Asthma, diabetes, heart disease: Central Valley health care is personal and political

Democrat Jessica Morse debates GOP Rep. Tom McClintock at Mariposa High School on Sept. 23. The Fourth Congressional District is the highest profile of Sacramento-area U.S. House races.
Democrat Jessica Morse debates GOP Rep. Tom McClintock at Mariposa High School on Sept. 23. The Fourth Congressional District is the highest profile of Sacramento-area U.S. House races. jwalker@fresnobee.com

Poor air and water quality, pesticides, food deserts and lack of accessible recreational spaces form a toxic cocktail plagues California’s Central Valley — and that’s made the area’s too-close-to-call House races virtual referenda on health care policy.

It’s a debate that’s unusually personal to a lot of voters in the region, voters who not only have incomes lower than state and national averages but suffer in big numbers from asthma, diabetes and heart disease.

About 10 percent of people in the Valley have diabetes, 26 percent have high blood pressure, 31 percent report some type of disability and 26 percent say they are in only fair or poor health, according to the most recent figures from the UCLA Center for Health Policy Research.

Democrats are pushing particularly hard, challenging vulnerable Republicans in the area and telling voters they’d maintain and boost protections for people with pre-existing conditions.

Republicans are insisting they can craft a health care system that’s less costly and will make it easier to get care.

Central Valley counties such as Fresno, Stanislaus and Merced have some of the highest shares of residents who have benefited from the expansion of Medi-Cal, California’s version of Medicaid, under the Affordable Care Act, according to Gerald F. Kominski, a senior fellow at the UCLA Center. In the region, 42 percent of adults ages 19 to 64 use Medi-Cal, compared to 29 percent of adults statewide.

“These areas have lots of pre-existing conditions, lots of people who have benefited from Medicaid expansion and are vulnerable both financially and medically,” Kominski said. “And because they benefited more they stand to get really hammered if the Medicaid expansion is rolled back.”

The air and water quality in the Central Valley is poor because of geographic issues, such as wind patterns taking pollution from San Francisco and then swirling in the Central Valley due to mountain ranges, and realities of the agriculture industry that is prevalent in the area.

A federal court is currently considering a case that would fully dismantle the Affordable Care Act, which puts coverage of those with pre-existing conditions at risk. Under the ACA, insurers cannot deny coverage to people based on pre-existing conditions.

Democratic candidates point to the 54 times House Republicans voted to repeal the ACA without what Democrats called a substantial replacement. House GOP leadership has also talked about cutting safety net programs like Medicaid and Social Security, but hasn’t taken tangible steps to do so.

The campaign of Jessica Morse, the Democratic candidate trying to unseat Rep. Tom McClintock, R-California, has repeatedly cited McClintock calling some pre-existing conditions “nuisances” during a TV interview in February 2017.

He, as well as other Republicans, has proposed allowing more competition in the insurance market to drive down costs as well as creating high risk pools for those with pre-existing conditions, though he conceded in a debate with Morse “those are difficult to insure that way.”

McClintock’s campaign did not return a request for comment.

Josh Harder, the Democrat trying to unseat Rep. Jeff Denham, R-California, has repeatedly pointed to Denham telling constituents he would not vote for the Republican health plan in 2017 but ultimately doing so anyway.

“I’ve expressed to leadership that I’m a ‘no’ on the health care bill until it is responsive to my community,” Denham said at a town hall before the health care vote.

Denham said in an interview with McClatchy that he had meant he wouldn’t vote for a bill that stripped protections for pre-existing conditions. The Republican health plan weakened those protections by allowing insurance companies to charge more but still guaranteed coverage. It also would have repealed the ACA and rolled back a Medicaid expansion that benefited low income adults. It went nowhere in the Senate.

The Democratic Congressional Campaign Committee launched new Spanish ads against Denham Wednesday on the congressman’s change. His district has a significant Hispanic population.

“Jeff Denham makes promises he doesn’t keep. Denham promised us he would vote against the Republican health care plan,” the TV and radio ad says. “But just days later, he did the opposite and voted for the plan, which would have been disastrous for the health and well-being of our community.”

Denham said he “absolutely” supports guaranteed coverage of those with pre-existing conditions, citing his co-sponsorship of a House bill that would continue those protections even if the ACA is repealed. That bill hasn’t gone anywhere.

Denham said he also supports the Medicaid expansion, but voted to repeal the ACA because costs for its patients continued to rise. He stressed his role in trying to bring more doctors to the community to expand access, which Stanislaus County Medical Society President Lynette Grandison applauded in a statement to McClatchy.

Denham accused Harder of being a “hypocrite,” citing his investment in Bright Health Insurance, which Harder worked with in his past role as a venture capitalist with Bessemer Venture Partners. The congressman said the company raised premium rates in Colorado while Harder was working closely with the insurer.

“Of the two of us, he’s the one who personally profited by raising rates, not me,” Denham said.

Harder called the assertion a “deep distortion” of his business record. He said he was responsible for a small investment in the company and then had no control over their business decisions. Venture capitalists with a minority stake in companies typically do not have direct control over those companies.

“This tenuous connection he’s trying to make just makes it obvious he’s trying to muddy the waters on this issue,” Harder said.

TJ Cox, the Democratic candidate working to unseat Rep. David Valadao, R-Calfornia, said health care is “absolutely the number one issue” in the district, and his ads remind voters how Valadao votied to roll back the Medicaid expansion. The ads also point to Cox’s work in the health care industry, and he emphasized in an interview with McClatchy his personal knowledge of the issue because of his wife’s job as a pediatric intensive care physician.

“She has kids keep showing up in her ICU for issues like poor air quality and water quality,” Cox said. “The amount of kids we have with pre-existing conditions here is double the national rate.”

While not double, the Center for American Progress, a progressive think tank, found there are about 52,600 minors in that district that suffer from pre-existing conditions, while the national average per district is about 40,400.

Valadao’s campaign did not respond to a request for comment.

Cox anticipated increased Democratic voter turnout due to the issue.

Health care costs are a huge concern for most Americans. A Kaiser Foundation poll among registered voters found health care was the number one issue for 27 percent of voters and one of the top issues for 81 percent. Seventy-five percent of people also say it is “very important” that protections for pre-existing conditions remain law.

Kate Irby: 202-383-6071; @KateIrby