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Sen. Hassan On Manchester VA Troubles, Next Steps for the ACA, & the Democrats' 'Better Deal'

Allegra Boverman for NHPR

Senator Maggie Hassan says she was outraged by allegations of substandard care at the Manchester VA Medical Center, first reported in The Boston Globe.    Hassan and other delegation members are planning to meet with U.S. Secretary of Veteran Affairs David Shulkin, who is visiting the Center this Friday, August 4.  Hassan also talked with The Exchange about what's next for the ACA,  after the recent failure of Repeal and Replace, and about whether Medicare for All, now being pushed by Senator Bernie Sanders, has a chance. She didn't seem to think so.  See highlights from the entire conversation below.    

Interview has been edited for clarity.

How surprised were you by the Boston Globe report on substandard care at the Manchester VA Medical Center?

I was outraged by what I read..Our veterans sacrificed for us. They deserve the absolute best quality  of care possible.   "I was outraged both at the allegations of lack of quality care, poor conditions but also what appeared to be administrative indifference to concerns raised by the whistle blowers." 

Our delegation sent the Secretary of Veterans Affairs Shulkin a letter outlining the questions we think need to be answered. He has indicated there will be an external medical review. But we need more details about the nature of that review. And we’ve asked questions about what kind of operational review there will be as well. I think its important the reviews be independent and that they look fully especially at allegations of poor quality of care for spinal-care patients.

Veterans are concerned that the review is not gong to be truly independent.

We are pushing for details from Secretary Shulkin and his staff about how they plan to structure this medical review and I think it’s going to be important that it be independent and we will be pushing for that.

While Governor, were you aware of problems at VA or hints of problem? 

We were not aware of this level of concern.  We heard concerns and continue to hear concerns about the Veterans Choice program and individual case-by-case concerns but had not heard from these whistle blowers. I’m glad they have spoken up and I’m looking forward to this meeting with Secretary Shulkin.

Now that the so-called “skinny repeal” of the ACA has failed, what’s the next step?

We know first and foremost we have to stabilize the markets. We know that some of the Trump administration's actions have destabilized those markets. We know there are improvements we need to make on the Affordable Care Act. And so we've put forward proposals to create a reinsurance market for high-risk cases.

Insurance Commissioner Roger Sevigny says he’s worried about market failure in the state and has proposed a re-insurance program that would ask insurers to pay into a pool, as a way to keep premiums from skyrocketing. 

I certainly support Commissioner Sevigny's efforts here. Commissioner Sevigny has long experience having now worked I think for this will be his fourth governor, and I think it's really important that legislators listen here. The things that folks from both the health-care industry and the insurance industry tell us is that one of the ways we really could stabilize things is creating a reinsurance mechanism. So I'm supportive of the commissioner's plan here and I hope that the legislature will take a very close look at it, ask questions for sure.

How about increasing subsidies to individuals?

One of the things that we are also proposing is that we really address that income cliff that people currently face. You know you can only earn up to a certain amount of money in order to get. for instance, advanced premium tax credits. And I think we should be not pegging this to your income but pegging it to the percentage of your salary that your health insurance premium is. And that's a bill that we also have pending in the Senate that I've co-sponsored.

I'm sure you've heard the argument that if the government continues to bolster subsidies or bolster insurance,  providers have no incentive to hold their costs down.

There is no doubt that health care is too expensive and that we have to reduce costs.

The thing that insurers tell you is the biggest cost driver now is the cost of prescription drugs and this is something I hear all over the state of New Hampshire from people of all walks of life. We've proposed to allow Medicare to negotiate prescription drug prices given their volume that would help us help us bring costs down. I also support the importation of safe and affordable prescription drugs from places like Canada. And I'm on a bill that would allow us to do that. And I think going forward that's going to be critically important. Insurance providers are also telling us that the instability in decision making in Washington and some of the actions of the Trump administration is also driving the cost of premiums up. But we all know we have to come together and make the health care system less costly bend that cost curve. That's something that we need to do together. But it starts with making sure everybody has access to primary and preventive care too so that they're not showing up in emergency rooms in crisis, which is not only bad for their health but also very expensive.

