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Sarah Varney, Kaiser Health News
Sarah Varney, Kaiser Health News
Health care continues to be a top political issue. While some congressional Democrats consider universal health coverage, state and local governments are already pushing ahead with proposals to corral costs and broaden access to care, including for the undocumented. Special correspondent Sarah Varney shares stories from California and New York, two states pursuing ambitious health care agendas.
Democrats in Washington are making health care a top priority. And calls for Medicare for all or some form of universal health coverage are growing louder.
But, as special correspondent Sarah Varney reports, Democratic governors and mayors aren't waiting. They are pushing ahead with urgency, signing executive orders and unveiling proposals to corral costs and bring health care to those who remain uninsured.
California Governor Gavin Newsom laid out some of his ideas in his State of the State speech last night.
Our story begins in California, and was produced in collaboration with our partner Kaiser Health News for our weekly series on the Leading Edge of science, health and technology.
Sandra Yamileth Lopez works at one of San Francisco's most celebrated bakeries, Tartine. She fled horrific violence in Honduras and applied for asylum in California. She can work legally, but, like many new immigrants, it will be years before she's eligible for Medicaid or federal health insurance subsidies.
So, she enrolled in Healthy San Francisco, a pioneering program that guarantees health care to any uninsured city resident. Lopez says she can live her life again.
Sandra Yamileth Lopez:
I often dreamt about what had happened to me. So they tried to give me sleeping pills and medicine to calm me down, because, when I walked through a crowd, I felt as if something could happen to me. I mean, I was psychologically traumatized.
Healthy San Francisco started in 2007, under then Mayor Gavin Newsom, years before the Affordable Care Act, when universal coverage was an audacious and radically liberal goal.
Partially funded through employer fees, the city reorganized its public health system. Patients like Mario Goes were moved away from expensive and overburdened emergency rooms, and into primary care clinics. They get visits to specialists, prescription drugs, and, perhaps most importantly, protection from massive bills should they need emergency care.
After most of Obamacare went into effect in 2014, most Healthy San Francisco patients enrolled in Medicaid or bought subsidized private plans. But about 13,000 remain — those who earn too much for Medicaid, but still can't afford private insurance, and people like Juan, who are undocumented and barred from federal public assistance.
He's been recovering from a heart attack under the watchful eye of a cardiologist and he's now back at work in a local warehouse. He takes a number of prescription drugs that he couldn't otherwise afford.
Just want to make sure that you can continue to get those, those medicines.
But here's the dilemma: He's only covered inside the city limits of San Francisco. It's not portable health insurance. Juan wants to move to San Diego to care for his aging mother, but then he will be out of the program and unable to afford his medications.
Is this hundreds of dollars a month or a few dollars a month?
Some of them… some of them over thousands of dollars a month, yes. And if I don't have that coverage, in San Diego, I would have to pay for it. And if I don't take that medication, it's like — it could be life-threatening.
Some three million Californians remain uninsured. About half don't have legal status, like Juan, and the rest can't afford the sky-high cost of American health care.
Sen. Bernie Sanders, I-Vt.:
Now is the time to get it done!
(CHEERING AND APPLAUSE)
Fury over those costs, even for those with insurance, has energized Democrats who want the U.S. to have universal health coverage, like all other industrialized nations.
But there are many variations: single-payer, Medicare for All, plans that would largely do away with insurance companies or employer-based coverage, others that would simply regulate them more closely.
Now that the former mayor of San Francisco has become governor, Newsom says he wants to make California a testing ground for universal coverage.
Gov. Gavin Newsom, D-Calif.:
Premiums are going up, deductibles are getting higher, people are feeling stress and anxiety about what's happening or not happening federally. And they're concerned that things will get worse, not necessarily better, in the medium term, and a lot worse in the long term.
