Health Care

Congressman DeFazio is committed to reining in the escalating costs of health care and ensuring access to quality health care for all Americans. Our health care system is capable of providing quality care to some, but that care can still be inefficient and expensive. Other Americans are left with poor care at best. The health care system is failing too many people. Too many families are vulnerable to the whims of the insurance and pharmaceutical industries, which are more interested in protecting profits than the health care of hard working Americans and seniors. Seniors are vulnerable to the same insurance and pharmaceutical industries, but their Medicare is also under an ideological attack.

Major Accomplishments  

Ending Abusive Insurance Industry Practices

The insurance industry has operated beyond the reach of America's anti-trust laws since the McCarran-Ferguson Act was passed by Congress in 1945. The insurance industry should play by the same rules as other industries in America. Insurance companies and Major League Baseball are the only two industries exempt from anti-trust laws. Insurance companies are free to collude amongst themselves to drive up prices and deny care.

Congressman DeFazio has been pushing to repeal the antitrust exemption for the insurance industry for 20 years. The Consumer Federation of America has said that this action alone would save consumers 10 to 25 percent on their premiums. Since the Senate stripped these reforms from the final health care bill, Congressman DeFazio successfully fought to have it passed as its own bill but it failed to advance in the Senate.

Protecting Medicare

DeFazio has successfully opposed efforts to privatize Medicare and lower benefits for seniors. Medicare was created because, at their age and with their pre-existing conditions, seniors could not purchase an affordable private health insurance plan. As a result health care costs were driving American seniors into financial ruin, often forcing them into poverty. DeFazio is opposed to any plan that brings those days back for current or future retirees. 

Medicare’s administrative costs are about 2 percent compared to 25 to 30 percent among private insurance companies. Medicare does, however, suffer from the same rapid increase in health care costs that is affecting all health insurance. Proposals that simply reallocate costs to seniors would not lower health care costs; it would simply shift the costs onto seniors. Healthcare costs need to lowered for everyone, not just seniors.

Improving Access to Care for Medicare Recipients

Because of an old Medicare reimbursement formula, Oregon was one of 17 states where doctors and hospitals received Medicare reimbursements at rates far below the national average, despite delivering better health outcomes. Oregon doctors were increasingly unable to take new Medicare patients because reimbursement rates were so low that they lost money on every patient.

After decades of trying, Congress finally fixed the Medicare geographic disparities formula. With the leadership of Congressman DeFazio, an agreement was reached that will fix the outdated formula and provide a path forward for the future. Because of this effort, Oregon doctors and hospitals will receive immediate relief for their unfairly low Medicare reimbursement rates.

Closing the Donut Hole and Lowering Prescription Drug Costs

The prescription drug Medicare Part D program gave massive subsidies to the insurance and pharmaceutical industries and created the dreaded “donut hole,” where seniors would lose coverage for prescription drugs.

The Affordable Care Act has begun to phase out this doughnut hole, helping over 14,000 seniors in the 4th district of Oregon. It also will provide a 50 percent reduction on brand name drug prices for seniors as they enter the donut hole until it is completely closed in 2020. So far, more than 10,000 seniors in the 4th District have received discounts.

Affordable Care Act

The Affordable Care Act was upheld by the Supreme Court. I have always said the law is not perfect, and I have been vocal about needed improvements such as antitrust protections and individual mandate reform. I am committed to working with my colleagues on both sides of the aisle to make common sense changes to the Affordable Care Act. No matter how you feel about the law, you should understand how the law will, or in many cases will not, affect you:

Medicare:

• If you are a senior on Medicare, you can now visit your doctor for preventative services without paying anything out of pocket. Nothing else about your Medicare will change.

•More than 52,000 seniors in Oregon who fall into the dreaded “donut hole” have already had their prescription drug costs reduced. The donut hole will be completely eliminated by 2020.

Small Business:

• If you run a small business with fewer than 50 employees, you will not be required to provide insurance to your employees. If you want to provide insurance, you may be eligible for a discount worth up to 50% of your contribution toward employees’ premium costs beginning in 2015.

Individual Private Insurance:

• If you buy your own insurance or are currently uninsured, you can shop for competing private insurance plans at www.healthcare.gov. If you make less than $44,680 as an individual or $92,200 as a family of 4, you will receive a discount on your premium. Last year, nearly 90,000 Oregonians received a discount. You can instantly calculate your premium on Healthcare.gov website: https://www.healthcare.gov/find-premium-estimates/

All Private Insurance:

• Insurance companies can no longer deny you care or rescind your policy because of a pre-existing condition or ongoing illness beginning in 2014. Without this protection more than 1,692,000 people in Oregon, including 207,000 children, could be denied insurance for having had conditions as common as high blood pressure or cholesterol.

• Kids can no longer be kicked off of their parents’ insurance the day they graduate from college. Now kids can remain covered by their parents’ policy until age 26. In Oregon, this affects 43,000 young adults. In Oregon's 4th Congressional District, this affects 10,400 young adults.

• Your insurance company is no longer allowed to place a cap on how much your policy will pay for medical care each year and over your life.

• Insurance companies now have to pay at least 80% of premiums back to customers as benefits. They used to be able to spend as much of your premium as they wanted on bonuses for executives and other things that did not benefit you. Because of this rule, nearly 50,000 Oregonians received rebates from their insurance companies.

Lowering Health Care Costs

The Affordable Care Act does not add to the deficit. The Congressional Budget office (CBO) , the official nonpartisan arbiter of the cost of legislation, estimates that it will lower the deficit by $143 billion in the first ten years and those savings would grow even more in the next ten years. CBO also estimates that premiums for families with comparable coverage will be lower under reform. More savings can be found by changing the way healthcare is delivered by incentivizing healthcare providers to work with each other and coordinate care for every patient.