Create Universal, Affordable Healthcare – Draft

Create Universal, Affordable Healthcare

The following is our draft plan for creating a universal, affordable healthcare system for the US. It is based on research comparing systems around the world, interviews with healthcare experts, discussions with constituents, and on the experience of the candidate living in two countries with universal healthcare.

It is the basic framework for how we believe the US system could be fixed to provide universal coverage affordably. It is considered a draft because we are continuing to receive feedback.

Please feel free to send your thoughts on the plan to team@sanchezforcongress2018.com.


Create Universal, Affordable Healthcare 

Universal affordable healthcare is a basic human right. And as Americans we pay more than any other developed country for healthcare and have the worst outcomes dollar for dollar. We can do better for patients and for all taxpayers by building on what works in the US system and expanding it to cover everyone.

Republicans have threatened the life and health of all Americans by rushing to repeal the ACA with no viable replacement. This is a political move that endangers the stability of our healthcare system and coverage for most Americans. We are too rich of a country to allow people to die because of a lack of basic and preventive care. Serving the uninsured through emergency rooms is insanely expensive and must stop.

My experience living in two countries with universal healthcare (Britain and the Netherlands) gives me first-hand insight into what would work and what would not work in the U.S. My priority is to make health care more affordable, effective and universal for all. Taking health insurance away from millions of Americans makes no sense. Making it more accessible and affordable for more people makes perfect sense.

My Personal Story

I lived 10 years in Britain, which has a single-payer plan. I had excellent essential and emergency care. There were long waiting times and sometimes frustrating bureaucracy for non-emergency diagnostic tests and specialist treatment. It was, however, far superior to what we have in the US at present. That system costs less than 9% of GDP.

Healthcare in The Netherlands, where I lived for about eight years, is consistently rated the best in Europe, and it costs approximately 11% of GDP (compared with 20% in the US.) It provides universal care, comprehensive coverage, and allows patients to choose their doctors and hospitals. Doctors, hospitals, and insurance companies are profit-making and compete for patients based on quality of care, but prices for all services and medications are agreed upon, and prices are contained. Companies subsidize their employees’ health insurance as an employment benefit, self-employed people don’t pay much more, and the unemployed or those dependent on social welfare receive the exact same coverage. Health insurance is mandatory and there are large fines for non-compliance – less than 1% of the population is uninsured. Deductibles are low – a few hundred dollars a year. Insurance costs are low – I paid less than $200 per month. A typical visit to the doctor’s office was about $40 and insurance reimbursed you 100 percent once you met your low yearly deductible. There are also waiting lists for non-urgent care but less so than in Britain. The Affordable Care Act was modelled on the Dutch system in part, but we failed to implement price controls on services and medicines – something we desperately need in the US but has been unfathomable due to the cozy relationship between the US Congress and lobbyist representing insurers and pharmaceutical companies.

I do not support a single payer mandatory system because currently large employers pay roughly 40% of insurance costs and we cannot afford to replace this in our system. Most people who are employed by corporations, government, universities and other large organizations are happy with their coverage, but would like to see price containment and need to ensure that they remain covered if they leave employment.

My Plan

I will push legislation that creates universal healthcare but that will work to control prices. The mechanism for this would be:

