Health Care - John Hickenlooper for U.S. Senate

Health Care

My Plan to Fight for a Healthier Future for All Coloradans

INTRODUCTION

Health care is a right, not a privilege. No matter where you live, who you are, or how much you earn, you deserve high-quality, affordable health care. As a nation, we have repeatedly fallen short of this aspiration. 

Unlike Senator Cory Gardner, I believe universal coverage is possible—and necessary. As governor, I expanded Medicaid to an additional 400,000 Coloradans. I also established our successful state exchange, Connect for Health Colorado, which allowed individuals to compare plans for quality and affordability. In the process, we cut the uninsured rate by nearly two-thirds. All told, 500,000 Coloradans got health insurance due to the implementation of the Affordable Care Act (ACA) in our state, and we reached nearly ninety-five percent coverage statewide.

No doubt, we still have challenges to address, and COVID-19 has exposed how fragile our health care system really is. We should be outraged that people of color are more likely to die from COVID-19 than white Americans. We should be outraged that nurses are wearing trash bags to work because their hospital has run out of PPE. We should be outraged that overwhelmed labs can take over 14 days to return a test, rendering the result essentially meaningless. And we should be outraged that Washington Republicans have presaged this failure by proposing over 70 measures to repeal the ACA, rather than addressing the cracks in the system that are all too apparent. 

Senator Gardner has voted at least a dozen times to repeal, block, or defund the ACA and could gut protections for people with pre-existing conditions. He supports President Trump’s U.S. Supreme Court lawsuit that could overturn the law in the middle of a pandemic. He doesn’t have a plan to protect access to health care. So I’m offering mine.

As your senator, I will fight every day to improve access to quality care. I will protect coverage for pre-existing conditions. I will fight to cut the cost of prescription drugs. I will expand mental health and substance misuse recovery services. And I will strengthen our vital social safety net programs including CHIP, Medicare, and Medicaid. More equitable, affordable, accessible health care is possible. COVID-19 has exposed how far we have to go to realize this goal. Time to get to work.

BUILD ON THE ACA

Establish a National Public Option: If elected to the U.S. Senate, I will support a federally-administered public health insurance option. Millions of Americans enjoy their employer-based or marketplace-based insurance, and they should be able to keep their plans. But for the millions who are uninsured, under-insured, or paying a disproportionate share of their income on coverage, a public option could be transformative. Not only could it make benefits more portable — enabling people to maintain their policy when switching jobs or starting a small business — but it could increase marketplace competition, lower costs across the system, and close gaps in coverage. 

Undo a Decade of Damage: The ACA was a watershed moment in our nation’s health. For the first time, insurers could no longer deny coverage to individuals with pre-existing conditions or charge women higher premiums than men. The law allowed young people to stay on their parents’ plan until age twenty-six, banned lifetime caps on coverage, and made mental health, prescription drugs, and preventive care required benefits. 

In the decade since the law passed, Republicans, including Senator Gardner, dedicated themselves with singular focus to repealing the ACA. When that proved unsuccessful, they joined forces with President Trump to sabotage the law’s coverage gains. His administration shortened the enrollment period, destabilized risk pools, promoted junk plans, canceled ninety percent of funding for outreach efforts, and filed a lawsuit with the U.S. Supreme Court that could strip millions of Americans — many with pre-existing conditions — of their health insurance. 

In essence, Republicans removed the engine from the car and then campaigned on why it wouldn’t drive. Senator Gardner still advocates for repealing the ACA, even in the middle of this pandemic. As your senator, I will work to immediately roll back these Republican-led efforts to prevent people from obtaining coverage. You can count on me to improve the ACA—not dismantle it.

Address Unintended Consequences: The ACA is not flawless. Strengthening the law will enable us to expand coverage affordably using the tools already at our disposal. We can boost enrollment by expanding subsidies to help more middle-class families afford their premiums. And we should fix the “family glitch,” which prevents families with access to employer-sponsored insurance from receiving premium tax credits on the exchange, regardless of whether or not their plan is affordable for the whole family. 

