by Eddie Roth
As I sit down to write this piece mid-February, top news organizations are reporting a potential watershed in the years-long march by Republicans in Congress to repeal the Affordable Care Act, President Barack Obama’s signature national healthcare program, also known as Obamacare.
Except this time, things are different. The GOP controls the presidency and both houses of Congress. Votes no longer are theater offered to placate the political base. Rather, the votes likely will result in grave consequences to millions of people, including hundreds of thousands in the St. Louis community who depend on Obamacare for access to healthcare.
Repeal efforts now sit menacingly off-shore, like a tropical storm steadily gaining hurricane strength. Its precise path remains uncertain. It may move out to sea. But should it make landfall at full strength, it may devastate the lives of many.
At least that’s how Obamacare repeal should be covered as news. Such coverage should reflect the impending crisis of a potentially deadly storm. It should be the lead daily news story. Reporters should press responsible local officials and community leaders for details and constant updates on contingency plans – focusing attention on those who have the greatest capacity and responsibility to protect the public.
That’s how I have been trying to cover it at my modest social media page on Facebook – “The Office of Special Inquiries and Reports | @STLinquiry,” a page devoted to “timely, independent, non-partisan investigation and analysis of St. Louis questions & controversies.”
Repeal not inevitable
Repeal of Obamacare and resulting hardship are not inevitable.
Enrollment is measured in the tens of millions and has driven down numbers of the uninsured to historic lows. The program’s advent has coincided with one of the nation’s longest sustained periods of job growth. The rate of healthcare costs, meanwhile, has slowed to an extent that actuaries calculate significant savings to entitlement programs.
But not everything about Obamacare has worked out well. Participation of private health insurers has been uneven, market to market. Premiums have risen and become unaffordable to some people who earn too much to be eligible for subsidies.
Political opponents of the Affordable Care Act have seized on these shortcomings and, rather than work to correct them, have done all within their power to undermine the program and poison its reputation in the minds of the public. Many now claim Congress must act to “repeal and replace” because the program is in a “death spiral.”
Still, in the early weeks of the new Congress, practical action to repeal Obamacare has not matched the bloody-shirt political brio. The Obamacare killers have been slow to get out of the gate. Repeal and replace strategies of Congressional Republican leaders have been met with resistance and worry among some of within the Republican caucus who understandably think eliminating Obamacare could cause a major political backlash as millions of Americans lose access to health care.
Impact of repeal on St. Louis residents
Should repeal come, it likely will come suddenly. It will be hustled through with a series of late night votes shrouded in an opaque cloud of alternate facts. Thus, news organizations should sound an alarm. Conventional news gathering approaches provide many opportunities to do so. I have marshaled data describing the scope of risk to this community, such as by noting, county-by-county, congressional district-by-congressional district, where for the more than 100,000 St. Louisans enrolled in Obamacare reside.
I have explained how sudden loss of health insurance at that scale would look (It is about the same number of people as are employed at BJC (24k), Boeing (15k), Washington University (14.5k), Scott AFB (13.k), Enterprise (6.8k), Express Scripts (6.4k), Monsanto (5.4k), Wells Fargo (5.3k), Edward Jones (5.2k), AB-InBev (4k), and then some, combined).
I have written and linked to information about potential long-term damage to the well being of hundreds of thousands of other St. Louisans who have health insurance but who suffer from or are at risk of chronic disease, and whose access to healthcare, even under high-quality employer provided insurance, depends on Obamacare protections that prohibit insurers from excluding coverage for pre-exisiting conditions and lifetime caps on coverage amounts.
I have tried to define the economic stakes to a community whose local economy has such a high concentration of healthcare related business enterprises, starting with world class hospitals and medical research. I also have tried to introduce my “small but influential” readership to key local players – people this community will be counting on to help avert disaster.
My focus has been on U.S. Rep. Ann Wagner. I have coined my Obamacare coverage as the #TheAnnWagnerProject. Ms. Wagner is the most influential House member representing the St. Louis region. She is a part of Republican House leadership. Under my #stormwatch metaphor, she’s the equivalent of the St. Louis region’s director of Emergency Management with direct responsibility for protecting the community from potentially disastrous effects of Obamacare repeal.
I regularly email Ms. Wagner’s press secretary. I request information on her plans for “repeal and replace” legislation. I seek comment from Ms. Wagner on steps she plans to take to ensure the St. Louis region is protected. So far I have received no reply, not even an acknowledgement.
But as part of my coverage, I also have reviewed Ms. Wagner’s Federal Election Commission campaign contribution disclosures. I have sought to identify contributors well known in the community and with reputations for thoughtful moderation in civic matters. I have written to a number of Ms. Wagner’s campaign contributors, inviting their comment on the community stakes involved in Obamacare repeal and what community consultation they would like to see from Congressional leaders such as Ms. Wagner.
Dr. Danforth’s response
One of Ms. Wagner’s most significant campaign contributors, Former Washington University Chancellor William Danforth, accepted the invitation. Danforth graduated from Harvard Medical School, received his medical training at Barnes Hospital and St. Louis Children’s Hospital and, since 1967, has been a professor of internal medicine at Washington University Medical School. He has served as Vice Chancellor of Medical Affairs and president of Washington University Medical Center. From 1971 to 1995, he was Chancellor of Washington University in St. Louis.
In a letter to me, Dr. Danforth wrote:
“You asked for thoughts on national health insurance that might be helpful in talking with Congresswoman Ann Wagner. My reply is probably different from others you might receive.”
“To start with, insurance for health care is very complicated. Health care is complicated with steadily advancing technologies, changing diseases, aging population, evolving private coverage, varying rates of employment, new diseases, new therapies and better prevention.”
“An objective look would conclude that financing health care in the United States has been improved by Obamacare; expenditures have risen slower than expected. Nevertheless, it is clearly imperfect, but to improve it will be hard and complex with possibilities for many mistakes. To throw Obamacare away rather than to learn from it and try to improve it would show very bad judgment, probably cause major decline in insured Americans and add to the burdens, likely including costs of disease.”
“The problem is that there is no tested alternative plan, perhaps no alternative plan at all. To try to write a new plan is risky and likely to be worse. A politicized Congress is the wrong place to try to devise alternatives. Congress could better decide the amount of money it is willing to spend on the health of the American people and then charge a panel of experts of various persuasions to develop the best improvements they can. The plan could allow states to experiment. The panel should also recommend a time to review it. One should not be thrown off by complaints; there are bound to be some. Complaints should be taken seriously, analyzed and used to help in future improvements.”
“Humans learn to improve complex systems by having people argue, debate, compromise and never stop trying to adjust it and make it better. No person or group can do it once and for all. What are necessary are imagination, trust, trial and error and patience. That is the way humans develop their best arrangements.”
“I hope these thoughts are helpful.”
Impact of local news coverage
Local news coverage can have an impact on impending Obamacare repeal, but only if it focuses sharply on local effects and if it pointedly brings accountability to local leaders. Senate Majority Leader Mitch McConnell is not following St. Louis needs or sentiment regarding access to health care. Neither is House Speaker Paul Ryan.
But both would be interested in what U.S. Rep. Wagner has to say. Wagner’s party cannot ignore her if she puts loyalty to this community ahead of loyalty to her party on access to healthcare. Wagner’s campaign contributors, in turn, bear a special responsibility for the leadership she exercises – or fails to exercise. They are fair game for news coverage in an impending crisis. That’s because repeal of Obamacare is life-and-death matter for this community. Urgent and sustained local news coverage of local people of influence may determine whether ordinary St. Louis voices – those who stand to lose the most – are heard in Washington.