  • Creation of a Healthcare Cost Review Commission in each state comprised of patients, doctors, hospitals, government (Medicaid/Medicare), pharmaceutical companies and insurers (with patients having half of all votes) that would set strict prices for all services and products (drugs). That price would be paid by the patient’s insurer, whether private or public. This has been successfully implemented in Maryland;
    • While the commissions could set lower prices, no drug could cost more for Americans than it costs on average across Europe;
    • The commission would mandate simplified billing that would limit the fees charged per procedure. For instance, the cost of an emergency appendicitis and all follow up care would be standard across all hospitals.
  • Insurance companies would compete for clients but the amount of the premium that could cover administrative costs and profit would be strictly regulated on a federal level;
  • Expansion of Medicaid to anyone below the poverty line and subsidies for health insurance to make sure all lower income workers can afford healthcare, funded by increased taxes on the very highest income earners;
  • Voluntary expansion of Medicare at cost for anyone of any age as an option to private insurance (and to increase competition to for-profit insurers);
  • Mandatory coverage through either private or state plans with significant penalties for non-compliance;
  • Absolutely no ability for insurers to charge extra for pre-existing conditions or refuse coverage under any circumstances;
  • Require all doctors and hospitals to accept Medicare and Medicaid without discrimination (the price received by them from all patients will be the same, so there is no financial disincentive to them.);
  • No limit on staying on employer insurance plans after leaving employment and the ability to switch to another market plan or Medicare, whichever makes more sense, and;
  • Remove requirements for employers to provide health insurance for full-time employees – this rule is causing many employers of lower-income workers to limit their hours, keeping the employees in poverty. It is also causing huge financial strain on small businesses. Either make the contribution proportionate to the number of hours worked or remove the requirement all together. Those employees who are lower income will be eligible for Medicaid expansion. Higher-income and professionals will continue to receive this benefit as employers compete for talent.

 

References:

http://www.beckershospitalreview.com/finance/has-maryland-found-a-solution-to-the-u-s-healthcare-cost-crisis.html
http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective
http://www.commonwealthfund.org/topics/international-health-policy/countries/the-netherlands
https://hbr.org/2016/11/improve-the-affordable-care-act-dont-repeal-it
http://www.commonwealthfund.org/publications/in-the-literature/2008/may/universal-mandatory-health-insurance-in-the-netherlands–a-model-for-the-united-states
https://www.forbes.com/sites/matthewherper/2017/02/10/a-6000-price-hike-should-give-drug-companies-a-disgusting-sense-of-deja-vu/#1ff5f61a71f5


 

Immigration Reform – updated

April 13, 2017: Jana Lynne has updated and revised her policy on immigration reform.

My grandfather, Lonjino Rodriguez Sanchez came to the US without documentation from Mexico in 1912. He became a citizen in 1969, one year before he passed away. During his many years as an undocumented worker he fathered 27 US citizen children here. The family travelled as migrant farm workers, providing essential agricultural services across the US and living in harsh conditions, even facing starvation at times in winter. Most of his descendants became grandparents and great grandparents and the majority of my extended family lives in Ellis County today.

Immigration is central to my story, my family is central to the American story, and I am a believer in the American Dream.

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EDUCATION POLICY

SUPPORTING GREAT PUBLIC EDUCATION

By: Jana Lynne Sanchez

Introduction

Effective, comprehensive public education is a fundamental building block of our democracy and the key to our continued prosperity and opportunity. As a product of public education, I support it 100% and believe the best place for most children to be educated is in their local neighborhood public schools. We must make sure these schools are not threatened by ideologies and initiatives that seek to deprive schools of vital funding in order to promote expensive and ineffective private and religious education. Vouchers deplete resources from those schools and only provide enough subsidy to wealthier parents who were already sending their kids to expensive private schools.

Emphatically, I do not support depleting public schools to provide vouchers for students attending private or for-profit charter schools and will do everything possible at a federal level to prevent such initiatives. While this is primarily a state and local issue, I will do everything possible at a federal level to promote public education.

Likewise, we must invest in public education that meets the needs of all children, including students from low-income families, English language learners, recent immigrants, and students with disabilities.

The Trump administration has floated the idea of providing more flexible education block grants to states.  They have made no secret of the fact that these monies can be used for state voucher programs that would divert federal tax dollars to private schools.