Boost Access to the Exchanges: We could significantly reduce the barriers to coverage if we establish a special enrollment period (SEP) for individuals who earn below a certain income threshold, and make it easier to enroll for those with qualifying life events such as job loss. The Kaiser Family Foundation estimates that thirty-one percent of Americans who lost employer-sponsored coverage during the pandemic qualify for subsidies on the exchange. They simply need a window in which to enroll as quickly and seamlessly as possible. Expanding SEPs in every state could increase the rate of coverage nationwide—a relatively straightforward step with lifesaving consequences, particularly during COVID-19.

SAVE COLORADANS MONEY ON HEALTH CARE

Strengthen Medicare and Medicaid: Our safety net programs are a lifeline for millions of the most vulnerable Americans. As senator, I commit to strengthening and modernizing Medicare, Medicaid, and CHIP. Not only did President Trump and Senator Gardner not act fast enough to help seniors in this crisis, but Senator Gardner has repeatedly voted to cut support for aging citizens and people with disabilities. He supports capping Medicaid, which would cut essential health care services and make cash-strapped states pick up the tab.

Lower the Cost of Prescription Drugs: Now more than ever, we need to make sure prescription drugs are affordable. Twenty-nine percent of Americans forgo medicine because of the cost. This is unacceptable. Congress has been in the pocket of the pharmaceutical industry for too long, and the American public has suffered as a result. Senator Gardner has taken $547,897 from the pharmaceutical industry and voted to put a drug company lobbyist in charge of the Department of Health and Human Services. In response to the coronavirus, Senator Gardner failed to support limits on the cost of new prescription drugs. If elected to the U.S. Senate, I will fight to reduce the cost of prescription drugs. This includes allowing Medicare to negotiate prices directly with drug companies; permitting the importation of safe medicine from Canada; requiring more transparency in drug pricing and curtailing significant increases in the price of both generic and specialty drugs; and investigating potential anti-competitive practices in the pharmaceutical industry. We simply need to find the courage to act. As your senator, I will.

End Surprise Medical Billing: Surprise medical billing occurs when patients unknowingly see an out-of-network provider—even if the hospital is in-network or the service is an emergency. Colorado is one of only twenty-six states that have passed legislation addressing surprise medical bills. But the state-level laws do not impact people on employer-sponsored plans, so action on the federal level is essential. 

Curb Provider Costs: The United States spends more on health care as a percentage of GDP than other high-income countries. You and I feel those costs in the form of expensive co-pays and sky-high deductibles. Reining in this reckless spending could lower costs across this board. As your senator I will push for greater transparency in hospital pricing. The ACA required hospitals to publish their “sticker prices,” but that information is often difficult to find and rarely reflective of what people actually pay. For elective procedures, price comparisons can help put some of the power back in the hands of consumers. We must also support high-need, high-cost (HNHC) patients. While HNHC individuals comprise only five percent of the population, they account for half of all health care spending. Pilot programs around the country have explored providing HNHC patients with intensive wraparound services to reduce hospitalizations and manage chronic conditions. These efforts have shown promising results and should be explored further. Finally, Congress should consider incentivizing value-based payment systems, which reward providers for positive outcomes and hold them accountable for negative ones. Evidence suggests that not only can cost savings be significant, but patients receive higher-quality care.

RESPOND TO COVID-19 

Do What We Know Works: COVID-19 caught us by surprise. It shouldn’t have. The Obama administration created an office of pandemic preparedness that equipped the government to respond to precisely this type of crisis. President Trump dismantled the team when he took office—an irresponsible move that Senator Gardner ignored. 

Once the virus gained steam in the United States, the president (after initially dismissing the threat) has categorically failed in his response. He sidelined scientists, pitted states against each other in a bidding war that drove up the price of essential PPE, and failed to develop an appropriate system of testing. 

And while the country looks to Washington for leadership, Senator Gardner has provided little. Despite his oversight power on the Science Committee, he has refused to call out the president’s missteps and supports a lawsuit that would strip millions of Americans of their health insurance during a pandemic. We need to do better.

