Q&A: a public policy expert with a disability on the GOP health care bill

Utah-based advocate Andrew Riggle had many reasons to meet with staff of Utah Sen. Orrin Hatch, a key player in the behind-closed-doors Republican legislation.

Health care stands a good chance of being overhauled. That’s because the Senate’s closed-door bill, which was voted on in the House and is being amended solely by Republican lawmakers, including Senate Finance Committee Chair Orrin Hatch (R-Utah), could also pass the Senate and White House. Andrew Riggle is the public policy advocate at Utah’s Disability Law Center and has a disability. He spoke with me on June 28 outside the Wallace F. Bennett Federal Building in downtown Salt Lake City, where Riggle and other advocates met with Hatch staff about the legislation, being called “Trumpcare,” that would replace the current federal health care law. Senate Majority Leader Mitch McConnell delayed a vote until after the July 4 recess.

If there is one data point that you would want people to know that pertains to the GOP bill, what would that be?

AR: If we are talking about the changes to the (Affordable Care Act) more generally, it would be the ability of states to decide what an essential benefit means. That means that a state could decide to no longer provide mental health coverage, no longer require insurers to provide maternity care; they probably wouldn’t decide to not require prescription drugs, but that is an option. The threat to essential benefits posed in this bill would be one.

The second piece would be that we’re looking at $1 trillion cuts to Medicaid over the next 10 years. That will ultimately force states to make cuts to services and put the states and Utah in the position to say ‘who gets covered? What services do we provide? And how much do we pay people to provide the services?’

And anybody who says the states will not want to or won’t make those decisions, the states still have no choice because they will have $1 trillion less in their budget. … plus, health-care costs will continue to grow, the cost to provide healthcare will continue to grow… And that’s going to be unsustainable for states. So they will have to decide who gets care, who doesn’t…

The GOP legislation would leave essential benefits to the states, but states haven’t (offered essential benefits) in the past?

AR: Right.

You mentioned a $1 trillion cut to Medicaid. Isn’t it $880 billion? Or is it up to $1 trillion because of the Senate’s amendments?

AR: Well, that’s why we need to read the fine print of… the bill, but the Congressional Budget Office projects that over the next 10 years, Medicaid will be cut by $772 billion; however, the CBO says ‘we are only statutorily authorized to make 10-year projections.’ …but because the rate of growth of Medicaid is cut even further later on, the CBO says ‘we don’t know what the numbers look like, but we fully expect that there will be further cuts beyond the 10 years.’

You mentioned that the per-patient cost of Medicaid is lower than both the private market and Medicare… Why do you think that there is perhaps a misperception of Medicaid’s effectiveness and cost efficiency?

AR: Because it is a policy question and a detail question and this would begin and always has taken place at a philosophical and ideological plane, rather than a practical one. And then people… when they look at Medicaid, they look at the overall number and the overall dollar figure and the overall dollar figure is significant; it is substantial — they are not wrong there. The reason… the overall numbers are so large for Medicaid, though, is because Medicaid covers a whole lot more people, and a lot of benefits that it does cover than any private insurance or Medicare does.

So when people say Medicaid costs are out of control, it’s not really a question of the costs themselves; it’s a question of the number of people provided in the types of services that are offered. And they are largely folks not who would not be covered by Medicare or the private market and they are largely services that are often not available in the private market or Medicare, especially when it comes to long-term care services. With long-term care services, Medicaid is your only option. And they are some of the most costly services you can provide, but for those who need them, there’s no choice.

Who specifically met with you in there? Was it Hatch’s staff? And how hopeful are you that they will consider the stories?

AR: They said they have a lot of reading ahead of them this afternoon, so I’m hopeful that they meant that and that they will actually read all of the stories and share them with Sen. Hatch and the staff in D.C. So the fact that they agreed to meet with us and the fact that they said that they wanted to read the stories gives me more hope… and the fact that they now have a couple days for them to share the stories that they do read with the staff and with the senator and the fact that we have a couple additional days to continue to gather the stories and get folks to turn out and get engaged, make calls, write letters.

So they have their work cut out for them, but we have our work cut out for us to keep the pressure up.

Since the vote on the bill has been postponed, is there more opportunity for the public to share their stories?

AR: I think so. You can’t let up now. … I fully agree with what (former Acting Administrator of the Centers for Medicare and Medicaid Services) Andy Slavitt said, that this is the most important fight since (The Americans with Disabilities Act) and potentially more meaningful in the long term.

For health care? For all of Congress?

AR: The most important for disabilities since the ADA and probably more impactful over the long term than the ADA.

You met with staff, not Hatch himself?

AR: I try to take any opportunity I can to go to D.C., but we took the next-best option. … Yesterday, (I met) with Sen. Hatch’s senior health person… in a call with the senator’s disability advisory committee, he reiterated the senator’s commitment to the disability community and we expect to hold him to that.

I assume you are not meeting with Utah Sen. Mike Lee? He opposes (the GOP bill) for different reasons but is a ‘no’ vote nonetheless…

AR: We’ve had previous conversations with the staff and will continue to at any opportunity, but right now, because of (Sen. Hatch’s) position in leadership, his close involvement with Sen. McConnell in drafting the language of the bill, and also his legacy with the disability community, we feel like it’s important to continue to engage with Sen. Hatch and that… of the two of them, he is probably more likely to perhaps not vote against the bill, but work internally to make it… as good as it possibly could be.

Is there a website about (the advocacy)?

AR: There are a couple Facebook groups: one is the Healthier Utah Coalition and they are the broader ACA and Medicaid group, and the other is Save Medicaid Utah, which, obviously, is focused on Medicaid specifically.

We share information as we get it, as well as calls to action through both of those groups… we encourage people to… come out, because the thing is, (Slavitt) put it the most starkly and the best (way): the debate over health care and Medicaid that we are having now will have… longer-lasting implications than the ADA does.

Note: Some questions were posed by the Deseret News’ Ben Lockhart, as the interview took place during a press conference function.