Herseth Sandlin says she's available for health care talks

One way to get the attention of U.S. Rep. Stephanie Herseth Sandlin is to accuse her of not being accessible to constituents to discuss health care reform.

While U.S. Sen. John Thune, R-S.D., has scheduled four public meetings, Herseth Sandlin, D-S.D., said she, too, has been available to discuss health care. She said she had meetings in July with different stakeholder groups in South Dakota and Washington, including insurance, doctors, patient advocacy and long-term care groups. She noted she attended the Midwest Rural Assembly last week and Chamber of Commerce events during the congressional August recess.

In response to whether she would have town-hall meetings as Thune is, the six-year representative emphasized that those stakeholder and Chamber meetings were open to the public. She also has been attending fairs in the state and said she has made herself available to people after such events, including Dakotafest in Mitchell earlier this week.

“They were well publicized,” she said in a strong tone of voice. “I have found that when people have questions, I have great interaction with people at different types of community events and at these Chamber luncheons. That’s not a stakeholder in the health care industry, but those are businesspeople who are not only representing themselves, but either their employees or they have family members or friends who don’t have insurance.”

Herseth Sandlin this week shared her views with The Daily Republic while she was in town for Dakotafest.

Following are her answers to questions posed during the session.

Q: Was the Dakotafest forum an ag speech where health care broke out?

A: Oftentimes, the Dakotafest forum goes beyond ag energy issues. While the people that are there are sometimes focused on agriculture or renewable energy, you do draw a number of folks that maybe wouldn’t attend Dakotafest otherwise and want a chance to see their political candidates or representatives in Congress. I fully anticipated there would be health care questions because it’s rural America. People in farming and ranching who are paying top dollar for insurance in an individual market or the spouse is going into town to take a job to get health benefits. Or they don’t have insurance because it’s cost prohibitive. I expected and actually welcomed the questions by even referring to it in my opening comments. It was a good opportunity.

Q: Are you going to do any open houses or health care forums while you’re back during recess?

A: I already did in July. I did a series of them in July in preparation for the fact that after the climate bill, I knew the health care bill was coming. I had a number of hearings in addition to all of the meetings I do in South Dakota and Washington with the different stakeholder groups, whether it’s the insurance, the doctors, patient advocacy groups, the long-term care groups. So I feel like I’ve had a lot of meetings and will continue throughout August, whether it was the Midwest Rural Assembly last week, whether it’s the Chamber of Commerce of events I always commit to. … In addition to my time at the fairs, we always let people know what time I’m going to be at the fair and which booth to visit with people one-on-one.

Q: It sounds like you have done a lot of meetings with stakeholder groups, but are you planning any town hall meetings with the regular people?

A: We did those all in July. They were all open to the public. They were well publicized. And I have found that when people have questions, I get great interaction with people at different types of community events and at these chamber luncheons.

Q: Several people spoke to you after the panel discussion (at Dakotafest). How many of them brought up concerns about health care reform and what were those concerns?

A: Half of the people wanted to talk about health care. One was a gentleman who farms in southern Davison County and pays $2,100 a month for him and his kids. He’s like, “I can’t keep (it).” This is the example of the guys paying top dollar for insurance in the individual market. Three of the people there were concerned about the public option. They wanted to know where I stood on co-ops. A couple of people gave me letters on how it’s going to be paid for or changes in Medicare. … I think that people have the same questions about co-ops that I do because we haven’t seen what the Senate Finance Committee is considering there yet. We’ve now started to hear from health-care … experts who think co-ops could work effectively and others who don’t. (It’s) all the more important to have slowed this down to get this kind of analysis and feedback without rushing this through artificial timetables and having to explain a bill to our constituents when we haven’t been afforded the opportunity to fully understand it and its implications.

Q: Have you read the Democrat version of the bill?

A: I have not only read it, but I have gone through, more importantly, a section-by-section analysis of it to understand the implications. We had a five-hour caucus meeting where we raised a number of questions about it. Now since that time, it’s undergone changes in the Energy and Commerce Committee. So in addition to the meetings I’ve been having since I have been home, I have been looking at what changes they may have made in committee but then have to marry it with two other bills in the House. So we’re going to have to go through the same process when we get back once the chairman and the committee members get back and meld the three bills.