The irony is, we know what works to get COVID-19 under control. Testing, contact tracing, social distancing, wearing masks, and providing PPE to first responders and essential workers are basic tenets of public health that have helped countries around the world manage their outbreaks. We need to scale up these interventions across the board. A vaccine will help, and we need to prepare for efficient and equitable mass distribution. That said, a vaccine is not a panacea, and until one becomes available, we will need to figure out how to coexist with this virus. 

To do so, Congress should increase the federal share of state Medicaid costs to twelve percent, as requested by a bipartisan group of the nation’s governors. Additional funding is also necessary for hospitals that are overwhelmed and frontline public health departments that have been underfunded for decades. As your senator, in addition to restoring sanity to our public health response, I will shore up our long-term preparedness by supporting pandemic research efforts, global health funding, and engagement with international bodies such as the World Health Organization. Targeted relief now, and careful preparation tomorrow will help resolve this crisis and prevent future ones.

Address the Long-Term Health Impacts of the Pandemic: We are still learning about the health impacts of COVID-19. Preliminary reports suggest patients can experience chronic heart, lung, and neurological issues after recovering from the acute phase of the disease. In addition, individuals who have deferred visits to physicians because of a moratorium on elective procedures will have pent-up demand for care. And fears are emerging of a mental health crisis in patients, first responders, and people whose lives have been disrupted by this pandemic. Congress must act to establish a national effort to study both the chronic impacts of COVID-19, as well as to coordinate federal resources to strengthen the capacity of our healthcare system in the face of increased demand. And we must protect coverage for pre-existing conditions, which includes the millions of Americans who have recovered from COVID-19.

Prioritize Oversight and Accountability in Relief Packages: Congress has appropriated over $2.4 trillion dollars to address the coronavirus pandemic. This money is desperately needed. Without strong coordination of government resources at the federal level, we will experience an even greater catastrophe in our economy, schools, and health care system. It is also desperately in need of accountability. President Trump has declared he will not comply with aspects of the oversight requirements. He fired the Inspector General responsible for overseeing the Department of Health and Human Services after she issued a report critical of his response. He also fired the Inspector General selected to lead the committee tasked with overseeing the administration of COVID-19 relief. And hundreds of millions of dollars in pandemic assistance have gone to donors who do business with the Trump Organization. No wonder the administration is unwilling to be transparent about the recipients of this government support—its members are actively profiting off of it. If elected to the Senate, I will join my colleagues in pushing for robust oversight of the stimulus packages, to ensure that the money gets to those who need it most. 

PRIORITIZE PUBLIC HEALTH

Fund Community Health Centers: Sixty percent of American adults suffer from a chronic condition. Forty-two percent have two or more. Yet according to the CDC, in 2015 only eight percent of adults thirty-five or older received the type of care designed to manage these conditions—or prevent them entirely. Preventive care is a cost-effective, critical component of living healthier lives. Community health centers are one of the best ways to provide preventive care. They are an essential part of the health safety net, serving 28 million Americans and 1 in 5 Medicaid patients. And their value often extends far beyond primary care, with integrated services such as nutrition counseling, smoking cessation therapies, enrollment support for government assistance programs, early detection screenings, and much more. These clinics were struggling before the pandemic, but now they are on the front lines of COVID-19. If elected to the U.S. Senate, I will make sure these critical health facilities have the support they need.

Prioritize the Social Determinants of Health: Prevention does not stop at the clinic door. It is rooted in the air we breathe, the food we eat, the education we receive, the job we go to during the day, and the home we return to at night. From safe neighborhoods to strong social ties, non-medical factors routinely impact our health. And these social determinants are a major contributor to disparities in health outcomes along racial or economic lines. As senator, I am committed to strengthening SNAP, increasing access to affordable housing, improving the quality of education, addressing the food deserts in underserved communities, and investing in our economic recovery—all of which will contribute to the health and wellbeing of Americans. 

