Rural lawmaker feels competing pressures in health debate

Kaiser Health NewsJuly 22, 2009 

US NEWS HEALTHCARE-KAISER 1 MCT

62-year-old Sandy Barham, of Prescott, Arkansas, is a restaurant owner with a heart ailment who canÍt afford health insurance for herself or her employees.

ANN CARNS/KAISER HEALTH NEWS/MCT

PRESCOTT, Ark. — Rep. Mike Ross, who grew up in this town of 3,600, about 100 miles southwest of Little Rock, represents residents such as 62-year-old Sandy Barham, a restaurant owner with a heart ailment who can't afford health insurance for herself or her employees.

"I can't tell you the stress of living on the edge, just wondering, 'Am I going to get sick?'" she said in an interview at the Broadway Railroad Cafe, where fried catfish with hush puppies is a popular feature. "I feel embarrassed, almost, when I go to the doctors and tell them I don't have insurance."

Many people here can't afford insurance, and the battered economy has made it harder for employers to provide coverage for workers. They're looking to Washington for help, and Ross, a conservative Democrat with a strong voice in the debate over health care legislation, says he's on their side.

Yet Ross stands ready to try to block passage of a House bill that, its supporters say, would provide exactly what Arkansas needs: guaranteed insurance and a wider choice of coverage at competitive prices.

Ross' position reflects the conundrum confronting many lawmakers, including many he helps lead as head of the fiscally conservative Blue Dog Coalition's health task force. Even if large numbers of constituents might benefit, many of the Blue Dogs generally oppose the $1 trillion bill because they say it's too costly and doesn't solve other problems in mostly rural areas.

"What we're talking about is containing the cost, slowing the rate of growth of health care down where it can grow at the rate of inflation," Ross said in an interview, "because if we don't, it's going to bankrupt this country."

Unless changes are made, Ross and six other Blue Dog members of the Energy and Commerce Committee say they'll vote against the bill this week, bucking party leaders eager for House passage by the end of July. The Blue Dogs are demanding guarantees that the legislation won't add to the federal budget deficit and would shield small businesses from a costly requirement to provide insurance.

Yet at the same time, the Blue Dogs also are seeking changes in the way rural hospitals and doctors are reimbursed for their services, which could substantially drive up Medicare and Medicaid expenditures.

As is often the case in congressional negotiations of this sort, overarching budgetary principles clash with regional or local interests. In pursuing the Blue Dog agenda, Ross may have a hard time reconciling competing pressures.

An array of politically powerful interests in Arkansas oppose the House bill.

Blue Cross Blue Shield, the dominant insurer with 75 percent of the state market, objects to a proposed government-run plan to compete with private insurers. The Arkansas State Chamber of Commerce also opposes this so-called public option and another feature that requires employers to provide coverage to workers or pay a stiff penalty.

Ross generally agrees with their positions, but has to decide how far he can go without alienating Democratic leaders and many constituents who likely would benefit from access to subsidized health insurance and an expansion of Medicaid, the state-federal program for the poor.

Rich Huddleston, the executive director of Arkansas Advocates for Children and Families, a nonpartisan social welfare advocacy group, said of Ross: "We believe he supports the overall concern of health care reform . . . It's just our hope that whatever he tries to push around cost containment doesn't get in the way of promoting good health care for kids and their families."

Ross knows the problems, and says he is prepared to hold out for a better bill.

"You know, it's easy to provide everybody a shiny new insurance card," he said. "But what's important here is they actually have access to a doctor once they get the insurance card."

Ross' 4th congressional district covers the southern half of the state outside of Little Rock, with a third of it rural and the remainder dotted by towns including Hot Springs, Magnolia, Texarkana and Hope, the nearest town to Prescott with a hospital. Ross' 660,000 constituents have a median income of $29,675.

Prescott calls itself "The City of Progress," but the government seat of Nevada County is barely hanging on. Vacant storefronts dot the streetscape. Workers are losing employer-provided health insurance or paying more for it. An average of two in 10 residents have no health care insurance, and those who have coverage have seen their premiums skyrocket by 80 percent since 2000, according to data compiled by Ross' office.

Locally owned J.D. and Billy Hines Trucking Inc. has had to raise the deductible on its family policy to $2,000 to keep premiums, now $336 a month for employees, from rising faster. At her restaurant, Barham sometimes hears patrons talking about how they're going to afford prescriptions. "They'll say, 'I'm going to get half my medication," she said.

The area's health system has other gaps: Prescott's hospital, which was the only one in Nevada County, closed in 1995, with local doctors saying low federal reimbursement rates were partly to blame. Only three doctors practice here, and two are nearing retirement age.

Consider the situation of Dr. Charles Vermont. He typically sees 40 patients a day in his office, but also visits patients in the hospital in Hope and in local nursing homes.

He's 63, but can't plan retirement in part because he worries about who will take care of his patients. "Prescott is not a lifestyle destination," he said. "How do you recruit and retain new physicians?"

These issues worry Ross, 47, a five-term House member who's a former pharmacy owner and the grandson of a nurse. He said they're not fully addressed in the House of Representatives legislation, with its focus on providing insurance for millions of Americans.

"We are very committed to health care reform and making health insurance affordable and accessible," he said. "But we just think the Democratic leadership has gone about this the wrong way."

(Kaiser Health News is an editorially independent news service and is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization that's not affiliated with Kaiser Permanente.)

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