than what is available today, competition will create the glide path toward Medicare for All.”

Former Housing and Urban Development Secretary Julian Castro said that while he supports Medicare for All, he doesn’t think we should eliminate private insurance completely, instead giving Americans the option to buy into Medicare or private insurance if they choose to do so, depending on what the final system is the winner. Castro hasn’t specifically endorsed any of the options presented as solutions to healthcare coverage, but has said that he feels healthcare should be a right for Americans.

Beto O’Rourke, the former Texas Representative, said that he would support Medicare coverage through private insurers, as well as allowing people the option of buying into Medicare.

“We need universal, guaranteed, high-quality health care so that every single American is healthy enough to go to school, work a job, start a business, raise a family, and live up to their full potential,” O’Rourke’s campaign said on its website. “Each day that we fail to deliver on that promise is another day that Americans will be forced to split their pills, to postpone seeing a doctor, to make the impossible choice between paying rent or paying their premiums. Beto’s plan would dramatically reduce out of pocket expenses and eliminate deductibles for Medicare participants—and it would ensure everyone who wants to enroll in Medicare can do so, without eliminating employer-sponsored insurance. That’s because Beto believes health care—including reproductive and mental health care—is a right, not a privilege.”

The last of the three candidates who debated on September 12th has supported keeping the Affordable Care Act as a way to provide more healthcare coverage to Americans.

Former Vice President Joe Biden said he supports taking the existing law and fixing it as a pathway toward universal coverage.

“Because of Obamacare, over 100 million people no longer have to worry that an insurance company will deny coverage or charge higher premiums just because they have a pre-existing condition – whether cancer or diabetes or heart disease or a mental health challenge. Insurance companies can no longer set annual or lifetime limits on coverage. Roughly 20 million additional Americans obtained the peace of mind that comes with health insurance,” Biden’s campaign said on its website. “As president, Biden will protect the Affordable Care Act from these continued attacks. He opposes every effort to get rid of this historic law – including efforts by Republicans, and efforts by Democrats. Instead of starting from scratch and getting rid of private insurance, he has a plan to build on the Affordable Care Act by giving Americans more choice, reducing health care costs, and making our health care system less complex to navigate.”

Senator Amy Klobuchar (D-MN) agreed.

“Amy supports universal health care for all Americans, and she believes the quickest way to get there is through a public option that expands Medicare or Medicaid. She supports changes to the Affordable Care Act to help bring down costs to consumers including providing cost-sharing reductions, making it easier for states to put reinsurance in place, and continuing to implement delivery system reform. And she’s been fighting her whole life to bring down the cost of prescription drugs,” her campaign said on its website.

While the plans vary, most all of the major candidates agree that medical insurance coverage for all is an important issue that must be addressed by the federal government.

This article was originally published by The Daily Yonder.

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