Residents tell Casey about health care concerns

Breaking into tears as she addressed U.S. Sen. Bob Casey, D-Pa., Margaret Deterline rattled off the medical bills that seem to arrive constantly in her mailbox.

“It gets to the point where you have to wonder, ‘How are you going to pay?'” Deterline of Altoona said. “I just take one day at a time and deal with whatever comes my way.”

The Tuesday meeting at Primary Health Network’s Altoona Community Health Center demonstrated the complications of health policy in Washington: Democrats such as Casey are fighting to preserve the Affordable Care Act but must acknowledge its limits as angry constituents turn out in growing numbers.

“We’re going to have some tough debates in the next few weeks and even months,” Casey told a circle of health care officials, practitioners and local political figures. “The good news is we’ve figured a lot out. The bad news is we’ve got a long way to go.”

The Affordable Care Act, often called Obamacare, has been embroiled in questions and controversies since Donald Trump won the presidency in November. After vowing for years to eliminate the law, Republicans in Congress have found themselves without a single, clear replacement plan — instead passing piecemeal reforms and worrying privately that repeal could be near-impossible.

In the past month, members of Congress have faced angry town hall meetings and millions of phone calls from constituents demanding Obamacare’s preservation. On Tuesday, locals gathered to demonstrate outside the office of U.S. Rep. Bill Shuster, R-9th District, to demand a meeting.

A few miles away in Altoona, Casey framed the fight to keep Obamacare — as well as Medicare and Medicaid — as merely the first step in a long campaign to reform and preserve the government role in health care. Calling the Republicans’ responses “schemes, not plans,” Casey said privatization ideas pushed by some on the right would be disastrous in Pennsylvania. Some in Congress have toyed with turning the low-income Medicaid system into a state-run system funded by federal grants and turning Medicare for the elderly into a voucher system.

“I think there’s a substantial and significant degree of concern out there,” Casey said of the protests across the country. “People know, for example, the value of Medicaid. … That’s real life. That’s not some political debate.”

Obamacare in particular carries its own risks, as two guests at Casey’s Tuesday meeting could attest. While medical experts and officials debated rural primary care and corporate wellness programs, Deterline and Marsha Hansard of Altoona posed a simpler concern: Care is simply too expensive.

“You work all your life, and boy, is it a rude awakening,” Hansard said. “I never thought I’d be in the position I’m in.”

When she reached the age cutoff, Hansard said, she signed on for Medicare and supplemental insurance. But before that, insurance through the Obamacare exchanges was simply too expensive for someone living on a retirement fund — especially when they fall through the means-testing cracks to get subsidies or assistance.

Hansard said before she could use Medicaid, she relied on Altoona doctor Zane Gates’ clinic for care.

“Otherwise, I wouldn’t know where to go,” she said.

For Deterline, chronic conditions combined with surgeries and physical therapy have made health care punishingly expensive. Forty-dollar copays and fees add up, she said; even her son has thousands of dollars on credit cards for his own care and travel outside Altoona.

“There’s days I think I should go see a physician, but I don’t go because I’m already up to $3,000,” Deterline said. “After a while, you don’t have that money in your bank account.”

Political solutions for people like Deterline and Hansard could be complex. Of the medical experts gathered Tuesday, none said Obamacare should be repealed — instead, individual problems should be targeted in Congress, they argued.

Rising insurance prices aren’t inherently a symptom of the law — some experts have said Obamacare actually reduced price hikes — but in states like Pennsylvania, care can remain unaffordable for some. That has contributed to both Republican opposition and, on the left, renewed calls for a public insurance option or even a “Medicare-for-all” system.

“We have to be open to changes,” Casey said. “We’re going to need inspiration and examples.”

Mirror Staff Writer Ryan Brown is at 946-7457.

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