Standardized Testing

Many parents and teachers tell me that far too many resources are spent on state tests mandated by federal law. I would like to see this policy reviewed to reduce the stress on students, teachers, parents and schools. While we do need to be assured schools are educating students, let’s make sure we are not creating an undue burden in doing so. The main groups that benefit from exam-based assessments are corporate testing agencies, not students. Companies that create state assessments, curriculum, and review materials for state assessment exams profit greatly from laws that make these tests mandatory. Some facts on standardized testing:

  • The annual assessments are not accompanied by federal funding for the assessments. A rough estimate of annual state spending (all 50 states) is $85,000,000,000.
  • Because failing to meet adequate yearly progress assessments (AYP) is so punitive to schools, excessive time is devoted to preparing students directly for the tests, including benchmark testing, and class time devoted to make sure students have sufficient test-taking skills.
  • Although the intent is admirable, and definitely makes certain that subgroups of students (such as African American males) are not ignored and receive necessary interventions, the overwhelming amount of testing has not resulted in dramatically improved test scores.
  • Many students will do well on every test in grades 3, 4, 5, 6, 7, 8 and high school. It is not necessary to measure what is going well. It would be better to reduce testing for students meeting state performance standards in reading and math, and perhaps test them every three years, or once in elementary, once in middle school and once in high school.  Keep the annual testing requirement for those NOT meeting state benchmarks.  This would allow schools to focus more time on intervention with students who need it.  They would be able to spend less time reviewing and preparing everyone across the board for the state test.  This can single out students who are not meeting performance standards, but it would focus time, money, staff and resources on the students who need it most.

Teachers

I credit my public school teachers in Ellis County for helping me go on to Rice University. Without these teachers who took time and initiative to help me of their own accord, I would never have been able to escape the cycle of poverty. Our teachers are our greatest resource in education, but there is too little support for teacher training and development. Unfortunately, schools with lower performing students have trouble attracting qualified and experienced teachers. Turnover rates are also high. If a district has a school that is not meeting expectations, a common first step is to change the principal. These schools do not have stable leadership, and so quality teachers leave to find more stability. Instead of changing leadership in schools that need good leaders, we should support our teachers and administrators.

I believe in holding our teachers to high standards, and in giving them the tools they need to succeed. With our funding focused on training and retaining excellent teachers instead of teaching to the test, we can improve public education for all Texas children.

Higher education

I support the continued funding of higher education in the US through Title IV institutions and through Pell Grants and other federal aid making it possible for students from low-income families to attend university.

I would like to see more funding going into programs in community colleges that provide graduates with successful careers in technology, healthcare and emerging fields such as renewable energy.



The following information is provided to help constituents understand the background leading up to the current federal policy in education.

ESSA Background and History

The purpose of the Every Student Succeeds Act (ESSA) is to provide equal access to education and establish high standards and accountability.  It is a reauthorization of the 1965 Elementary and Secondary Education Act (ESEA), which was passed as part of Lyndon B. Johnson’s War on Poverty.  The intent was to close the gap in basic skills (reading, writing and math) between low income and middle class students. Funding from ESEA provided states with grants for teacher professional development, instructional materials, resources to support educational programs, and for programs to increase parental involvement.

When ESEA was reauthorized in 2001 as the No Child Left Behind Act (NCLB), sweeping changes were made in regard to school accountability.  It required each state to give assessments to every student in basic skills (reading and math in grades 3-8 and high school, and science at elementary, middle and high school).  NCLB was also punitive to schools that did not make adequate yearly progress (AYP) for the school overall as well as for subgroup student populations.  NCLB dramatically changed the role of the federal government in public education, and eliminated much of state and local control. NCLB also opened up a wide door to corporate interest in education.  Companies that create state assessments, curriculum and review materials for state assessments began to greatly profit from the NCLB mandates.  In Texas alone, one company had a five-year contract for $462,000,000.  After receiving the contract a state senator on the Education committee went to work for the same company.  Multimillion-dollar deals went on in all fifty states to follow the mandates of NCLB, and states were left with no choice but to comply.

