INSIGHTS | Democrats in 2020 will try to breathe life into the health care issue

Jun. 28--Two freshman Democrats in Congress were talking about the policy and politics around health care in their districts recently.

U.S. Rep. Joe Neguse met June 14 at a conference table in Boulder with a dozen people -- advocates, a diabetes doctor, a 17-year-old with the disease, a retired pharmacist and a cancer survivor -- to talk about the high cost of staying healthy and staying alive in an expensive, complicated system.

Meanwhile, on the same day, Rep. Jason Crow huddled with constituents in Aurora on health care. That wasn't a coincidence, but a strategy.

Democratic House leadership dispatched members across the country to raise the profile of an issue that the left hopes to use to beat up on Republicans on the campaign trail next year.

Neguse chalked up the lack of productive talk on the life-and-death issue to the "current media environment" -- read: the obsession with President Donald Trump. Neguse said he's never heard anyone say America's health care system works or that the prices seem fair.

Sometimes, people pay with their lives trying to afford the drugs they need. One in four of the nation's 7.4 million diabetics ration their insulin because of its high price, according to a Yale Diabetes Center study last December. Some of those people live in Boulder and across Colorado, Neguse said.

Retired pharmacist Virginia Gebhart of Lafayette sat next to me at the rectangle of tables set up by Neguse's staff. I poured each of us a glass of water before she told her story. Gebhart's son had a liver transplant in 2007 when he was in his 20s. The medicine he had to take cost $9,000 a year, and the rules to get it were always changing. He spent hours on the phone with his insurer.

"As a young man trying to take ownership of his life and ownership of his illness, he was literally abused by the insurance companies and PBMs," Gebhart said, referring to the acronym for pharmacy benefit managers, the administrators who determine which drugs insurance companies allow and how much they cost.

"At first when he was getting his medication, we had reasonable co-pays and we could go anywhere to get the prescription filled," she said. "But then they kept piling on more restrictions, narrower networks, then they forced him to go to mail order, which was a nightmare for a young man trying to navigate that system."

Gebhart's son asked his mom why his insurance company made it so hard for him to get his medicine.

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"I said, 'Michael, I'm sorry to tell you this, but the reason is because they want you to go away,'" Gebhart recalled. "They want higher-cost individuals to say, 'Oh man, this insurance company is so terrible, I better go with somebody else.'"

She told her son, "You have the bad manners to actual need medication on a long-term basis, so they want to get rid of you."

Gebhart, an advocate for Medicare for All, said her personal and professional experience leads her to believe high prices and frustration are by design. First the drug makers set astronomical prices, then pharmacy benefit managers negotiate a little but mostly advise insurers to square the costs with higher co-pays, difficult authorizations and, of course, higher premiums.

"The strategy is to shift more and more of the cost onto the backs of sick people," Gebhart believes.

The group's conversation keyed in on drug prices, among the ills of the American health care system. But all the issues related.

Insurance is so expensive that many people turn to cheaper, higher-deductible plans that also come with co-pays so high that they're almost as bad off as those with no insurance at all. They're insured just enough to keep the government off their back.

But when those people can't afford their medicine, they wind up in the hospital, and the unpaid cost gets passed on to taxpayers and insurers, who raise the rates some more.

It's as connected as the passengers on a sinking ship. We all pay. And year after year, administration after administration, Americans are left to dog paddle in what both sides call a crisis.

One of the first bills Neguse co-sponsored in Congress was about drug-price relief, which Democrats say will shave $360 billion off the price of U.S. drugs in a decade by negotiating for the price Canadians pay.

Despite the Democrats' majority in the U.S. House, the bill hasn't budged since it was referred to a subcommittee on Jan. 25.

Neguse said it's hard to make progress on the big issues, while Republicans continue to hammer away in Congress and in the courts to undermine President Barack Obama's Affordable Care Act, rather than trying to improve the current system.

"If you were going to design a health care system that is expensive and inefficient, this would be it," Neguse said.

He praised his predecessor in Congress, Jared Polis, for making the high cost of health care front and center as governor.

Colorado is creating governance that federal policymakers could look to, including a new $100 cap on insulin co-pays and a law enforcement investigation into why the prices of the life-sustaining drug skyrocketed without clear reason.

"I feel like we're emulating a lot of what we're doing in Colorado," Neguse said of D.C.

We're yet to see if talk matters in either place, however.

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