Shawn Vestal: Elegance wasn’t really the issue, Congressman Labrador

Raul Labrador says his words were inelegant.

Labrador – the would-be next governor of the Gem State – says that the media has focused unfairly on a five-second clip of him sticking his foot in his mouth at a town hall in Lewiston. But his words in that clip were elegant enough to make it clear: He and the others who are trying to do things that will worsen the health care system for vulnerable people either believe – or are willing to say – things that are demonstrably not true in order to minimize the level of need and inoculate themselves against seeming to be the kind of people who would do what they want to do.

Labrador says that when he confidently stated, “Nobody dies because they don’t have access to health care,” what he really was trying to “explain” was that he completely rejects the notion that the GOP plan will “cause people to die in the streets.”

“I was trying to explain that all hospitals are required by law to treat patients in need of emergency care regardless of their ability to pay and that the Republican plan does not change that,” he said in a news release.

So, there’s a real feather in the cap of the GOP plan: It continues to require hospitals to treat you if you show up dying at the ER.

The sales job that Labrador, Cathy McMorris Rodgers and the House GOP are trying to put on their American Health Care Act would make a snake-oil salesman blush. They are claiming, variously, that: cutting Medicaid by more than $800 billion won’t result in fewer people having health insurance; that adding back a fraction of that amount to help sick people will fix that; that allowing insurers to charge more for pre-existing conditions is a way of protecting people with pre-existing conditions; that letting insurers reduce benefits or cap payments will work out fine because states will incubate magical solutions.

All that, plus: Nobody dies because they don’t have access to health care.

So, whatevs.

I think Labrador succinctly and accidentally expressed an important and factually aloof belief that lurks mostly unstated inside politics on the right: The safety net is too big and too soft, the people who use it are mostly undeserving, and those who speak up for them are hysterically overstating the case.

It’s extra ironic for Labrador to make this statement, given that the state he represents has managed to allow its Medicaid gap to thrive since the passage of Obamacare – meaning that some 78,000 Idahoans make too much to qualify for Medicaid but too little to qualify for subsidies to help pay for private insurance. This population was meant to be covered by an expansion of Medicaid, but Idaho has rejected – and rejected, and rejected – that expansion.

Dr. Ken Krell, an Idaho Falls physician who has campaigned in favor of closing the Medicaid gap, seems quite confident that the working poor and others in the Medicaid gap often suffer worse health than the insured. Without primary care access, their conditions deteriorate and become more expensive to treat, for them and for the system that often ends up absorbing the costs of those ER visits the GOP is protecting.

“Several times a week I see people who have delayed medical care because they don’t have coverage, either Medicaid or insurance,” Krell told the Idaho Falls Post-Register in 2015. “They put off being seen until it’s really dire. It’s a very common occurrence.”

But nobody dies, right? Like, in the streets, before they can make it to the ER?

Krell has spoken about the death of one of his patients, Jenny Steinke, who was in the Medicaid gap and unable to afford insurance. Steinke died in 2015 after suffering a severe asthma attack that Krell has said would have been preventable with routine preventive care.

Her story has been a prominent part of the effort to get Idaho lawmakers to close the Medicaid gap, which has fallen on deaf ears – ears like Labrador’s – in the Idaho Statehouse. It is, after all, just one story. Just one person’s life. An anecdote, an aloof critic might say. And you shouldn’t make policy by anecdote.

But the data on the question is stronger than that, for those who care to see it. Andrew Wilper, a primary care doc and researcher at the University of Washington, was a part of a Harvard team that analyzed the effects of insurance on health outcomes in 2009. The team estimated that nearly 45,000 deaths each year were tied to a lack of health insurance – more than the estimated number of deaths from renal failure.

He testified before a Senate committee in 2013, and his words read today like an elegant answer to Labrador’s verbal shrug.

“The body of literature is enormous, and the signal is clear; lack of health insurance is definitely associated with decreased access to medical care and poorer health for those without such access,” he said. “Lack of health insurance is associated with worse health status, decreased likelihood of having a usual source of medical care, and death.”