Even then it’s going to undergo change because people will say, “I can’t vote for it if it doesn’t have that. We have to do more on the employer protection side or we have to do more on cost containment.”

Q: What do you think is going to happen with the public option?

A: I think that it will not survive the conference committee. I think that there is a chance that it could survive the House bill but only if structured under very stringent requirements to meet the many concerns that people have about the potential of driving out private companies that would offer plans on the exchange.

Q: Where do you stand on it?

A: I would prefer that a public option, if we have one, would have a trigger. I want to take a closer look at the co-op proposal before I take a position on whether I think co-op or a public option with a trigger, with a look back, is the most appropriate mechanism to hold private insurance companies accountable to hold down costs. As I said at the forum, Medicare Part D actually has a trigger for a government-run Medicare Part D option. It hasn’t been triggered because thus far, even though we have started to see premiums increase for seniors who take Medicare Part D, they have been able to keep the costs below what was projected. ... That’s why the Blue Dogs put forth in our statement of principles that if we have a public option, we’re not convinced it’s necessary. If we have one though, it has to be structured this way — you have to carry a reserve. You have to negotiate rates so you’re competing fairly and offering true choice in competition. … Many Blue Dogs, including myself, want to see how the co-op might be structured. We would be comfortable with a member-owned, nonprofit, member-operated system. I think we still have some work there before I can determine my preference.

Q: Do you have any amendments that you want to offer or ones that you specifically want to support?

A: A number of the changes that were made in the Energy and Commerce Committee because of some the Blue Dogs negotiated would be some that I would have supported. Now I’m still in the process of seeing what additional amendments I would have to offer based on how they might meld the bill. But clearly, we want stronger language in the form of an amendment if need be or put in a manager’s amendment to deal with the disparity for Medicare reimbursement. For South Dakota, 19 other states and parts of other states (they) have had this lower reimbursement for Medicare for decades. That’s a threshold issue for me. … The Senate Finance Committee … is actually looking at no employer mandate. At one time, it was toying with the idea of an individual mandate. You have to deal with the free riders in the system somehow so that we don’t keep having the uncompensated care.

If you set up a system where you’re providing credits for people to afford a plan on the exchange if they don’t have employer-sponsored insurance, then you’ve got to have some way of not just through the incentive but making sure people are participating so that they’re not continuing to shift costs on the ranks of the uninsured.

Q: You read about 50 million uninsured Americans, but many sources say that number is unrealistic for a variety of reasons. Wouldn’t it be best to focus on those who are just truly uninsured and try to clean up other problems in health care like the crazy settlements … or is this the answer?

A: That’s part of the problem, in my opinion, with the House bill is that some of my colleagues got so enthusiastic about extending coverage to the ranks of the uninsured that they paid very little attention to cost and reform. So if you’re just going to move all these people into a system that we can’t sustain financially, that’s just kicking the can down the road and reforming Medicare, dealing with issues in Medicaid as well and entitlement reform. It also raises the question: Well, how generous of a benefit are we going to be able to provide in terms of how we afford it?

I understand people are getting nervous that here we’re trying to deal with the uninsured but you’re messing with mine. That’s where I think the discussion around the public option is focused. There’s concern people have that if we have a government-run program that even though the president says, “If you like it, you can keep it.” There is a sense that if you set up a government program, it’s going to drive everyone else out of business and I can’t keep it. (It’s) a legitimate concern, which is why you have to be very careful of how you structure a public option if you have one. If it’s government-run vs. co-op owned. If it’s a player right away or if it comes in on a trigger. The reason is that public option is part of the discussion for some of us or a co-op is the issue of containing costs, of injecting competition to bring down premium costs. Some of my colleagues are convinced that you have to have a government-run program to help bring that down — a true competitor. They think that co-ops will take too long to establish. They won’t have enough market share. Those are legitimate questions that we should raise.

Q: How long do you think the debate is going to last? Do you foresee this extending well toward the end of year or early next year?

A: Possibly. I think there will be a real push, especially if the Senate Finance Committee can produce something. I think there will be a real full-court press by the White House to try to get both chambers to act on something just to get it out of the chambers, get it to conference (committee) if the Senate Finance Committee can act. … I think you’re looking at November, possibly December before something can be signed.

Tags: stephanie herseth sandlin, health care reform, news