Democrat-led cities and states move toward universal health care on their own terms
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Democrat-led cities and states move toward universal health care on their own terms


JUDY WOODRUFF: Democrats in Washington are
making health care a top priority. And calls for Medicare for all or some form
of universal health coverage are growing louder. But, as special correspondent Sarah Varney
reports, Democratic governors and mayors aren’t waiting. They are pushing ahead with urgency, signing
executive orders and unveiling proposals to corral costs and bring health care to those
who remain uninsured. California Governor Gavin Newsom laid out
some of his ideas in his state of the state speech last night. Our story begins in California, and was produced
in collaboration with our partner Kaiser Health News for our weekly series on the Leading
Edge of science, health and technology. SARAH VARNEY: Sandra Yamileth Lopez works
at one of San Francisco’s most celebrated bakeries, Tartine. She fled horrific violence in Honduras and
applied for asylum in California. She can work legally, but, like many new immigrants,
it will be years before she’s eligible for Medicaid or federal health insurance subsidies. So, she enrolled in Healthy San Francisco,
a pioneering program that guarantees health care to any uninsured city resident. Lopez says she can live her life again. SANDRA YAMILETH LOPEZ, Healthy San Francisco
Patient (through translator): I often dreamt about what had happened to me. So they tried to give me sleeping pills and
medicine to calm me down, because, when I walked through a crowd, I felt as if something
could happen to me. I mean, I was psychologically traumatized. SARAH VARNEY: Healthy San Francisco started
in 2007, under then Mayor Gavin Newsom, years before the Affordable Care Act, when universal
coverage was an audacious and radically liberal goal. Partially funded through employer fees, the
city reorganized its public health system. Patients like Mario Goes were moved away from
expensive and overburdened emergency rooms, and into primary care clinics. They get visits to specialists, prescription
drugs, and, perhaps most importantly, protection from massive bills should they need emergency
care. After most of Obamacare went into effect in
2014, most Healthy San Francisco patients enrolled in Medicaid or bought subsidized
private plans. But about 13,000 remain, those who earn too
much for Medicaid, but still can’t afford private insurance, and people like Juan, who
are undocumented and barred from federal public assistance. He’s been recovering from a heart attack under
the watchful eye of a cardiologist and he’s now back at work in a local warehouse. He takes a number of prescription drugs that
he couldn’t otherwise afford. MAN: Just want to make sure that you can continue
to get those, those medicines. SARAH VARNEY: But here’s the dilemma: He’s
only covered inside the city limits of San Francisco. It’s not portable health insurance. Juan wants to move to San Diego to care for
his aging mother, but then he will be out of the program and unable to afford his medications. Is this hundreds of dollars a month or a few
dollars a month? JUAN, Healthy San Francisco Patient: Some
of them some of them over thousands of dollars a month, yes. And if I don’t have that coverage, in San
Diego, I would have to pay for it. And if I don’t take that medication, it’s
like — it could be life-threatening. SARAH VARNEY: Some three million Californians
remain uninsured. About half don’t have legal status, like Juan,
and the rest can’t afford the sky-high cost of American health care. SEN. BERNIE SANDERS (I), Vermont: Now is the time
to get it done! (CHEERING AND APPLAUSE) SARAH VARNEY: Fury over those costs, even
for those with insurance, has energized Democrats who want the U.S. to have universal health
coverage, like all other industrialized nations. But there are many variations: single-payer,
Medicare for all, plans that would largely do away with insurance companies or employer-based
coverage, others that would simply regulate them more closely. Now that the former mayor of San Francisco
has become governor, Newsom says he wants to make California a testing ground for universal
coverage. GOV. GAVIN NEWSOM (D), California: Premiums are
going up, deductibles are getting higher, people are feeling stress and anxiety about
what’s happening or not happening federally. And they’re concerned that things will get
worse, not necessarily better, in the medium term, and a lot worse in the long term. SARAH VARNEY: Newsom has asked the Trump administration
to allow California to pursue a single-payer system. Since that’s unlikely to happen, he’s pursuing
other options by creating what he says is the nation’s largest prescription drug purchasing
pool to negotiate drug prices, restoring the individual health insurance mandate, letting