Although ESSA gave states greater flexibility with some accountability measures (like using SAT or ACT scores for high school testing), it does not reduce the amount of testing that goes on in public schools.  ESSA does add some new programs such as the National Center on Reading Issues and requires states to get parental input on state education plans.  Under the Trump administration (3/13/2017), the application for states to submit their accountability plans is shorter, notable reducing requirements for states to use input from educators and advocates of public education.

ESSA funding divisions are as follows:

  • Title I—Improving Basic Programs Operated by State and Local Educational Agencies (funding for schools with a high percentage of students from low income families)
  • Title II—Preparing, Training, and Recruiting High-Quality Teachers, Principals, or Other School Leaders
  • Title III—Language Instruction for English Learners and Immigrant Students
  • Title IV—21st Century Schools
  • Title V—State Innovation and Local Flexibility
  • Title VI—Indian, Native Hawaiian, and Alaska Native Education
  • Title VII—Impact Aid
  • Title VIII—General Provisions

States and school districts can receive funding based on grant programs, and direct allocation (Title I).  Federal funds are still used to address issues of education inequity such as providing additional funds to schools with large numbers of low-income students or schools with large percentages of English language learners.  Accompanying these funds are requirements to show adequate yearly progress.

How ESSA advances education equity:

 ESSA requires state-adopted standards for all students that are aligned with the demands of postsecondary education and workplace readiness.

  • Standards can vary widely from state to state
  • “Readiness” is also not defined, and although each state has a common goal of ensuring that students are prepared for education and employment beyond high school, the interpretation varies widely.

ESSA requires annual assessments aligned with state standards.

ESSA has clear requirements that state accountability systems must track and demand progress for low performing groups of students, base school ratings on the progress of all groups of students, and expect state intervention when any group of students is consistently underperforming.

  • Making sure that the lowest performing groups of students show progress is a worthy goal, but this cannot be met merely by testing. For example, annual testing compares one year’s fourth-graders in math versus the next year’s fourth-graders in math. The group of students is entirely different, and the teachers may have also changed from year to year.  There are too many variables to determine what will result in school improvement.
  • A far better way to ensure that the lowest performing students show progress is to make sure they have the best teachers – ones that are teaching in their certification area, ones that are paid well, and ones with more teaching experience.

ESSA asks for more detailed public reporting on academic outcomes and opportunities to learn for all groups of students, including, for the first time, school-level per-pupil spending and access to rigorous coursework.

  • Adding the reporting requirement of per-pupil spending is a wonderful addition.
  • The achievement gap between students in high-income districts and low-income districts shrinks when school funding is more equitable.
  • Additional spending on subgroup of children targeting broader skills can help. When low-income students receive training in social-emotional skills (sharing, cooperation, persistence), they do better in a different measure – last level of educational attainment and adult income.
  • Often schools with high numbers of low income students offer fewer advanced high school courses, and this requirement will bring that to light. Conversely, it may lower the accountability of rural schools, that have fewer students and fewer teacher, making it more difficult to offer a wide variety of advanced courses.

ESSA provides resources to support teachers and leaders, and asks states to report and address inequities in the rates at which low-income students and students of color are assigned to ineffective, out-of-field, or inexperienced teachers.

  • Adding the reporting category of out-of-field, or inexperienced teachers is a great step. Unfortunately, schools with low-income students have trouble attracting more highly qualified and experienced teachers.  When teachers are held directly accountable for student performance on assessments, it is not surprising that they would prefer to work with students who have a greater chance of meeting accountability standards.
  • Schools with high numbers of low-income students also have greater teacher turnover. This is due to a wide variety of factors, most notably that there is a high turnover in campus leadership.  If a district has a school that is not meeting AYP, a first step is often to change the principal.  These schools do not have stable leadership, and teachers will leave to find more stability.

ESSA targets federal funding to the highest poverty schools and districts.

  • This ESSA provision has remained largely unchanged since ESEA was passed in 1965. It has been incredible successful at providing education funding to millions of low income students each year.

