MOUNT VERNON — In an exclusive one-on-one interview with the News, 18th District Rep. Zack Space talked candidly late Monday afternoon about HR 3296, the health care reform bill passed by the House on Saturday.
“This is not a perfect bill. There are things I’d like to see improved in the bill, but it represents a big step forward from where we are right now,” Space said. “I think status quo is unacceptable and something is better than nothing at this point.”
The bill develops a National Exchange, which will be available to those without health care insurance and those who don’t like their coverage (and qualify), as well as the private sector carriers. The exchange is essentially a marketplace for policy competition, he said.
Space believes reform is a necessary and inevitable step in stabilizing the cost of health care in America.
“The reason we are in this crisis right now is the cost of medical care has far outpaced the cost of ordinary inflation,” he said. “That has been happening for decades. It’s come to the point now where it’s unsustainable. We have to address costs. If we don’t, it compromises our ability to defend our nation, invest in infrastructure, and educational and social programs.”
Although the public option is a big part of the House bill, Space emphasizeed the overhaul attributions of the legislation that will have the greatest effect on the people he represents.
“The bill sets up a lot of pilot programs designed to maximize quality while decreasing costs. We do that through things like medical homes concepts. Rather than extend broad bureaucratic mandates across the board, this bill wisely sets up all the different pilot programs and sees what works. What does work we are going to expand. What doesn’t work we will discontinue. So, it gives it some sense of malleability and the ability to be creative and bring a new perspective to health care,” he said.
Included in the pilot programs is the Medical Home program. This program, according to Space, gives one medical provider the ability to oversee the patient’s entire medical needs. This plan would streamline and coordinate all of a patient’s physicians and medical providers through one advocate in order to keep costs down and patient care at an exceptional level.
The bill also expands reimbursement rates that equal out the playing field for rural hospitals.
“We will see a significant increase in reimbursements,” Space said. “One of the biggest problems I had with the public option, as it was originally designed, the reimbursement was tied to Medicare. Our hospitals, like Knox Community Hospital, they are losing money on their Medicaid and Medicare patients right now. If we tied that public option with Medicare, not only would it give the public option an unfair advantage over private carriers, it would also potentially drive people into the public option and put hospitals like that in jeopardy. I worked extremely hard to make sure that this was an actual level playing field and that the bill works for our rural hospitals. I’m comfortable and confident this bill is the one that’s going to work for them.”
For seniors covered under Medicare’s Part D, the bill offers relief from the “doughnut hole.” Currently, seniors with Part D drug prescription plans have medications covered, with a deductible, up to the first $2,250. The doughnut hole, between $2,250 and $5,100, is the threshold that requires seniors to pay 100 percent of the cost of medications. According to the bill, effective Jan. 10, 2010, a 50 percent discount would be given on drug costs in the “hole.” The “hole” would be completely phased out by 2019, Space said.
“What that means for seniors who fall within that doughnut hole, is they are going to be able to afford their medications. A lot of people who get into that doughnut hole are either taking half doses or not taking any at all, and that aggravates their condition and creates higher health costs,” Space said. “One of the many good things about the bill is that it does address that issue for seniors and it should help them get the medications they need.”
Another advantage Space said the bill has for residents in the 18th district is it will limit out-of-pocket expenses and remove lifetime limits, regardless of whether the insurance plan is purchased through the exchange or the private sector. A family of four, according to Space, which earns $88,000 a year or less, would pay a maximum of $10,000 in medical expenses per year; an individual (in the family) no more than $5,000.
“There were 1,400 bankruptcies last year in the 18th district that were health care related,” Space said. “Most of them were by people who had insurance — either deductibles were too high, out-of-pocket expenses were too high or limits were too low. With this bill, people will not be losing their homes and everything they’ve worked their whole lives for just because they got sick.”
Although the public option is perhaps the most contested issue of the House’s plan to restructure health insurance and care, Space said he is confident the overall effects the country would see with such a sweeping overall of a flawed, profit-driven insurance market will well outweigh apprehension of a government-run plan. But he is willing to compromise on the public option if that means opening the door to an agreement with the Senate allowing for the major concessions in the bill.
“I’m very open minded about it,” Space said. “I think the government option, if it is properly structured like it is now with negotiated rates, is a good thing because I think it’s going to help keep the insurance industry honest. I think there are a lot of things in this bill that transcend the public option.”
Space said he is aware of how the process works when trying to push through legislation and fully anticipates the bill will change with input from the Senate as well as input from the conference committee.
“We have a responsibility, not just for America today, but for America in 10 years, to do something now,“ Space said.
Other key factors Space said will impact on the 18th District include:
•Approximately 65,000 residents will gain access to health insurance.
•Over 8,000 residents will see relief from doughnut hole.
•Over 11,000 small businesses will qualify for tax relief simply by providing health insurance for employees.
“I look at it through the prism of what’s best for my district. I am honestly and sincerely doing what I think is right,” Space said.