undocumented young adults up to age 26 into Medicaid, and giving state subsidies to 250,000
more middle-income Californians. GOV. GAVIN NEWSOM: You look around the rest of
the world, they’re just rolling their eyes, higher life expectancy. They do chronic disease management better
than the United States for roughly half the price. You look at quality indexes, we dropped to
37 in the world in our quality index last year, below Cuba and Costa Rica. This is ludicrous, and so it’s incumbent upon
governors, mayors to take the lead, in the absence of the federal government doing its
job. SARAH VARNEY: And that’s happening across
the nation. In Washington state, New Mexico, Colorado
and elsewhere, Democrats have put forward a flurry of proposals to expand access and
restrain health care costs. And, in New York City, Mayor Bill de Blasio
is promising health care to undocumented immigrants and those who can’t afford insurance. BILL DE BLASIO (D), Mayor of New York: There’s
enough people in this city who don’t have any health care coverage to fill the entire
city of Milwaukee or the entire city of Baltimore. There’s just a vast number of people. SARAH VARNEY: It’s a total of some 600,000
New Yorkers. De Blasio recruited Dr. Mitch Katz, the public
health mastermind behind Healthy San Francisco, to build a similar program in the city’s five
boroughs. They plan to pump more than $100 million a
year into the city’s financially strained public hospitals and clinics and actively
enroll the uninsured into a program called NYC Care. That includes struggling young people, like
freelance musician and composer Andrew Sharkey, who has Crohn’s, a serious bowel disease,
that has gone untreated. He dropped his coverage in 2015. ANDREW SHARKEY, New York City Resident: I
just didn’t know where the money was going to come from. I was working two jobs. They were both part-time, so they didn’t have
to pay into my insurance. SARAH VARNEY: Under de Blasio’s plan, Sharkey
would have a regular primary care doctor and treatment from specialists and access to prescription
drugs. Word about NYC Care is already spreading among
the more than 300,000 undocumented immigrants in the city, like Antonio, who asked us to
use only his first name. He thinks de Blasio’s plan would simplify
his life. He could focus more on his health and work,
and less on the endless paperwork that comes with being uninsured. ANTONIO, New York City Resident (through translator):
Oh, my God, that is going to be a great change for everyone. Now, when I go to an appointment, I need to
be running around from social workers, to organizations, to find a way to reduce those
bills. SARAH VARNEY: Americans already pay for undocumented
immigrants when they come to the emergency room, says Mayor de Blasio. BILL DE BLASIO: Let’s face it, we kind of
kid ourselves in this country about the reality of health care. So, right away, we have got 12 million, maybe
even more, undocumented folks who are part of the fabric of the United States of America,
and who need health care because they are human beings. But in all of our policy-making, we deny their
existence. This is the greatest don’t ask, don’t tell
you have ever seen. We should have universal health care nationally. We should have single-payer. We should have Medicare for all. But, in the absence of that, health care has
become this luxury item for so many people. SARAH VARNEY: Universal health care polls
well with American voters. But the Trump administration says, if it became
a national policy, it would consume the federal budget. Seema Verma runs the federal Centers for Medicare
and Medicaid Services for the Trump administration. SEEMA VERMA, Director, Centers for Medicare
and Medicaid Services: It’s fiscally unsustainable. But to make matters worse, it would destroy
Medicare for the seniors who have spent their whole life paying into it. SARAH VARNEY: And some Democrats are voicing
warnings of their own. Former Vermont Governor Peter Shumlin, a Democrat,
was forced to abandon his attempt to bring single-payer to his state. PETER SHUMLIN (D), Former Vermont
Governor: What I realized, and I think a lot of legislators too, did was, hey, if we don’t
get costs under control first, instead of getting that premium increase in the mail,
you are going to get a tax increase passed to your legislature on an annual basis. And there aren’t very many politicians from
any party who want to be raising taxes at the rate of our current health care inflation. SARAH VARNEY: Fifteen percent every year,
18 percent. PETER SHUMLIN: So, 15, 12. Can you imagine the politicians going, hey,
this is fun? SARAH VARNEY: As Democrats across the country
and in Washington push ahead with their health care agenda, patients like Andy Sharkey are
listening carefully. For the “PBS NewsHour” and Kaiser Health News,
I’m Sarah Varney in New York.

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