Nancy Pelosi Visits the New Seton

U.S. House Minority Leader Nancy Pelosi was in town this morning, joining Austin Rep. Lloyd Doggett at a roundtable sponsored by Seton/Ascension health care. Following a tour of the nearly complete new Dell Seton hospital, the two officials hosted a discussion focused on the role of the Affordable Care Act.

With more than a dozen panelists joining the two officials in the Clinical Education Center of UMC-Brackenridge, the hourlong discussion was a fairly high-speed overview of the ACA. But the panelists did manage to review what the law has meant to many people who previously were uninsured and without access to regular medical care, the current threats from the Trump administration (and others) against the law, and what still needs to be done to provide broader and more effective U.S. health care.

In a fairly remarkable feat of moderating legerdemain, Doggett – introduced as a “Seton baby, father of Seton daughters, grandfather of Seton grandchildren” – managed to draw everyone at the table into the discussion, and beyond them a couple of attendees with a professional interest in the subject. Among the panelists were: host Yvonne VanDyke, chief nursing officer for Seton Healthcare Family; Larry Wallace, interim CEO of Central Health; Elizabeth Colvin of Insure Central Texas and Foundation Communities; Dr. Mark Hernandez, chief medical officer for Community Care Collaborative.

Musicians Ben Kweller, Tate Mayeux, and Daisy O’Connor were also on hand, sharing personal stories of the role of the ACA as well as the Health Alliance for Austin Musicians in helping them and their families – and representatives of Austin’s tech community shared similar stories.

If there was a running theme throughout the conversation, it was along the lines of “the ACA is absolutely necessary, but it isn’t enough.” The medical professionals described how, under the ACA, their patients have received health care that was previously unavailable, and also how it too often stops short of continuity, or indirectly denies care to some who need it most – e.g., in Texas, where the state’s refusal to accept Medicaid expansion has left many patients in “the gap” between the destitute and those who earn enough to qualify for insurance through the ACA marketplace.

The most striking anecdotes in that vein were from Lorie Miller, an oncology “nurse navigator” for Seton cancer patients. She recalled patients with no hope of care who were suddenly able to receive it under the ACA rules; she also recalled some who initially received treatment, but who found that after they received a certain level of Social Security disability income, they were dropped from continuing care because their income level had, mid-treatment, become “too high.”

Several speakers addressed two ACA provisions that had been crucial to their lives: 1) the “pre-existing condition” provision, that allowed them to qualify for insurance coverage even with health conditions that might have previously disqualified them; 2) the movability provision, meaning they could change jobs or take the risk of starting their own businesses while maintaining their health insurance, and not be restricted to “job-lock” by insurance needs.

Bill Blackstone, of Galvanize and Rackspace Austin, said that his work as an entrepreneur would have been impossible without the protections of the ACA. Barbary Brunner of the Austin Technology Council told similar tales, and noted that tech workers, like musicians – and often the roles overlap – work in risky professions that often can only be sustained with the safety net of health insurance.

Wrapping up the discussion, Pelosi welcomed Kweller’s description of the 20 million additional Americans covered by the ACA – aka “Obamacare” – as a “Double Diamond” achievement (in music industry parlance), and said she would be eagerly passing on that praise to Barack Obama. She and Doggett urged the audience to continue to turn out to support the law, as the two officials exchanged compliments for their roles in the initial adoption. Pelosi called Doggett “brilliant, impatient, persistent” in his advocacy for health care; Doggett credited Pelosi with insisting upon “health care as a right, not a privilege.”

“Public sentiment is everything,” said Pelosi, quoting Abraham Lincoln, and Doggett urged continued citizen engagement to defend the ACA. In a brief follow-up exchange, Doggett told the Chronicle that Trump had momentarily pulled back from a direct assault on the law – “that should enable insurance companies making decisions now about next year’s coverage to plan that coverage” – but that Trump might yet decide to undermine the law by cuts in appropriations, or other strategies.

Pelosi said that while the ACA has been the immediate target of Republican reaction, the full GOP intention is to “get rid of the public role” in health care, eventually targeting Medicaid, Medicare, and even Social Security in that campaign. “We have a real fight on our hands,” Pelosi said. “We have pushed open the gate to save lives, but there is more work to be done.”