As chairman of the Blue Dog Democrats’ health care reform task force, Rep. Mike Ross, D-Ark. is pivotal in determining the final language of the bill, especially as it emerges from the House Energy and Commerce Committee. KFF Health News’s Eric Pianin spoke with Ross at his office in the Rayburn House Office Building, July 16, 2009 about his district and health reform. Below is the edited interview.
Eric Pianin: Can you describe the health care problems of your home town and the Fourth Congressional District?
Rep. Mike Ross: My hometown, Prescott, Ark., has about 3,600 people and two traffic lights. Twenty years ago we had six doctors. Today we have three, of which two are over the retirement age, with no prospects of any new doctors moving to a small rural community like Prescott.We lost our county-owned hospital, where my grandmother spent much of her life working as a nurse, in 1995. Shortly thereafter, Congress passed the Critical Access Designation for Rural Hospitals, and as a result we haven’t lost any hospitals since, although we have a handful barely hanging on today. So I don’t have a hospital in my home county.
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EP: Where’s the nearest hospital?
MR: It’s in Hope, Ark., 16 miles down the road. And that’s not just reflective of Prescott. That’s reflective of rural Arkansas and rural America. There’s a lot of reasons why providers are no longer locating in rural areas. One of the largest reason is the regional and rural disparities that exist in Medicare reimbursement rates.
We need reform. We need health insurance that’s affordable for those who do not have it. We need to ensure that those who have it today will have it 10 years from now.
Right now health care is growing at about twice the rate of inflation. If we don’t contain the costs, it’s going to bankrupt this country and it’s going to cost 160 million people in this country who have health care today their health care in the future, perhaps as early as ten or 15 years from now. Everybody is concerned about ‘national’ health care. But the reality is that half the people in America already have it. It’s called Medicare, Medicaid, SCHIP, veterans health care, military retirees’ health care. Those national programs, combined with Social Security, consume 40 cents out of every [tax] dollar. If we don’t get the rate of health care down to inflation, that number is going to reach 100 percent of all federal revenues by 2040, which means we no longer have a Department of Defense or a Department of Education or a Department of Agriculture. Obviously, as a nation we cannot afford to let that happen.
The same thing is happening in the workplace. You see the employer shifting more and more of the cost of health care to the employee. If we don’t slow the rate of growth, it will reach a point where neither the employer nor the employe can afford to pay for health insurance. That’s what this national debate is really all about. Somewhere along the way some members thought it became about covering the uninsured. And I certainly am committed to covering the uninsured, that’s why I fought for an SCHIP expansion, to cover more Arkansas children. But this health care reform debate is really about containing costs, and it’s got to be about addressing the rural health care crisis that we have in this country.
EP: What about the public option?
MR: The president says we need a public option to make the private insurance companies do right. Well, we’re the Congress. Why don’t we reform the private insurance companies, and then have a public option as a trigger, that basically tells the insurance companies you’re going to cut costs, you’re going to reform your system, your’re going to do away with preexisting conditions, you’re going to make health insurance portable? And if you don’t, then we’ll pull the trigger and have a public option that competes along side your private plan. That’s exactly what we have with Medicare part D. A lot of people forget because the trigger was never pulled because the insurance companies did what we asked them to do, because of the threat of the trigger.
But if there was a public option it can’t be Medicare rates. If it takes three months to get in to see a doctor now in rural areas now when you’re on Medicare, we’re going to add 48 million more people, and possibly more, because the public option is not just for the 48 million that don’t have insurance today, it’s for everyone to be able to pick and choose from. So we’re going to add tens of millions and perhaps hundreds of millions more to a public option that’s based on Medicare rates and that will require Medicare doctors to treat them and there’s already a wait of three months or longer to get in and see a Medicare doctor. It would be a disaster.
It’s easy to provide everybody a shiny new insurance card. But what’s important here is they actually have access to a doctor once they get the insurance card.
EP: What are you looking for?
MR: Well, the seven of us that are Blue Dog members of Energy and Commerce Committee are meeting several times a day. We are crafting a number of amendments that will be offered to the bill. What they have right now is a bill that they cannot even get out of committee, and it’s a bill that certainly cannot pass on the House floor.
We feel very strongly about health care reform. We want to see it happen this year. We simply want to slow down and do it right. We simply are demanding a bill that contains costs, that addresses many of the rural health care concerns.
Rural America is filled with small businesses. And it’s not uncommon for small businesses not only not be able to afford to provide insurance for their employees but they don’t have a policy. It’s not because they don’t want their employees to have insurance. It’s a matter of staying in business. A small business insurance mandate, we’ve got to be careful how we do that. Because if we do it incorrectly, not only will employees of small businesses not have health insurance, they will not have a job either.
EP: Let’s get back to your district and hometown. There’s a conundrum here: on the one hand you have these very strongly held fiscal conservative views about the deficit, controlling spending, bringing down health costs. On the other hand you know full well a lot of your constituents are having a very tough time, and there are things in these bills that would benefit them. Can you describe the tug and pull in making this decision?
MR: Well there’s really not a . . . [conundrum]. You can’t address one without the other.
The House bill, in my opinion, is simply built of false hope. It will provide everyone an insurance card, but not access to a health care provider. We want to address the lack of providers in rural America, we want to insure that every employee of every small business has access to insurance they can afford. So to me it all fits together. The president said the same thing I’m saying, and I wouldn’t call him a fiscal conservative.
EP: [John] McCain did well in your district and many other Blue Dog districts. Is this weighing on you? Republicans are trying to target some of these districts [for 2010].
MR: I think the majority of people in my district trust my judgement on these types of issues. I never moved to Washington. I’m on the next plane home after the last vote each week. I get out and listen to the people, and then I bring their issues and concerns back up here and try to be a voice for them. I think people understand that. Politically I’m not worried about it. I’ll tell you, health care is so important that if doing the right thing meant losing the next election, it would be worth it for the American people. My friends and my neighbors and people I deer hunt with and go to church who can’t afford health insurance today. We are very committed to health care reform and making health insurance affordable and accessible. But we just think the Democratic leadership has gone about this the wrong way. And we tried to make them aware of our concerns three months ago, we had some nice meetings where they appeared to be listening to us. But yet as these drafts evolved and eventually the bill evolved and was filed, our concerns weren’t really reflected in the legislation,
EP: Are you hearing from consitutents who want health care reform and coverage but don’t want to pay for it?
MR: My constituents want health care reform but they want it to be done correctly, they don’t think it should be done in a hurry. They think that we need to cut costs instead of increasing taxes whenever possible, and I don’t think we’ve done enough to cut the cost.
