Congressman Rick Nolan

Representing the 8th District of Minnesota
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Duluth News Tribune: Nolan hears ACA repeal concerns at forum in Duluth

Apr 5, 2017
In The News

State and local health care officials voiced concerns on Friday in Duluth that repealing the Affordable Care Act may impact low-income residents the hardest, and also affect public health, mental health and addiction programs.

U.S. Rep. Rick Nolan, DFL-Crosby, heard comments about the ACA from officials and residents in a packed room at the Duluth Depot during a forum on health-care access hosted by the Head of the Lakes United Way.

Nolan spoke briefly at the beginning of the forum, with most of the time devoted to hearing from panelists from health-care organizations and advocacy groups, and audience comments.

President Donald Trump ran on a campaign promise of repealing the ACA, and Republicans in Congress have been working on a replacement plan. Nolan likened congressional members who have long wanted to repeal the ACA to "a dog that caught the car — it's like, what do I do with it now?" He pointed out there have been 67 previous attempts to repeal the ACA.

During audience comments, one speaker said the government can't fix its health care problems while it's spending money on wars, while another suggested that people share their stories about how the ACA affects them with members of Congress. A third speaker asked Nolan to consider a better system for paying off medical debt instead of collections and bankruptcy.

Buddy Robinson, staff director of the Minnesota Citizens Federation-Northeast, said things aren't going well for Minnesota's health insurance marketplace, MNsure, even without the repeal of the ACA. MNsure had fewer people sign up for plans — and fewer people could mean financial devastation for the state's marketplace, he said.

The Lake Superior Community Health Center serves 11,000 people a year and has 1,000 new patients on a three-year waiting list for its dental services. The health center is a safety net that provides care no matter if the patient can pay, according to CEO Dayle Patterson. The health center receives grants to cover a $2.75 million funding gap, and she said Friday that changes to the ACA would mean it would have to either serve fewer people or eliminate some of its services.

"If we reduce the amount of money for primary care, which is what we do, people are still going to get those services. They're just going to go to far more expensive locations to get that care. In fact, if we don't see them at the primary care level, they're going to have acute episodes," Patterson said.

Public health funding falls under the ACA's umbrella and a repeal of the law is a "looming health crisis," said Louise Anderson, director of the Carlton-Cook-Lake-St. Louis Community Health Board. Repeal of the ACA will affect more than 50 percent of immunization funding statewide, a significant amount of the epidemiology and laboratory capacity, and funding for preventive programs for heart disease, stroke and diabetes, as well as prevention of health concerns such as the Zika virus, measles and lead poisoning, she said.

"It has to be protected. It became a part of the Affordable Care Act when it was implemented, seemed like a great idea, but now can place our nation in crisis," Anderson said.

One in five Minnesotans is enrolled in a government health insurance program such as MinnesotaCare, which covers low-income working Minnesotans. The ACA expanded Medicaid to include 200,000 more Minnesotans, and a repeal of the ACA would put at risk $2 billion in federal funding that Minnesota receives, according to Nathan Moracco, assistant commissioner for health care at the Minnesota Department of Human Services. The state's programs have a focus on children and on people with disabilities, and the ACA expanded mental services and chemical health services, he said.

Gary Olson, executive director of the Center for Alcohol and Drug Treatment in Duluth, noted that the failure to treat mental health and addiction has an impact on public safety in the community.

"What people need to realize is that the safety net is not just a safety net to prevent people from falling into hopelessness and despair; it also protects our community from untreated mental health and addiction problems," Olson said.

Moracco noted that state laws authorizing programs such as MinnesotaCare were eliminated when the ACA was enacted.

"There is a nostalgia for pre-ACA, but what we need to be clear about is that there is no pre-ACA. ... You can't just repeal the ACA and say, 'OK, now it's just like 2010 again.' You can't go back. A lot of what we had authority to do prior to the ACA is gone so what we have to do is either rebuild back up to that through state or federal authority or it's just a completely different direction," Moracco said.

Ernest Peaslee, a retired Essentia Health primary care doctor, noted that the impact of medication costs gets lost in the discussion of the ACA. He held up a magazine, noting that the first four pages were ads for a medication that costs more than $1,000 per month that he said has only a marginal effect for patients.

Pharmaceutical companies are in the marketing business and people go bankrupt for "miracle drugs" that only extend the patient's life by a few weeks, he said. Prices figure into health insurance companies' costs and drug prices need to be negotiable, he said.

Nolan responded that he's directed his staff to research the situation in countries that ban advertising medications, to which the audience applauded.