What are Democratic ideas on health care?

We’re hoping they will sit down with us at the table to explore some of these ideas like a reinsurance pool, like putting cost-sharing reductions into law, like addressing the cliff, like lowering the cost of prescription drugs. There are I think a lot of ideas out there.  In the middle of this debate when people were pointing out that there are counties in this country where there aren't any insurers on the exchange, Senator McCaskill offered up a bill that said any citizen in one of those counties could buy the same insurance that Congress and members of Congressional staff buy.

Several listeners asked:  Why don’t you support single-payer Medicare for All?

I don't think there is a receptive group of senators on the other side of the aisle to the notion of single-payer health care, so I don't think it's something that is going to happen... There are states where the Affordable Care Act is working pretty well but still needs some improvements. There are states where it's obviously not working well and I think all of us want to focus on stabilizing what we have right now. And there are legitimate concerns about what the upfront cost of transitioning to single-payer would be.

Bernie Sanders ran on this idea. And he did very well here in New Hampshire.

I understand. I understand why people support the idea. I'm always happy to hear them out on it. But what I know right now is that there are people who are challenged with skyrocketing premiums, high prescription drug costs and places in our country where people don't have access to coverage on the exchange. And what we need to be focusing on right now is stabilizing what we have and moving forward and again looking at the overall cost of health care, because regardless of how we pay for it, if the costs keep going up, we are going to be deeply challenged.

What are some examples of bipartisanship efforts in Congress?

I've been working with Senator Portman on a Hack Homelands Security bill.  We know cybersecurity is such a major issue. And in the Pentagon one of the things they've done is vet really smart computer hackers to make sure that you know they're doing this for the right reasons but then offer them a small bounty if they can break into the computer systems of the Pentagon and then help us improve and close those holes. 

I’m also working with Senator Portman and a bipartisan group  on the Stop Act, which is really aimed at cracking down on fentanyl entering this country from places like China.  And with Senator Manchin I’m on the Lifeboat Act, which would create a revenue stream, which would help fund treatment for the opioid crisis. I’m on a couple of bills on workforce development… that make Pell groups more available to people who  are in apprenticeships.

On the issue of foreign policy, I was proud to join almost all the other senators on the Russian sanctions bills, which also includes additional sanctions against Iran. And now with House action against North Korea. 

I’ve been really buoyed by the degree to which people are working across the aisle.

What does North Korea’s test of another intercontinental missile mean for Homeland Security?

It’s very concerning. We really need to see from the administration steady and strategic leadership and they need to develop a comprehensive and clear strategy on North Korea.  We need to put pressure on China, which has many more economic levers with regard to North Korea than most of the rest of the world does. 

What’s your view on General John Kelly, former Secretary of Homeland Security and President Trump's new chief of staff?

General Kelly has served his country with incredible distinction. I was one of his supporters for his nomination to be Secretary of Homeland Security. I heard really strong recommendations about him from members of the military including people in the New Hampshire National Guard who had worked with him. And so I feel very strongly that he had the credentials to run Homeland Security as well as the credentials to serve as the President's chief of staff.

I am concerned that he's been  on duty at Homeland Security now for only about seven months. And just as this agency, which is still relatively new for a federal agency, just as as he and the agency were kind of getting up to speed together, he's now gone off to work at the White House, and I'll observe that in President Obama's Administration there were two secretaries of Homeland Security in eight years and now we're going to have two secretaries of Homeland Security in the Trump administration in eight months. And that does concern me. But you know we all have to come together and do our best to support the men and women working at the Department of Homeland Security, as well as support people who are trying to serve this administration.

Listener on Facebook: What is the Senate doing to ensure that the White House cannot interfere with the Mueller inquiry? Are there measures being considered to keep his investigation independent from outside influence? What if Trump fires him. What are you prepared to do in that case?

This is of great concern to all of us. It is absolutely clear from consensus by our national security agencies that Russia interfered with our elections in 2016.  It's really important that we get to the bottom of whether there were potential connections between these efforts and President Trump's associates. And we really have to get to the bottom of whether President Trump attempted to obstruct justice or did obstruct justice with his firing of Director Comey.  So special  prosecutor Mueller absolutely has to have independence. There are some folks working on legislation in the Senate to make sure that he does continue to have that independence and to protect him from attempts by this president to fire him. And I will look at all of that legislation very clearly because this is this is critical to our Constitutional system of government.