Improve Treatment for Substance Misuse and Mental Health: COVID-19 has caused dislocation, isolation, and extreme economic hardship for many Americans. Experts warn that rates of addiction and mental health crises will rise in tandem. But both were challenges before the virus and will continue to be after the pandemic has passed. Today, nearly half of Americans report COVID-19 has had a negative impact on their mental health. In the short-term, I support the allocation of dedicated emergency funds to address the substance misuse and mental health effects of COVID-19. In the long-term, I am committed to funding Certified Community Behavioral Health Clinics and substance misuse treatment programs, supporting community-led efforts to end stigma associated with seeking help, and investing in telehealth for counseling. In 2013, I signed a bill requiring coverage for substance misuse and mental health treatment by individual and group plans. I am committed to continuing this advocacy in the U.S. Senate.

In addition, I support scaling up Colorado’s best practices to curb the opioid epidemic by expanding access to naloxone treatment, researching alternative pain management therapies, supporting Medicated-Assisted Treatment (MAT)—a whole-patient approach to substance misuse, and updating prescribing guidelines to reinvigorate federal efforts to address this crisis. 

Support Rural Hospitals: Rural hospitals serve 1 in 5 Americans. But rural providers have been struggling on razor-thin margins for years and our nation is facing a crisis of closures as a result. As governor, I was proud to offer rural hospitals some relief by signing a bill to avert hundreds of millions in cuts. I also expanded Medicaid, which saved 12 critical access hospitals in Colorado from closing. But the challenge is not over. The pause on elective services during COVID-19 has slowed revenue even more. If elected to the Senate, I commit to advocating for rural hospitals and clinics, to make sure they have access to the federal funding they need to meet the health care needs of their communities. 

FOCUS ON EQUITY

Address Racial Disparities in Health Care: Health care outcomes diverge dramatically based on race. This reality is rooted in structural biases, systemic racism, and decades of underinvestment in communities of color. It is not enough to simply expand the scope of coverage, we must change the nature of how care is provided to ensure more equal treatment for all. I support funding research into outcomes where divergences are pronounced — including diabetes, heart disease, hypertension, and maternal and infant mortality — to better understand their roots. Congress should appropriate funds for programs addressing the social determinants of health, including nutritious food, public transportation, and safe spaces for physical activity. Training and educational programs must play their part by prioritizing diversity and inclusion when recruiting the next generation of practitioners, and curriculums should provide thorough training in identifying and correcting biases in care. And communities of color should have a seat at the table for all discussions of health care reforms.

Honor Our Commitment to America’s Veterans: As a nation, we owe a debt of gratitude to our service men and women. These heroes put themselves in harm’s way to keep us safe. When they return home, it should be to a health care system that fully supports their reentry to civilian life. The ACA was a big leap forward in this regard. Almost half a million veterans obtained coverage under the law, with coverage gains being the largest in Medicaid expansion states like Colorado. But challenges remain in the form of long wait times and logistical hurdles. For example, these obstacles limit access to care for the estimated twenty percent of Iraq and Afghanistan war veterans suffering from major depression or Post Traumatic Stress Disorder. In the U.S. Senate, I will be an advocate for our nation’s veterans, working to ensure we provide programmatic support commensurate with their sacrifice.

Secure Reproductive Rights: Roe v. Wade is threatened more than ever before. Reproductive rights are under attack in courtrooms, in the U.S. Senate, and in legislatures across the country. The constitutionally protected right to an abortion is an essential component of reproductive health care. We must also guarantee access to affordable and safe contraception — covered in the ACA — and coverage for routine cancer screenings and management of chronic conditions. I support organizations like Planned Parenthood, which provide intersectional care for individuals of all ages, identities, and backgrounds. 