Newsom has asked the Trump administration to allow California to pursue a single-payer system. Since that's unlikely to happen, he's pursuing other options by creating what he says is the nation's largest prescription drug purchasing pool to negotiate drug prices, restoring the individual health insurance mandate, letting undocumented young adults up to age 26 into Medicaid, and giving state subsidies to 250,000 more middle-income Californians.
You look around the rest of the world, they're just rolling their eyes — higher life expectancy, they do chronic disease management better than the United States for roughly half the price. You look at quality indexes, we dropped to 37th in the world in our quality index last year, below Cuba and Costa Rica.
This is ludicrous, and so it's incumbent upon governors, mayors to take the lead, in the absence of the federal government doing its job.
And that's happening across the nation. In Washington state, New Mexico, Colorado and elsewhere, Democrats have put forward a flurry of proposals to expand access and restrain health care costs.
And, in New York City, Mayor Bill de Blasio is promising health care to undocumented immigrants and those who can't afford insurance.
Mayor Bill de Blasio, New York:
There's enough people in this city who don't have any health care coverage to fill the entire city of Milwaukee or the entire city of Baltimore. There's just a vast number of people.
It's a total of some 600,000 New Yorkers. De Blasio recruited Dr. Mitch Katz, the public health mastermind behind Healthy San Francisco, to build a similar program in the city's five boroughs.
They plan to pump more than $100 million a year into the city's financially strained public hospitals and clinics and actively enroll the uninsured into a program called NYC Care.
That includes struggling young people, like freelance musician and composer Andrew Sharkey, who has Crohn's, a serious bowel disease, that has gone untreated. He dropped his coverage in 2015.
I just didn't know where the money was going to come from. I was working two jobs. They were both part-time, so they didn't have to pay into my insurance.
Under de Blasio's plan, Sharkey would have a regular primary care doctor and treatment from specialists and access to prescription drugs.
Word about NYC Care is already spreading among the more than 300,000 undocumented immigrants in the city, like Antonio, who asked us to use only his first name. He thinks de Blasio's plan would simplify his life. He could focus more on his health and work, and less on the endless paperwork that comes with being uninsured.
Oh, my God, that is going to be a great change for everyone. Now, when I go to an appointment, I need to be running around from social workers to organizations to find a way to reduce those bills.
Americans already pay for undocumented immigrants when they come to the emergency room, says Mayor de Blasio.
Let's face it, we kind of kid ourselves in this country about the reality of health care. So, right away, we have got 12 million, maybe even more, undocumented folks who are part of the fabric of the United States of America, and who need health care because they are human beings.
But in all of our policy-making, we deny their existence. This is the greatest 'don't ask, don't tell' you have ever seen. We should have universal health care nationally. We should have single-payer. We should have Medicare for All. But, in the absence of that, health care has become this luxury item for so many people.
Universal health care polls well with American voters. But the Trump administration says if it became a national policy, it would consume the federal budget.
Seema Verma runs the federal Centers for Medicare and Medicaid Services for the Trump administration.
It's fiscally unsustainable. But to make matters worse, it would destroy Medicare for the seniors who have spent their whole life paying into it.
And some Democrats are voicing warnings of their own.
Former Vermont Governor Peter Shumlin, a Democrat, was forced to abandon his attempt to bring single-payer to his state.
What I realized, and I think a lot of legislators did too was, 'Hey, if we don't get costs under control first, instead of getting that premium increase in the mail, you are going to get a tax increase passed to your legislature on an annual basis.'
And there aren't very many politicians from any party who want to be raising taxes at the rate of our current health care inflation.
Fifteen percent every year, 18 percent.
So, 15, 12. Can you imagine the politicians going, 'Hey, this is fun'?
As Democrats across the country and in Washington push ahead with their health care agenda, patients like Andy Sharkey are listening carefully.
For the "PBS NewsHour" and Kaiser Health News, I'm Sarah Varney in New York.
Watch the Full Episode
Jason Kane is a PBS NewsHour producer, focusing on health care and national affairs.
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