How confident are you that the federal and state money going to opioid treatment now is being used properly, that there’s enough oversight of these organizations?

The scientists tell us that medically assisted treatment is considered state of the art. And that takes a level of credentials and expertise, and we need to make sure we are allowing physicians to increase the number of people they treat so we can increase our capacity. There’s also a younger and, perhaps by scientists, less well understood prevention and recovery movement. And we know we have to find ways to measure the outcomes of those efforts.

An email from listener Steve: How would Senator Hassan compare threats to our homeland from refugees vs. from foreigners entering the United States other ways, like the Visa waiver program and tourist and student Visas?

We have to be constantly vigilant to protect our homeland. That means securing all of our borders not just the southern border but our maritime border, our northern border as well.  Certainly we also have to e strengthening our Visa entry programs and our vetting of refugees. Sen. Shaheen  has been particularly active in making sure we’re doing more vetting of social media. But we also can’t ignore the fact that we have concerns about homegrown terrorism, too.

We have heard from a number of people on the frontlines in our communities around the country about the importance of working with communities especially perhaps communities of immigrants to make sure that we understand immigrants and refugees, to make sure that we are understanding each other and rooting out potential cases of homegrown terrorism wherever we can. And that requires community engagement and involvement. And that's something we've been taking testimony about in our Homeland Security hearings so that we can improve in that regard too.

Listener Verona asks: What exactly do we need to strengthen in the vetting process?

It is set up to be a thorough system. One of the things we heard in 2013 from FBI and CIA is they felt there wasn’t the kind of actual documentation that would allow them to actually operationalize the vetting as they were directed to do. There are always ways you can strengthen vetting systems… I think it’s important to listen to law enforcement people on the ground about what their concerns are, and they have some.

An email from listener Seth: With consistent low voter turnout and almost every statehouse in Republican hands, why is the (Democratic) party not more focused on overhauling their platform to win votes and hearts? Why isn't there a greater push towards the Democratic Socialist policies that millions of Democrats voted for in the primary? 

I’m as disappointed with the outcome of the election as many Democrats are -- although I will point out that Hillary Clinton won the popular vote.  I think it’s really important that we continue to focus on the people we represent.

I think what you see is Democrats really focused on strengthening the middle class -- helping to support innovative businesses and making sure our state and our country are free and strong and secure. That's what I will continue to focus on. There are lots of different ways to get there  but you know one of the things that there's again bipartisan focus on is workforce development. And I think there's Democratic focus on that too. We know that our economy is changing; we know that there are good paying jobs that are going unfilled because people don't have the right skills. I'm on a couple of bills that would help address that.

People are working so hard to put food on the table and then to cover the expenses that are critical to support a strong middle-class life, which is the cost of health care, child care, education, housing -- those are all things that Democrats want to focus on and help strengthen our economy, while keeping our country safe. And I think you will hear all Democrats talking about those things and focused on how we solve problems together to strengthen the middle class and support innovative businesses so we can all thrive together and move forward.

Do you support three aims included in the Democrats' "Better Deal" -- a trillion in infrastructure, a $15 minimum wage, and paid family leave?

Certainly I think the platform that Senator Schumer and other leaders from the Democratic Party put out really reflects our focus on strengthening middle class families and creating jobs in this country while keeping us safe and secure. I think it's important that we look at each proposal as they would affect each individual state. As you know I supported strengthening infrastructure in New Hampshire and we came together and found a way to do that in New Hampshire.  A bipartisan bill that provided revenues and resources so we  could complete For instance the expansion of I-93. I think it's really important that people who work full time don't live in poverty. I'm not sure that $15 an hour is the right level especially for a state like New Hampshire which doesn't have an income or sales tax. $12 seems a more appropriate level for New  I think we should be definitely looking at paid family leave. There are a number of different proposals in the United States Senate for that. I also hear about the cost of child care as well as the cost of higher education and health care and those are things we have to continue to work to lower the costs.

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