 

References:


 

Immigration Reform

Proposal for Immigration Reform (revised)

Introduction

My grandfather, Lonjino Rodriguez Sanchez, came to the US without documentation from Mexico in 1912. He became a citizen in 1969, one year before he passed away. During his many years as an undocumented worker he fathered 27 US citizen children here. The family travelled as migrant farm workers, providing essential agricultural services across the US and living in harsh conditions, even facing starvation at times in winter. Most of his descendants became grandparents and great grandparents and the majority of my extended family lives in Ellis County today.

Immigration is central to my story, my family is central to the American story, and I am a believer in the American Dream.

Today, however, there is less belief in the American Dream, and less optimism about the role of immigrants than there was when my father was born. Many US citizens believe there is a problem with illegal immigration from Mexico and Central America.  Although the influx of undocumented immigrants from south of the border has dropped since 2005 (as economic conditions in Mexico have improved) we still have no firm grasp of how many are in our country illegally. Some may be a threat to law and order in general or involved in the drug trade. Apprehending undocumented entrants, enforcing border controls, and providing public services is costly.

Undocumented immigrants have always filled a labor void by providing services that most Americans are unwilling to do at a lower wage. In addition, fairness to them and their children, practicality, and economics still dominate this complex discussion.

Further Facts

  • Today, an estimated 11.3 million immigrants are living in the US without documentation. Approximately 7.4 million of those originate from Mexico and Central America. However, it’s important to note that a full 43% of those in the US illegally came here legally and simply overstayed their visa.
  • Many who came across the border paid $3,000 – $4,000 to smugglers who are part of criminal cartels. Often risking their lives to cross in dangerous conditions, immigrants live in constant fear of being deported if they do make it into the United States.
  • Until now, the policy we as a nation have pursued is to make it physically difficult for immigrants to get here. This includes increased border enforcement and physical structures such as a wall. The problem with these are that the end result will not eliminate illegal immigration but it will destroy our environment, cost us billions of wasted dollars – and economic damage due to retaliatory measures – and lead to even more deaths of economic migrants who will continue to attempt to cross the border.

Real and perceived Impact on Texas and our district

Some citizens in Texas and District 6 mirror national objections. They complain about the number of undocumented workers here, because they say it’s not fair that people who broke the law in coming here are benefitting from their crime. It’s a matter of right and wrong. Furthermore, they feel they are paying the costs of providing for these immigrants in terms of emergency healthcare, education and other social services. A big complaint I also hear is that because these people live outside of the law without driver’s licenses, they often drive uninsured and are therefore not responsible for damage caused. There is a wider fear that immigrants are not obeying the law more generally and are using so called “anchor babies” as a way to be allowed to stay.

If you accept these problems to be true, then you also need to acknowledge that there are also some positive benefits of undocumented workers. They are being hired because there is a demand for cheap and flexible labor, particularly in construction, farming, food production and the hospitality industry. We all benefit from the low cost of labor and do not pay any penalties for the abuse that might occur to these undocumented workers who live without any protection. Furthermore, in the vast majority of cases, these workers use social security numbers and pay income tax and social security without the ability to claim a refund. Billions each year is paid in Federal taxes against fake or unmatched social security numbers. Any US citizen earning at these low rates would be able to receive all or most of that income back.

I hear these concerns and believe my suggestions for improvement address these issues.

MY PLAN

Background

My plan is based on the understanding that the vast majority of undocumented workers here are simply economic refugees. They plan to stay here several years and return home to their families and communities. Of course, there are exceptions. There are people who want to stay in America, become American citizens and contribute to the building of our great nation. Often, those people already have  family here. This plan is intended to accommodate both sets of migrants.

Legalizing the status of those already here

I’m going to start first with the biggest threat to our security: we simply have no idea who the majority of people who are here illegally are. They have no driver’s license and we have no way of finding them. They are not vetted in any way. There well might be terrorists and criminals among them. They might be hard workers who keep their noses clean or they might be hardened criminals praying on others. How do we know? During the Reagan administration, 2.7 million undocumented immigrants were given amnesty and became citizens following a 30-minute interview. That wasn’t enough.

