Neal spent time discussing various issues, though health care was the top, with reporters after announcing a grant for Fairview Hospital on Thursday.
GREAT BARRINGTON, Mass. — A single payer health care policy has been picking up steam and support among Democrats locally and nationally.
It had been a key part of Bernie Sander's presidential platform. U.S. Sen. Elizabeth recently called for such a program to be considered. And Massachusetts state legislatures have put forth a bill to study on moving to one.
But U.S. Rep. Richard Neal is somewhat more reserved about bringing such a program to the federal level. He says he'd like to see Massachusetts enact single payer first, and then the federal government can replicate it.
"I think when you reorganize 20 percent of the national economy, you need to do it on a fact-based initiative," Neal said on Thursday.
Neal didn't reject single payer, but rather said he'd like for state leadership to implement it first. That's the same path forward as what happened with the Affordable Care Act. Massachusetts created a model of universal care first, and then the national lawmakers could review and learn lessons from that when crafting their own.
"The ACA was modeled on what we did in Massachusetts. Let's see if we can emulate the same here," Neal said.
What Neal is more focused on right now is protecting Medicare, Medicaid, and the Affordable Care Act. Neal says hospitals in Massachusetts are dependent on that revenue and he doesn't want to see those programs gutted.
"These hospitals are heavily dependent on Medicare and Medicaid. The rule of thumb is about two-thirds [of revenue from those two programs]. If you go to Mercy in Springfield and Holyoke Hospital, those numbers are north of 80 percent," Neal said.
The Affordable Care Act is particularly under threat as Republican leaders and President Donald Trump have called for the repeal. Republican leaders had put forth plans to repeal and replace the ACA, but struggled to find support. More recently there have been calls for repealing it and then working on a replacement program later.
"I hope that they don't come back and say we're going to repeal and then wait until after the next election cycle to tell us what's going to happen after the election. That will satisfy a political issue but I'm not sure that it satisfies the policy side of the issue," Neal said.
Neal says repealing the ACA will mean 23 million people will lose insurance. He says that while the ACA isn't perfect, it can be fixed.
"You cannot deny today that 23 million more Americans have health insurance than before the Affordable Care Act. But you can't put your head in the sand either and say there haven't been some problems with it. The problems, overwhelmingly, have been in the single-market space. The individual who purchases private health insurance. It is about 8 percent of overall expenditure but is about 100 percent of the bad stories," Neal said.
"If we were in a more reliable and stable political system, we would have gone back and repaired these things."
Neal says the bickering in Washington over the health care system is getting in the way of progress on other issues.
"Before you go forward with health care before you go forward with tax reform, you need a budget. It is just kind of interesting that if you heard for years with the Obama presidency we couldn't pass a budget, well, they can't pass a budget now. It is an example of how strident political debate has become across the nation," Neal said.
"I think there are more crusaders in public life than there are legislators. I think there are more people who are very good at the microphone. And I think there are some of us very interested in policy, who have spent decades doing this. I think you always look for a modicum of where you can find common ground and if we were to lower our voices, for example on health care, we could find a path forward."
All of the debate over health insurance policy is causing harm to the industry, he said, because insurance companies and hospitals are stuck wondering what will happen on the federal level, and how it will impact them.
"You can't plan if you don't know what is going to be there. One of the things they've done is provide uncertainty to insurance markets everywhere. It is causing the private insurance groups to back off a bit because they don't know how to plan. Hospitals don't know how to plan for reimbursement schedules. On one hand, they are saying they are going to repeal but without saying what they are going to replace it with, causes great uncertainty," Neal said.
Neal's statements on health care were delivered to reporters on Thursday after the congressman announced a $100,000 grant to help Fairview Hospital develop a more robust service network with community partners. Neal said there are provisions in the ACA which help protect rural hospitals like Fairview, which is more reason he opposes Republican plans to repeal the act.
He said rural hospitals across the country are struggling. The county has already lost one hospital in the former North Adams Regional. Since then Berkshire Medical Center has taken over the property and restored some, by not all, of the services. Neal said he'd be supportive of efforts to restore a full-service hospital there, but "it is a big lift."
"If you didn't have a star in the health care galaxy in Berkshire Medical Center, you may have ended up with nothing there. I think that Berkshire Medical was able to put together what they have is a good start. Many of the problems they had at the hospital in North Adams were well advanced when I became the U.S. Rep for that area. I recall visiting and you could see by the testimony that there was a series of structural differences and I think as time goes on, I'm certainly more than willing to try for a full-service hospital," Neal said.
"But, I must tell you, it is a big lift. Today there are not many hospitals across the country, if any, that say they will reopen after they have closed their doors."
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