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Monday, March 13, 6:00pm-7:30pm, Santa Barbara Museum of Natural History Fleischmann Auditorium

Contributed by R.T. – IndivisibleSB

Propaganda, Truth, and Consequences

A March 9, 2017, email from the White House announced, “President Donald J. Trump continued building momentum this week toward fulfilling one of the most important promises he made to the American people: the repeal and replacement of Obamacare. After seven long years of disaster, President Trump and Republicans in Congress have begun the process of fixing America’s broken healthcare system and giving the power back to the American people.” Appalled (yet again) by the propagandistic bent of White House communications under the new regime (seven long years of disaster?), I again debated removing myself from the White House mailing list, weighing the benefits of being in the loop against the nauseating effects of a regular diet of dumbed-down dribble – paid for with tax dollars.

Notwithstanding White House propaganda, in just the past few days, key stakeholder organizations have weighed in on what Congressman Salud Carbajal’s health care town hall invitation referred to as a “fast-tracked healthcare repeal plan,” the American Health Care Act. For example, in a March 7 letter to Congress, AARP states:

“We write today to express our opposition to the American Health Care Act. This bill would:

  • weaken Medicare’s fiscal sustainability,
  • dramatically increase health care costs for Americans aged 50-64, and
  • put at risk the health care of millions of children and adults with disabilities, and poor seniors who depend on the Medicaid program for long-term services and supports and other benefits.”

And, on the morning of the March 13 town hall, the non-partisan Congressional Budget Office (CBO) released its “scoring” report. The report concludes that 14 million more Americans would be uninsured in 2018 under the House Republican health care bill than under the Affordable Care Act (Obamacare), with 24 million more uninsured by 2026.

Panelists and the Public Weigh in at Health Care Town Hall

In addition to Congressman Carbajal, the town hall panel at the Santa Barbara Museum of Natural History included Dr. Charles Fenzi of the Santa Barbara Neighborhood Clinics; Dr. David Dodson, from Sansum Clinic; Dr. Charity Dean, Santa Barbara County Public Health Officer; Jenna Tosh, Executive Director of Planned Parenthood Central Coast; and Michael Harris, Director of Administrative & Government Services at CenCal Health, described in Mr. Harris’s Linkedin profile as the oldest managed Medi-Cal Plan in California. Both the panel and the standing room-only crowd of over 300 had a decidedly different take on those “seven long years of disaster,” voicing vivid concerns about the harmful impact of the repeal-and-replace American Health Care Act, aka Trumpcare or TrumpRyan Care.

Congressman Carbajal made the initial introductions, commenting on the level of engagement in his district and the high stakes in the healthcare debate. The Congressman’s initial points on the proposed legislation were direct and simple to understand: 

  • The overall effect on healthcare is that we would “pay more for less.”
  • Seniors would pay up to 5 times more for coverage.
  • Medicaid would suffer real damage.
  • The legislation represents a direct attack on women’s health, including defunding of Planned Parenthood and other providers of family planning and other services.

Each of the panel members also made brief introductory remarks, which were particularly effective in highlighting some specific concerns that don’t always make it into the online and on-air discussions:

  • Dr. Dean, pointing out they she was attending on behalf of the County, stated that the legislation eliminates the CDC’s Prevention and Public Health Fund, which pays for vaccine programs and other core public health functions. The legislation would also have other severe financial impacts on the provision of public health services; under the Affordable Care Act (Obamacare), 11,000 patients served by the County went from uninsured to Medi-Cal-covered, a success that would be undone by the proposed legislation.
  • Sansum Clinic’s Dr. David Dodson, noting that was attending as “an alarmed citizen,” expressed his view that Congress and the administration should be pushing to improve the Affordable Care Act, not repeal it. He stated that the actions of Congress and the administration are actually working to cause a “death spiral” that would otherwise be avoidable. (A death spiral is a condition of the insurance market in which costs rapidly increase because of changes in the covered population, e.g. due to lower risk policyholders choosing to be uninsured.)
  • Dr. Fenzi detailed some of the adverse effects for the Santa Barbara Neighborhood Clinics and the populations they serve. These concerns include reduced coverage, rollbacks of eligibility, higher costs, the repeal of the Prevention and Public Health Fund, and the designation of Planned Parenthood and other organizations as “Prohibited Entities” ineligible to receive funding.
  • CenCal’s Michael Harris emphasized the financial impact to California and the Central Coast, especially the impact of the Medicaid funding limitations. He stated that the direct impact to California will be $15.5 billion, with the total economic impact around $20.0 billion.
  • Jenna Tosh of Planned Parenthood, who seemed to be applauded each time she spoke, stressed the wide range of preventative care the organization provides, including pre-natal care that is funded by the Affordable Care Act. According to Ms. Tosh, Planned Parenthood Central Coast stands to lose $10.0 million of its $15.0 million budget.

25 attendees had an opportunity to ask questions of the panel, and several used the opportunity for multiple questions or comments. The crowd was supportive and polite; the panel was patient and responsive, offering in some cases to get back to individuals whose questions could not be answered on the spot. At Congressman Carbajal’s suggestion, the town hall went into overtime to accommodate additional questions and comments.  The subjects were diverse and far-ranging, covering personal health concerns, more technical questions from healthcare professionals and caregivers, and the broader topic of the political and civic engagement needed to avoid or mitigate the harmful effects of the proposed legislation. Highlights included:

  • Fears of individual patients and their caregivers that options will be limited, healthcare outcomes will be worse, and lives will be lost.
  • The concerns of several healthcare professionals and caregivers, including doctors, nurses, homecare providers, administrators, and others, that the proposed legislation will seriously harm patients and their families, limiting treatment options and causing severe financial distress. Several people pointed out that limiting coverage and access to preventative care would only result in higher costs.
  • Some very pointed comments about gun violence as a public health issue, the need for parity for mental health care, provisions in the legislation related to genetic screening, and the advantages and economics of a single payer system.

Several participants stressed the need for sustained, very public and vocal involvement on healthcare and other issues that the Trump administration and Congress are moving on. Congressman Carbajal emphasized this several times as well, but he also noted that he will continue to work on bipartisan collaboration. 

I opened my email when I got home from the town hall. Waiting for me was another propagandistic email from the White House with the title of Share Your Obamacare Disaster Story. It seems pretty clear that the White House is not getting the point or doesn’t care. We can change that, but we need to keep at it.