Oregon GOP Congressman Greg Walden, who represents a large red district in a very blue state, will be the point man on replacing the Affordable Care Act if it is repealed in whole or part. His main job will be to balance politics with policy, and that won’t be easy.
A case in point: Walden’s Republican colleagues, many of whom he helped win election to the U.S. House, want to move ahead quickly on repeal of the individual mandate to have health insurance coverage. However, a map, conveniently posted online by Governor Brown, shows that rural areas Walden represents receive the largest amount of federal subsidies to pay for that coverage.
Walden also represents rural Oregon counties with as many as a third of their residents who are on Medicaid. Walden’s GOP congressional allies want to curtail federal spending on Medicaid, which could put states such as Oregon that expanded its Medicaid coverage in an even greater financial bind. The website www.95percentoregon.com says 1.1 million Oregonians are covered by Medicaid or the Oregon Marketplace.
Serving in his 10th term, Walden’s challenging political predicament captured the attention of Robert Pear, long-time health care reporter for The New York Times.
"As a former chairman of the committee responsible for electing Republicans to the House, Mr. Walden knows the politics of health care as well as anyone,” Pear wrote. "But in his new role, he must reconcile the political goals of his party, which is committed to repealing the 2010 health law, and the interests of his state, where officials say the law has been a big success. In 2010, nearly one in five Oregonians lacked health coverage. Today, state officials say, 95 percent of Oregonians have coverage.”
Unlike some of his colleagues, Walden’s town hall meetings have been respectful, if forceful about the importance of retaining viable health insurance for individuals and families not covered by policies paid for by their employers. Walden has responded by telling constituents he will ensure pre-existing conditions cannot be used to deny coverage and complimenting the strides Oregon has made in terms of coverage and addressing the cost of health care through coordinated care organizations (CCOs).
“Our state of Oregon has had quite a bit of innovation over the years,” Mr. Walden told Pear. “We’ve got the coordinated care organizations in place that have actually brought better health care outcomes at lower cost. There are great ideas out there among the states, but right now, they have to come back and beg permission from a federal bureaucrat to be able to do much of anything innovative.”
Nevertheless, Walden has consistently called for and voted for repeal of Obamacare. Some of his constituents he is more discriminating in what replaces Obamacare.
Pear interviewed Dennis Burke, president of the Good Shepherd Health Care System in Germiston, who said, “Medicaid [expansion] did better than expected and subsidized commercial insurance did worse.” Even though people participating in the federally subsidized individual health insurance market “proudly present an insurance card,” Burke said premiums and deductibles have sharply increased, driving health people from the marketplace,
Burke’s advice to Walden: “I think [Obamacare] could be fixed. We need more of a retooling.” That may be advice Walden has a hard time convincing his Republican colleagues to accept.