Birth equity is also of vital importance. The United States has one of the highest maternal mortality rates in the industrialized world, and Black women die three to four times more often than white women when giving birth. Individuals of color deserve equal access to high-quality, patient-centered care, which I am committed to fighting for as senator. This means gathering data about maternal mortality, investing in culturally sensitive perinatal care and doula training, extending Medicaid coverage for new mothers to one year, providing wraparound services for new mothers, and using innovative payment models to incentivize improved outcomes. As senator, I pledge to protect the right to choose, fully fund critical government programs for reproductive health such as Title X, and work to reduce racial disparities across the spectrum of reproductive care. 

Fight for Comprehensive Care for LGBTQ Americans: Even after the passage of the ACA, LGBTQ Americans are more likely to be uninsured than non-LGBTQ Americans. The numbers are even higher for transgender individuals and queer people of color. And when fifty-five percent of LGBTQ Coloradans fear being treated differently by their provider, it is clear that insurance is only a part of the problem. LGBTQ individuals deserve to receive gender-affirming and inclusive care. Congress should expand competency training for physicians to address internal biases regarding gender and sexual orientation. Transgender Americans suffer inconsistent coverage for hormone replacement therapy and gender reassignment surgery, and Congress should step in to equalize access to medically necessary treatments and discrimination-free care. Finally, I support ending the FDA’s restriction on blood donations from men who have sex with men, an antiquated policy that embodies the legacy of discrimination against LGBTQ individuals in the medical community. 

Prioritize the Needs of Americans with Disabilities: Any conversations about health care reform must center the voices of Americans with disabilities. As senator, I will commit to just that. I will work to make sure that a public option is structured to meet the needs of the disability community by soliciting input from the individuals who would be directly affected. In addition, I support ending the two-year waiting period for coverage under Medicare for people who become disabled before the age of sixty-five and raising the standard of Medicaid coverage for people with disabilities nationwide. Finally, Congress should appropriate additional funding for disability services, including reducing the shortage of direct support professionals who work with people with disabilities.

INVEST IN OUR FUTURE

Restore the Independence of Our Nation’s Science Agencies: As a former geologist, I deeply appreciate the power of science. That is why, as senator, I will support funding for NIH, the CDC, and other research institutions that move our country forward. These agencies are responsible for critical breakthroughs — establishing the link between E. coli and human disease (CDC), the creation of a hepatitis vaccine (NIH) — and their success is to our direct benefit. But Trump has sidelined and politicized these institutions during his presidency. In the Senate, I will work to restore the independence and leadership of our federal science-based organizations by voting for experienced nominees to lead these agencies who actually believe in science.

Support Scientific Research and Technological Innovation: As senator, I will commit to supporting legislation that elevates cutting-edge science and technology in our health care system. Whether that is making investments in precision medicine and targeted genomic therapies, using 3D printers to make medical devices and prosthetics, or exploring how artificial intelligence and virtual reality could be applied in a health care setting, Congress has a role to play in nurturing the technological innovations that can make Americans healthier. 

Expand Telemedicine: During COVID-19, routine visits to the doctor immediately stopped. But medical needs did not. Enter telemedicine, which the CARES Act expanded on a temporary basis to individuals covered by Medicare and Medicaid. I believe we should make these changes permanent. Telehealth is not a perfect fit for everyone, but for some, it works very well and dramatically increases access to care. It is popular too—in March, adoption increased by 4,300 percent. There is work to be done to enable telemedicine to reach its full potential. The technology remains a challenge, as many Coloradans live without access to reliable broadband, and we will need to modernize patient confidentiality laws to ensure data collected during virtual meetings is secure. But telehealth is here to stay, and as senator, I will make sure it becomes a safe, valuable resource to keep Americans healthy. 

CONCLUSION

The world is reeling from COVID-19. The pandemic is imposing a stress test on our health care system and institutions. Tens of millions of Americans are unemployed, and many lost their health insurance along with their job. Nurses and doctors, paramedics and first responders, essential workers across all industries—these are the heroes getting us through. This crisis is also an opportunity. It has reminded us that we are all in this together and that tomorrow’s health care system can be better than today’s. As your senator, l will fight to build a health care system that works for all Americans. Change is coming, and it is long overdue.

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