My proposal, based on the Hoover Plan developed by Arizona scholar and activist Robin Hoover, says we should exchange this much-needed information for the right to legally remain in the US for a limited period of time (up to 3 years for instance).

Come forward and give us your details. You will be fully vetted and we will know who you are and how to find you. The very act of having your status legalized is worth the trade off. It means you can pay tax at the same rate as other Americans, you would be required to get a driver’s license and to have auto insurance like other drivers. And when your visa is up, we know where to find you. We can and should require all these guest workers to deposit $500 to $1,000 into a government account and to further add 10% of their gross salary – taken off the top – for the duration of their legal stay. (They could be given time to deposit the base amount.) If they overstay their visa, they would be charged with a felony, and that money they paid would be forfeited to law enforcement to pay for their capture and deportation. If they leave as required, that money would be wired to them in their country of origin.

This of course puts them within the legal category and decreases the chances that they were victimized by unscrupulous employers and others who prey on them. It also would require them to follow all the laws that citizens are required to follow. We would know how to find them.

Citizenship path

After one year of living and working in the US, these visa holders should have the right to apply for citizenship. They would follow the normal procedure and it would likely take years, during which they would abide by all the laws pertaining to their visa status. It is possible some of the money they amass and continue to amass during the process could be used to fund this process. The remainder would be given to them once their citizenship is confirmed.

This path would only be available to those already in the US. Anyone wanting to pursue family reunification from abroad would need to apply from abroad through the normal channels.

Legal immigrants

It is almost impossible to immigrate legally to the U.S. from Mexico or Central America. For instance, 1.38 million Mexican citizens are waiting in line for a work or immigration visa through a family member. But only 26,000 visas are available yearly for Mexico. Mexico has by far the longest waiting list, according to U.S. State Department figures. It is that scarcity – the realization that there really is NO line to get into – that sends people into the arms of the cartel.

So what if we made it easier to come as a guest worker for a limited amount of time, with a huge financial incentive? If immigrants are willing to risk their lives and pay up to $4,000 to smugglers to live with the constant fear of deportation, we could give them a legal option that was far superior and they would take it. We could modify the quotas to give each country a decent quota so that those who are qualified – and vetted by their governments – could come here. We would require them to deposit an amount – at least $3,000 – in a US government savings account. Additionally, they would pay 10% of their gross off the top straight into the account. If they overstayed their visa, they would be charged with a felony and that entire pot would be given to law enforcement to apprehend and deport them.

This plan would remedy the most challenging problems of the current situation for both sides. It would remove the illegality that bothers so many Americans and create an environment of accountability for these migrants. For those on the left side of the spectrum it would eliminate the senseless deaths as well as exploitation that these workers face. For all of us as Americans, it would dramatically reduce the billions we waste on enforcement each year.

“Anchor babies”

One final point I will address because it is symptomatic of the heated and ideological arguments about this issue. I’ve heard a lot of people complain about “anchor babies” – when undocumented immigrants have children in order that the entire family would be given permission to stay. The reality is that this is impossible to accomplish in the short term as it requires more than 21 plus years to benefit the parent. Children born to undocumented immigrants have the right to petition to bring their parents into the country from abroad, but the waiting list is seven years and they are not allowed to petition until they are 21 years of age. While it might be true that immigrants do in fact use this as a tactic, it’s a very slow and unsuccessful one. So, in reality, this is not an issue. It is symbolic of some of the hysteria around immigration today.

Conclusion

If we will stop listening to hysteria, much of it designed to scare us, we can come up with a creative solution that solves all of the problems associated with illegal immigration. And we can continue to fulfil the American dream – the one my grandfather believed in more than 100 years ago when he crossed the border in search of a future for him and his family.